双极电凝在全身麻醉下扁桃体摘除术中的应用

目的 探讨双极电凝在全身麻醉下扁桃体摘除术中的应用效果。方法 全身麻醉下采用双极电凝、单极电刀与传统剥离法实施扁桃体摘除,三种术式共实施扁桃体摘除65例。比较各术式对应的手术时间、术中出血量及术后并发症、疼痛程度及恢复时间。结果 用双极电凝镊行扁桃体摘除在包埋型扁桃体、扁桃体周围明显粘连患者中与单极电刀及传统的剥离法扁桃体摘除相比,术时短,术中出血少,术后并发症发生率低。结论 全身麻醉下,采用双极电凝扁桃体摘除手术尤其适用于包埋型扁桃体以及扁桃体周围明显粘连的患者。     

显微手术双极电凝扁桃体切除术

用双极电凝在显微镜下行扁桃体切除术是两种耳鼻喉科技术的结合。2年间行265例扁桃体切除术。此手术优点为：安全且术中出血极少。组织损伤小，术后并发症少，手术精度高，手术时间短，住院费减少。手术采用300mm透镜的显微镜，目镜可调倍数，镜头前后左右均可移动，使术野清楚明亮。通常用6倍目镜，用前端或角的无损伤型电凝镊，既可分离又可牵拉，此手术无需作经典的粘膜切口，从扁桃体和前柱粘膜反折部电凝切开，然后用双极电凝分离。此手术的标准是做到术中不出血组织损伤小。因此这种简单、安全、可靠的手术方法成为扁桃体切除术的常规…     

单极电刀电凝模式切除儿童扁桃体的临床研究

目的通过与传统剥离法扁桃体切除术比较,探讨单极电刀电凝模式(以下称凝切法)切除儿童扁桃体的临床意义。方法对30例需行双侧扁桃体切除术的儿童患者,采用同体异侧对比的方法,按照随机方案一侧扁桃体采用凝切法切除、另一侧采用剥离法切除;分别记录双侧扁桃体的切除时间、止血时间、总手术时间、术中出血量,并观察术中创面损伤、术后白膜生长、咽痛反应等,并对两组数据进行统计分析。结果凝切法与剥离法的切除时间分别为(6.5±2.6)min和(5.6±2.7)min,两种手术方法切除扁桃体的时间差异无统计学意义(P=0.14)。凝切法的止血时间、总手术时间、术中出血量分别为(2.5±2.8)min、(9.0±4.3)min、(6.0±6.8)ml,剥离法的分别为(7.7±3.9)min、(13.2±5.6)min、(18.9±8.8)ml,两种方法在止血时间、总手术时间、术中出血量方面的差异均有统计学意义(P=0.00),凝切法治疗儿童扁桃体肥大疗效明显优于剥离法。凝切法侧的肌纤维损伤积分优于剥离法,其差异具有统计学意义(Z=-4.916,P=0.00)。术后两组白膜生长情况和咽痛比较无明显差异。结论与传统的扁桃体剥离法相比,凝切法的术野清晰、手术时间短、术中出血量少、手术对组织的损伤轻。单极电刀电凝模式儿童扁桃体切除术安全、高效,值得临床推广使用。     

甲状腺切除术中双极电凝与钳扎止血的应用比较

目的探讨双极电凝法在甲状腺手术止血中的应用及其替代传统的血管钳扎法的可能性。方法甲状腺(单侧)行次全和全切手术患者78例,其中38例采用双极电凝法,40例采用传统钳扎法。统计术中出血量、术后第1天引流量、手术时间等进行比较。结果术中、术后出血量两组间无统计学差异,术后第1天引流量双极电凝组较钳扎组少。结节性甲状腺肿组中双极电凝组的手术出血量为(54±14)ml,钳扎组为(63±10)ml,两组间无统计学差异;术后第1天引流量双极电凝组较钳扎组少,有显著性差异(P<0.05)。钳扎组中1例甲状腺乳头状癌患者出现术后喉返神经麻痹并发症。两组均无甲状旁腺功能减退并发症。结论双极电凝法可缩短手术时间,减少术腔内的结扎线异物,减少医疗费用并使局麻开展甲状腺手术成为可能。     

低温等离子刀与双极电凝在扁桃体切除术中的疗效比较

目的比较低温等离子射频消融术与双极电凝法对扁桃体切除术患者的临床疗效。方法选取我院于2012年6月-2014年8月收治的82例行双侧扁桃体切除术的成人患者为研究对象,将其分为观察组与对照组,观察组采用低温等离子刀切除扁桃体,对照组采用双极电凝切除扁桃体。比较两组扁桃体切除时间、术中出血量、术后疼痛程度、恢复正常饮食时间、假膜脱落时间。结果观察组切除扁桃体手术时间、术中出血量均较对照组少,且比对照组更早恢复正常饮食,术后疼痛也较对照组轻,假膜脱落时间也短于对照组,差异均有统计学意义（P〈0.05）。结论低温等离子刀切除扁桃体具有术中出血少、手术时间短、安全有效等优势,值得临床推广应用。     

双极电凝止血在全麻扁桃体手术中的应用

双极电凝止血在全麻扁桃体手术中的应用孙士铭，邵湘云扁桃体切除术中扁桃体床的有效止血，是预防术后出血的关键。结扎和电凝止血是两种常用的处理方法。我们於１９９０～１９９３年间应用双极电凝处理２５例扁桃体手术出血患儿，止血效果可靠，明显缩短手术和麻醉时间，...     

两种扁桃体切除方法的临床观察

目的比较两种不同扁桃体切除及止血方法的优缺点。方法将诊治的90例扁桃体切除术患者随机分为等离子手术组（A组）和传统手术组（B组）,每组各45例,所有手术均由同一术者完成。等离子手术组用低温等离子法切除扁桃体并止血;传统手术组则采用常规扁桃体剥离并用双极电凝止血。记录切除双侧扁桃体所需时间和出血量;术后第1天起每日记录患者咽部疼痛评分情况,连续10 d;术后第10天观察并记录扁桃体窝内的白膜状况。结果A、B两组手术总时间分别为（18.0±1.6）min、（43.5±3.4）min,术中总出血量分别为（9.3±1.3）ml、（53.8±5.5）ml,两组间差异均具有统计学意义（P〈0.05）;两组患者术后1周内疼痛指数差异比较具有统计学意义（P〈0.05）,1周后疼痛指数比较差异无统计学意义（P〉0.05）;A、B两组术后出血发生病例数分别为3例、4例,出血发生率比较差异具有统计学意义（P〈0.05）,术后比较,A、B两组白膜与扁桃体窝面积比分别为（43.8±6.6）%、（40.5±5.1）%,两组之间差异无统计学意义,但等离子组白膜较为清洁。结论与传统扁桃体剥离法比较,低温等离子法切除扁桃体具有手术损伤小、术中出血少、术后疼痛轻、恢复好等优点,可作为扁桃体切除手术的首选。     

扁桃体挤切术在成人扁桃体摘除术中的应用及与剥离术的比较

目的探讨扁桃体挤切术在成人扁桃体摘除术中的应用及其优点。方法将临床中符合手术指征的14岁以上患者422例随机分成两组(切术组和剥离术组)并对两组进行多方面的比较：结果扁桃体挤切术同剥离术相比有手术时间短、创伤范围小、痛苦小、术后愈合快、进食早等优点。结论扁桃体挤切术小仅适合于儿童的扁桃体摘除，也适合成年人，并具有诸多优点，值得在成年人扁桃体摘除手术中推广运用。     

全麻下单极电刀切除扁桃体的疗效观察

目的观察并总结我科在全麻下使用单极电刀切除扁桃体的临床疗效。方法回顾我科自2013年09月至2018年7月收治的90例符合扁桃体切除手术指征的患者,随机分为对照组和实验组,每组45例。均在全麻下,对照组采用传统剥离的方法切除扁桃体,而实验组采用单极电刀切除扁桃体。对比两组患者手术时间、术中出血量、术后疼痛时间、伪膜生长等情况。结果相对于传统剥离术,单极电刀切除扁桃体的方式具有手术安全、手术时间更短、出血量更少、视野清楚的优势。结论单极电刀切除扁桃体的方法具有手术时间短、创伤小、恢复快以及手术疗效确切的优点,值得临床推广应用。     

超声刀在儿童扁桃体切除中的应用

目的探讨超声刀在儿童扁桃体切除中的优点及其应用价值。方法采用完全随机分组的方法 ,一组采用超声刀切除扁桃体;对照组应用剥离法切除扁桃体。均在全身麻醉下进行,对比两组病例的术中出血量,手术时间,术后疼痛程度,以及术后并发症的情况。结果两组病例中,超声刀组术中出血量明显少于剥离组,手术时间明显缩短,术后疼痛及术后并发症情况无明显差异。结论超声刀切除扁桃体具有切割精确,出血少,能缩短手术时间。     

低温等离子刀对比双极电凝镊在扁桃体切除术中治疗效果观察

目的分析变应性鼻炎(AR)患者接受鼻腔冲洗治疗的临床疗效。方法将2019年6月~2020年8月作为研究时间段,选取期间我院接诊的78例AR患者,另将随机数字表法作为分组依据,将全部病例分为对照组(行常规治疗,纳入39例)、研究组(加用鼻腔冲洗治疗,纳入39例),对组间气道反应性、症状消失时间展开分析。结果(1)组间气道反应性指标在治疗前无明显差异,P>0.05;研究组共振频率(Fres)、中心气道阻力(R20)、气道总阻力(R5)在治疗后低于对照组,P<0.05;(2)研究组鼻塞、流涕、喷嚏、鼻痒消失时间均少于对照组,P<0.05。结论鼻腔冲洗对改善AR患者气道反应、临床症状均有明显效果,值得推广。     

Tonsillektomie mit dem Argon-Plasma-Koagulations-Raspatorium

BACKGROUND: The Argon-Plasma-Coagulation (APC) offers an innovative possibility for the tonsillectomy combined with a high-frequency technology. Aim of our study was to inves-tigate the differences between this high-frequency-technology and the traditional tonsillectomy. No reports exist in the use of the APC in the tonsillectomy. METHODS: Argon-Plasma-Coagulation tonsillectomy (TE-APC) was compared with the traditional blunt dissection tonsillectomy (TE-trad) with hemostasis by compression and bipolar coagulation. 133 patients were stratified in two age groups in a clinical prospective randomised study. RESULTS: Average surgical time and blood loss were markedly decreased in the TE-APC group (p<0,01). There was no significant difference between the two techniques concerning postoperative pain, otalgia, and primary or secondary haemorrhage. In the TE-APC group more extensive fibrin layer appeared after surgery. In the TE-APC patients' group, there was a slightly higher consume of analgetics in some postoperative days. CONCLUSIONS: The one-step dissection and coagulation procedure leads to an almost bloodfree woundground and to a reduction of operation-time. The self-limited and effective coagualative properties of the APC-method leads to a controlled penetration depth. The often associated extensive post operative pain and uncontrolled tissue- damage, known from electrical and lasersurgical techniques, was not found in TE-APC-patients-group.     

Blunt dissection versus electronic molecular resonance bipolar dissection for tonsillectomy: operative time and intraoperative and postoperative bleeding and pain

OBJECTIVE: To compare operative time, intraoperative and postoperative bleeding and pain using two different techniques for tonsillectomy: electronic molecular resonance bipolar tonsillectomy and blunt dissection tonsillectomy. METHODS: From January 2005 to December 2006, a prospective, randomised study was performed in 800 children, aged from 3 to 10 years, admitted to the ENT (Ear Nose Throat) Unit of Giannina Gaslini Institute, Genoa, Italy to undergo tonsillectomy. Patients were randomised into two surgical groups, Group A (electronic molecular resonance tonsillectomy, EMRBT) and Group B (blunt dissection tonsillectomy). Operative time, intraoperative blood loss and postoperative complications were recorded. During 10 days after surgery, children and their parents were also asked to provide a rating of the patients' current pain intensity using a visual analogue scale. In this period, the parents were also asked to note the analgesic drugs administered. RESULTS: Duration of surgery and blood loss were significantly much lower in the group undergoing electronic molecular resonance bipolar tonsillectomy (p<0.0001). Postoperative pain scores resulted significantly different between the two methods on days 5 (p=0.05) and 8 (p=0.001) in evaluations by mothers. Moreover, in evaluations by patients pain scores resulted significantly different between the two methods on days 3 (p=0.02), 8 (p=0.005) and 9 (p=0.01). We found no difference between boys and girls in pain scores in the 10 days considered, nor between children older than 5 yrs and children younger than or aged 5 years. No statistically significant differences between the two techniques were found in the use of analgesics in all postoperative evaluations. CONCLUSIONS: This study showed that the use of electronic molecular resonance bipolar tonsillectomy, compared to blunt dissection, has several advantages. Reduced operative time and intraoperative bleeding make EMRBT more cost effective and allow an increased number of operations. Concerning postoperative pain, the two techniques did not present significant differences in the use of analgesics. The number of postoperative bleeding episodes was also similar in the two groups of patients.     

The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection

ObjectiveAlthough tonsillectomy is one of the most common surgeries performed in pediatric, it has potential major complications such as pain and bleeding. This study aimed to compare the bleeding and pain after tonsillectomy in bipolar electrocautery tonsillectomy versus cold dissection.MethodsThis double blind clinical trial was conducted on 70 pediatric patients who were candidate of tonsillectomy. Patients were divided into two groups of including bipolar cautery (BC) and cold dissection (CD). operation time, intraoperative blood loss, and postoperative bleeding and pain were evaluated in the current study.ResultsIn both of the CD and BC groups, no significant difference was found in terms of sex and age. The average amount of the intraoperative blood loss in BC group was 14.086 ± 5.013 ml and in CD group was 26.14 ± 4.46 ml (p. v = 0.0001). The mean time of operation in BC group was 19 ± 2.89 min and in CD group was 29.31 ± 5.29 min (p. v = 0.0001).patients were evaluated in terms of pain on the first, third, fifth, and seventh days after the operation. No statistically significant difference was found between two groups.Moreover, Compared pain scores in all times across two groups, no significant difference was found.In terms of postoperative bleeding, none of the patients in both groups had bleeding during follow-up.ConclusionOur study showed that bipolar electrocautery tonsillectomy can significantly reduce the operation time and intraoperative blood loss; however, postoperative pain and blood loss were similar in both techniques. We recommend bipolar electrocautery as the most suitable alternative method for tonsillectomy, especially in children.     

Argon plasma coagulation versus cold dissection tonsillectomy in adults: a clinical prospective randomized study

PURPOSE: Argon plasma coagulation (APC) is a new surgical procedure based on a conductive plasma of ionized argon between an activating electrode and a tissue surface. It is a good alternative for tonsillectomy because of its effective hemostasis and limited penetration depth of the coagulation beam. The aim of this prospective, randomized trial was to evaluate operative time, intraoperative bleeding, and postoperative morbidity of the "hot" APC tonsillectomy as with regard to with a traditional "cold" dissection tonsillectomy in adults. MATERIALS AND METHODS: Two hundred twenty six adult patients (age, >18 years) were randomized into 2 groups: TA (tonsillectomy with APC, n = 113) and TB (conventional tonsillectomy, n = 113). The outcome measures were (1) operative time; (2) intraoperative blood loss; (3) postoperative pain (evaluated using a Visual Analogue Scale with a range score 0-10 on postoperative days 1, 3, 5, 8, and 15); and (4) postoperative primary and secondary hemorrhage. Statistical analysis was carried out using the Student t test. RESULTS: In the TA group, the mean duration of operative time and the intraoperative blood loss were significantly reduced (P < .001). There was no statistically significant difference between 2 groups in the intensity of postoperative pain and the incidence of postoperative hemorrhage (P > .05). CONCLUSIONS: Tonsillectomy with APC is a safe technique and offers an innovative procedure as with regard to the conventional cold dissection. It significantly reduces the operative time and the intraoperative blood loss without increasing the postoperative morbidity.     

低温等离子刀扁桃体切除术与传统扁桃体剥离术疗效的比较

目的:比较分析低温等离子刀扁桃体切除术与传统扁桃体剥离术的疗效。方法:将64例慢性扁桃体炎患者随机分为传统扁桃体剥离术(传统手术组)和低温等离子刀扁桃体切除术(等离子手术组)2组。传统手术组39例采用传统扁桃体剥离术治疗,等离子手术组25例采用低温等离子刀扁桃体切除术治疗。分析2组手术方式在手术时间、术中出血量、术后疼痛时间、术后出血发生概率上有无差异。结果:传统手术组与等离子手术组在手术时间、术中出血量、术后疼痛时间上差异有统计学意义(P<0.05);2组术后出血发生概率差异无统计学意义(P>0.05)。结论:低温等离子刀扁桃体切除术较传统扁桃体剥离术手术时间短,术中出血少,术后疼痛轻,恢复快,安全性高。     

Multiparametric comparison of cold knife tonsillectomy, radiofrequency excision and thermal welding tonsillectomy in children

OBJECTIVE: This is a prospective study evaluating certain intraoperative and postoperative parameters, comparing the relatively new technique of thermal welding tonsillectomy with cold knife tonsillectomy, and radiofrequency excision in pediatric population. METHODS: Ninety children aged from 5 through 13 years were enrolled a randomized prospective trial comparing cold knife tonsillectomy, radiofrequency excision, and thermal welding tonsillectomy. Indications included recurrent acute tonsillitis and/or obstructive sleep apnea syndrome. All techniques were compared by means of length of surgery time, blood loss, postoperative bleeding and postoperative pain. RESULTS: Sixty-eight patients underwent tonsillectomy for obstructive sleep apnea, whereas 22 children underwent tonsillectomy due to recurrent acute tonsillitis. Median values of all variables tested, length of surgery time, blood loss, postoperative bleeding and postoperative pain, were found to differ significantly among the three surgical techniques (P<0.001). Particularly, a statistically significant higher median duration (P<0.001) and intraoperative blood loss (P<0.001), as well as, a statistically significant lower median pain score in each day tested (P<0.001) of the cold knife group, compared to each one of the other two groups, were found. Tissue welding and radiofrequency groups did not differ significantly in any aspect tested. CONCLUSIONS: Both thermal welding and radiofrequency excision techniques have shown comparable results regarding intraoperative blood loss, postoperative hemorrhage, and pain. Compared with cold knife tonsillectomy, welding and radiofrequency excision techniques were associated with less intraoperative blood loss and duration, though cold knife tonsillectomy seems to prevail over the two techniques in terms of the postoperative pain.     

Harmonic scalpel versus bipolar tonsillectomy: a double-blind clinical trial

This is a double bind clinical trial which evaluated harmonic scalpel versus bipolar diathermy tonsillectomy The study was conducted at Diyarbakir government hospital, Diyarbakir, Turkey. The study population comprised 144 patients, aged 4–18 years (mean 9 years  ± 4.12 SD). All patients underwent tonsillectomy with or without adenoidectomy. The indications for tonsillectomy were obstructive sleep apnea (84 patients [58.3%]) and chronic tonsillitis (60 patients [41.7%]). All 144 patients were randomly divided into two groups: bipolar dissection (81 patients [56.2%] with mean age 8.98 years ± 4.22) and harmonic scalpel (63 patients [43.8%] with mean age 9 years ± 4.02). BD group showed statistically significantly less intraoperative bleeding (< 0.05). There was no statistically significant difference on postoperative day 1 but a statistically significant difference was determined on postoperative days 4, 7 and 14. There was no statistically significant difference between the two techniques with regard to immediate and delayed bleeding. The mean operative time was the same in both the groups. Bipolar dissection group showed statistically significant less intraoperative bleeding than harmonic scalpel group. An analysis of postoperative pain scores showed that the harmonic scalpel group pain scores are lower than the bipolar dissection group on all recorded days, and no statistically significant complications was seen in both groups. The results of this study indicate that the HS technique is associated with lower pain scores with the same complication rates as the BD technique.     

Tonsillectomy with argon plasma coagulation (APC): evaluation of pain and hemorrhage

OBJECTIVE: Argon plasma coagulation (APC) offers a new possibility for tonsillectomy (TE) because of its effective hemostasis and limited penetration depth of the coagulation zone. The APC dissector allows dissection and hemostasis in a one-step procedure. The aim of this prospective, randomized, single-blinded study was the evaluation of pain and hemorrhage of the "hot" argon-plasma-coagulation tonsillectomy (TE(APC)) compared with a conventional "cold" non-electrosurgery tonsillectomy (TE(Conv)). METHODS: Two hundred one consecutive patients undergoing tonsillectomy were included in a single-blinded, randomized, prospective study with stratification in two age groups. RESULTS: There was no statistical significant difference between TE(APC) and TE(Conv) in the intensity of postoperative pain and primary or secondary hemorrhage in both age groups. In the TE(APC) group, the mean duration of tonsillectomy was significantly reduced by more than 50% in both age groups (P <.01). The blood loss was 90% decreased in the TE(APC) compared with the TE(Conv) in both age groups (P <.01). CONCLUSIONS: The APC technique does not face the general problem of electrosurgery or thermal coagulation techniques in which the postoperative pain is often increased compared with conventional cold techniques. It offers an innovative new tonsillectomy method with significant reduced blood loss and surgical time.