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Master Thesis

Intérêt de l'adéno-amygdalectomie chez l'enfant drépanocytaire

Abstract : Introduction: Sickle cell disease is a genetic disease detected systematically in Guadeloupe since 1989. It has an incidence of 1/304 birth in our archipelago. The disorder is characterized by the formation of abnormal hemoglobin, which will polymerize in deoxygenated condition deforming the red cells blood in sickle. One of the main expressions of the disease is vaso-occlusive crisis whose chronic intermittent hypoxia is a contributory factor. The obstructive sleep apnea syndrome in children causes of nocturnal hypoxia. The surgical management of adenotonsillectomy is one of the available treatment options. The objective of this study is to investigate the interest of adenotonsillectomy in children with sickle cell anemia.
Methods: A retrospective and single-center study was conducted from 2001 to 2014. The affected children who underwent adenotonsillectomy CHU Guadeloupe were included. Biological variables such as hemoglobin, reticulocytes, LDH, free and conjugated bilirubin and oxygen saturation were evaluated twelve months before and after the intervention. The main statistical test used was the Wilcoxon test on matched data.
Results: Forty-three children (23 boys and 20 girls) with 32 sickle cell SS and 11 sickle cell SC were included. The mean age of management of sickle cell SS was 7 years (3-17) and 8.4 years (4-17) for sickle cell SC. Surgical indications were an obstructive sleep apnea syndrome (79%, n = 34), tonsillitis (14%, n = 6) and the occurrence of sickle cell complications (7%, n = 3). It showed a significant difference in favor of a number of children operated SS over the period studied more important than SC children (10% n=32 versus 4% n=11, p = 0.018). For the SS population, hemoglobin at 1 year after surgery was higher (8gr/dl versus 7,9gr/dl, p = 0.17) and the reticulocyte count was lowered (261G/L versus 32G/L, p = 0.36). It is also reported a significant reduction in acute episodes associated with the disease after surgery.
Conclusion: Early and surgical management of the obstructive sleep apnea syndrome in sickle cell children is important and helps reduce the appearance of complications of the disease. The adenotonsillectomy treats chronic intermittent hypoxia is one of the main factors of vaso-occlusive crises. Our study has allowed us to propose a management protocol sickle cell child.
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Master Thesis
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Emmanuel Mouchon. Intérêt de l'adéno-amygdalectomie chez l'enfant drépanocytaire. Organes des sens. 2015. ⟨dumas-01200580⟩

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