可视喉镜等离子系统切除会厌舌根良性病变71例

目的 探讨可视喉镜等离子系统切除会厌舌根病变的适应证和手术方法,总结运用这种方法进行手术切除会厌舌根病变的经验。 方法 对经常规检查临床初诊为会厌舌根乳头状瘤、舌扁桃体增生、会厌囊肿等良性病变的患者,在可视喉镜等离子手术系统下进行病变切除,术后随访病变复发与并发症情况。 结果 经过临床初诊符合条件的舌根会厌良性病变患者71例,其中会厌囊肿44例,会厌舌根乳头状瘤17例,舌扁桃体增生10例。均经气管插管全麻,在可视喉镜和等离子手术系统辅助下完成病变切除。术后均恢复良好,除2例迟发型术后出血外,无其他并发症。其中舌扁桃体增生和舌根会厌乳头状瘤均经病理最后确诊。随访6~18个月,病变均无复发。 结论 舌根会厌良性病变可以在可视喉镜等离子系统下方便快捷的经口切除,该术式具有暴露充分、视野宽广、切除彻底、创伤小、安全性良好、并发症少和疗效确切的优点。     

支撑喉镜下手术切除联合平阳霉素注射治疗咽喉部较大血管瘤23例

目的 观察支撑喉镜下手术切除联合平阳霉素注射治疗咽喉部较大血管瘤的疗效.方法 咽喉部较大血管瘤病例23例,均采用支撑喉镜下手术切除加术中病变部位平阳霉素注射治疗,术后随访1～6个月,观察其治疗效果.结果 20例治愈无复发(87%),剩余3例血管瘤明显缩小(13%).结论 咽喉部较大血管瘤采用支撑喉镜下手术切除联合平阳霉素治疗,疗效显著、操作简便、安全可靠.     

茎突截短术改善茎突综合征咽痛症状八例

目的 探讨茎突截短术对茎突综合征患者咽痛症状的改善情况。 方法 对8例9侧茎突综合征患者进行茎突截短术,对比分析患者手术前后临床资料。 结果 所有患者术后咽痛症状完全消失,随访7~30个月,平均20个月。1例术中切开咽上缩肌损伤小动脉致术中出血30 mL,经结扎止血;1例术后第7天发生扁桃体窝迟发性出血,经局部过氧化氢棉球压迫止血。 结论 茎突截短术可以有效改善茎突综合征患者的咽痛症状。     

喉镜评分预测支撑喉镜手术暴露的临床意义

目的 研究喉镜评分系统对于支撑喉镜手术中声门暴露困难程度的预测作用。 方法 应用双盲试验方法,测试员用喉镜评分系统对支撑喉镜手术患者进行术前测量及评分,术者在术中对患者声门暴露困难程度进行评估分级,收集数据后统计两者是否具有相关性,及分析主要相关因素。 结果 当患者术前喉镜评分为6分及以下时,术中82.8%的概率出现可接受喉暴露,17.2%的可能出现困难喉暴露。当患者术前喉镜评分超过6分时,术中100%的概率会出现困难喉暴露。困难喉暴露预测系统(>6分)的灵敏度、特异度、误诊率、漏诊率分别为100%(20/20)、82.8%(48/58)、0%(0/20)、17.2%(10/58)。有统计学意义的变量为:开口牙裂距离、甲状软骨角-颏下距离、颈部伸展角度、体质量指数、小颌畸形。 结论 利用简易可行的术前支撑喉镜评分系统,将6分作为困难喉暴露与可接受喉暴露的分界,准确度较高,在临床上简单易操作,具有一定的实用性。     

大气泡法辅助深板层角膜移植治疗圆锥角膜的临床观察

目的 研究大气泡法辅助深板层角膜移植术治疗圆锥角膜的临床疗效及安全性。 方法 对18例(20眼)圆锥角膜患者采用大气泡法辅助的深板层角膜移植手术。分析手术技巧,观察术后疗效及安全性。 结果 全部患者均手术顺利,恢复良好,术后视力得到不同程度的提高,术后未出现感染、排斥等并发症情况。 结论 大气泡法辅助深板层角膜移植治疗圆锥角膜患者具有良好的临床效果及安全性。     

超声刀扁桃体切除术与低温等离子扁桃体切除术的对比研究

目的 探讨超声刀扁桃体切除术与低温等离子扁桃体切除术的优缺点、安全性及可行性。 方法 计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库和Pubmed等数据库中国内外关于超声刀扁桃体切除术与低温等离子扁桃体切除术的随机对照试验。运用RevMan 5.3软件对两种手术方式在术中、术后指标进行Meta分析。 结果 共纳入8个随机对照试验,共722例患者。超声刀扁桃体切除术与低温等离子扁桃体切除术相比,术后出血率明显降低［SMD=0.30,95%CI(0.15, 0.600.11, 0.79), P=0.010 007］,而在手术时间、术中出血量、术后白膜开始脱落时间及术后疼痛评分等方面,超声刀组与等离子组差异无统计学意义。 结论 超声刀扁桃体切除可明显降低患者术后原发或继发出血的概率,改善患者术后的生活质量。     

支撑喉镜下喉显微手术患者的体位改进

目的 探讨嗅物位对支撑喉镜下喉显微手术术野暴露的优势。 方法 选择拟行支撑喉镜下喉显微手术的嗓音疾病患者60例,随机分为嗅物位组(A组)及去枕仰卧位组(B组)2组,每组30例。A组患者予以枕下垫自制头枕,肩背部紧贴于手术台面,再将其头部伸展于寰枕关节;B组患者摆放去枕仰卧位。评价声门暴露情况,根据声带病变范围及性质行喉显微手术。 结果 (1)暴露声门耗时:A组(2.42±1.04)min明显短于B组(3.20±0.95)min,两组比较差异具有统计学意义(P<0.05);(2)手术并发症:A组术后喉部疼痛VAS评分低于B组,两组比较差异具有统计学意义(P<0.05);A组术后咽喉部黏膜损伤发生率(6.7%)明显低于B组(30.0%),术后舌部麻木及术中术后牙齿损伤情况基本无发生,与B组比较,术后恢复良好、手术并发症少。 结论 嗅物位较去枕仰卧位更有利于支撑喉镜下的声门暴露,耗时更短、手术并发症更少。     

咽腭弓肌黏膜瓣闭合扁桃体等离子术后创面的临床疗效

目的 对扁桃体等离子切除术的术式进行改进,分析咽腭肌黏膜瓣闭合扁桃体等离子术创面对术后疗效的改善情况。 方法 对需行扁桃体等离子切除术患者进行随机分组。105例行常规扁桃体等离子切除术(大多数囊内切除),94例在扁桃体等离子切除后制作局部咽腭肌黏膜瓣闭合扁桃体窝创面。对两组患者的术后疼痛、创面反应及出血情况进行分类统计,分析比较应用咽腭肌黏膜瓣修复的临床效果。 结果 在术后第1至第7天,实验组与对照组患者间的疼痛程度、创面反应情况及出血并发症的发生均有差异。实验组不同层次疼痛程度的病例数明显少于对照组,术后创面反应观察中,实验组白膜脱落时间较对照组明显缩短,出血概率明显减低。 结论 应用咽腭肌黏膜瓣闭合扁桃体等离子切除后创面操作简便,可明显改善患者术后疼痛,促进创面愈合,减少创面术后出血概率。     

儿童阻塞性睡眠呼吸暂停低通气综合征等离子

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)低温等离子消融术后并发症产生原因,总结并发症处理方案及预后。 方法 2007年10月至2017年6月,行低温等离子消融手术的OSAHS患儿3 106例,均在全麻下行腺样体等离子消融术,伴或不伴扁桃体切除术。统计3 106例患儿中术后出血、发热、腭咽弓穿孔、鼻腔反流等并发症的患者数量,分析原因。 结果 3 106例中术后出血76例(2.44%),再次全麻手术止血12例,手术止血后送PICU,原因为失血过多行输血治疗1例,止血术前麻醉时出现呕吐物窒息并抢救1例;术后1周内出现体温超过38.5 ℃的患儿44例,经对症处理后体温正常。术后患儿出现腭咽弓穿孔5例,因患者无症状未做特殊处理,穿孔自行愈合3例。腭瘘患者术后出现进食时鼻腔反流1例,经保守治疗后愈合。 结论 儿童OSAHS低温等离子消融术后并发症发生率较低,但如果处理不恰当可造成严重后果,甚至可危及患儿生命。临床上应注意预防并发症发生,妥善处理,尽量减轻并发症给患者带来的伤害。     

CO2激光联合质子泵抑制剂治疗复发性声带突肉芽肿的疗效观察

目的 探讨CO₂激光联合质子泵抑制剂治疗复发性声带突肉芽肿的疗效。 方法 对复发性声带突肉芽肿患者28例,采用全麻支撑喉镜下CO₂激光手术,其中有胃食管反流症状16例,胃食管反流症状不明确12例,术后应用质子泵抑制剂抗胃酸反流治疗8~12周,术后随访1年观察疗效。 结果 28例术后声嘶、咽异物感等症状均有明显改善,病理证实均为肉芽组织。术后随访1年复查电子喉镜复发2例,给予埃索美拉唑40 mg/d口服1个月,肉芽肿明显缩小1例,肉芽肿未见进一步增大1例,无声嘶及异物感等喉部症状,未予再次手术治疗。 结论 胃食管反流是声带突肉芽肿术后复发的一个重要因素;CO₂激光手术联合质子泵抑制剂是治疗复发性声带突肉芽肿的一个有效方法,创伤小、复发率低。     

Pediatric coblation total tonsillectomy: intracapsular or extracapsular?

Objectives: To compare the results of coblation intracapsular total tonsillectomy (CITT) with those of conventional coblation extracapsular total tonsillectomy (CETT) in the treatment of tonsillar hypertrophy in children with regards to efficacy and complications.

Methods: Ninety children with adenotonsillar hyperplasia underwent tonsillectomy?±?adenoidectomy (48 CITT and 42 CETT). Intraoperative situation was observed and recorded. Patients were reexamined regarding recovery condition and tonsil regrowth, and were followed for at least one year.

Results: Significant differences were observed in four clinical features when the CITT group was compared with the CETT group: intraoperative bleeding score, intraoperative tonsillar fossa score, color of white membrane one day postoperatively, and visual analogue scale (VAS) value one week postoperatively (p?p?p?Conclusions: Compared with conventional extracapsular tonsillectomy, CITT has the advantages of decreased pain and bleeding, and promote healing of wounds. No tonsillar regrowth was observed after at least one year of follow-up.     

Rate of post-tonsillectomy hemorrhage after elective bipolar microcauterization of nonbleeding vessels

The objective of this paper is to describe an extended microscopic hemostasis technique involving cauterization of exposed blood vessels that were not actively bleeding in tonsillar fossa after bipolar tonsillectomy and to assess the rate of post-tonsillectomy hemorrhage with this technique in children who had bipolar tonsillectomy. The medical records of children who underwent microscopic bipolar tonsillectomy with extended hemostasis between June 2008 and January 2011 were reviewed. Relevant history and physical examination, diagnosis, and characteristics of postoperative hemorrhage were recorded; 994 children (531 males, 463 females), aged between 1 and 18 years (6 ± 3 years), underwent tonsillectomy; of the 994 patients, 11 (1.1%) developed post-tonsillectomy hemorrhage. No primary post-tonsillectomy hemorrhage occurred. The hemorrhage was seen 6–13 days after the surgery. One patient had bleeding after having trauma to the neck on postoperative day 13. Of the 11 patients with post-tonsillectomy bleeding, 3 had blood clot with no active bleeding and 8 exhibited active bleeding after removal of blood clot. Of the 994 patients, 8 (0.8%) needed intervention to control active bleeding. Compared to previous studies of bipolar tonsillectomy, extended microscopic hemostasis achieved by cauterization of tonsil fossa non-bleeding blood vessels appeared to reduce bleeding rate after bipolar cautery tonsillectomy. The present study did not include a control arm; further randomized controlled studies are needed to establish the definite effect of extended microscopic hemostasis technique on the rate of hemorrhage rates after tonsillectomy techniques.     

Inside-out complete tonsillectomy: extended intracapsular tonsillectomy for severe sore throat

OBJECTIVES: This consecutive case series is presented to describe inside-out complete tonsillectomy and to assess its effects on postoperative pain and bleeding and its initial effectiveness in controlling recurrent sore throat and peritonsillar abscess formation. METHODS: Bipolar electrosurgical scissors are used for bloodless resection of 90% of the tonsillar mass. During controlled resection, tonsil tissue is intentionally left at the superior and inferior poles and at the deepest part of the tonsillar fossa to provide coverage for nutrient arteries and the tonsillar plexus of veins. This tissue is then electrodesiccated and removed under direct vision and indirect mirror guidance to achieve complete tonsillectomy. RESULTS: One hundred eighty-three consecutive tonsillectomies were performed by a single surgeon in a 16-month period, 47 of which were for the indication of recurrent sore throat (44) or recurrent peritonsillar abscess (3). Among these 47 children, there were 2 readmissions for dehydration. There were no immediate or delayed bleeding episodes. The average child required 4 days of narcotic pain medication. The mean annualized number of severe sore throats decreased from 5.24 before operation to 0.36 after operation (p < .0001, Student's paired t-test). There were no recurrent peritonsillar abscesses. CONCLUSIONS: Inside-out complete tonsillectomy achieves the surgical goal of complete tonsillectomy with the smallest possible wound and minimal injury to the surrounding tissue. The perioperative morbidity is markedly decreased compared to that of historical controls. The initial results suggest effectiveness similar to that of extracapsular tonsillectomy.     

Peritonsillar abscess: risk of disease in the remaining tonsil after unilateral tonsillectomy à chaud

The occurrence of disease in the remaining tonsil after unilateral tonsillectomy à chaud in the treatment of peritonsillar abscess, was studied in 536 patients. No patient had a history of previous severe tonsillitis at the time of the unilateral tonsillectomy, 6.1 per cent of the patients were readmitted for surgery of the remaining tonsil during the follow-up period. Ninety-seven per cent of these patients were younger than 30 years of age. Previous investigations have shown increasing frequency by age of pharyngitis after bilateral tonsillectomy. We suggest bilateral tonsillectomy in all cases of patients younger than 30 years old who suffer from peritonsillar abscess irrespective of previous tonsillar disease. Patients older than 30 should be treated with unilateral ablation, unless there is a clear indication for bilateral tonsillectomy.     

Using the carbon dioxide laser for tonsillotomy in children

Carbon dioxide laser tonsillotomies were performed on 33 children aged 1-12 years for the relief of obstructive symptoms due to tonsillar hyperplasia. As opposed to conventional tonsillectomy, only the protruding part of each tonsil was removed. A carbon dioxide laser delivering 20 W was used for the excision. Twenty-one children were seen in active short-term follow-up and the records of all the children were checked for possible surgery related events up to 20-33 months after surgery. Laser tonsillotomy was uniformly effective in relieving the obstruction, with good hemostasis. The tonsillar remnants healed completely within 2 weeks. No major adverse events occurred. Post-operative pain appeared slight and easily controlled. There was no gain in operating time compared with conventional tonsillectomy. The laser tonsillotomies were in most cases done in day surgery. No recurrence of obstructive problems was reported up to 20-33 months after surgery. It was concluded that tonsillotomy, using a carbon dixoide laser, is a valid treatment for obstructive symptoms caused by enlarged tonsils, which can be performed with little bleeding and post-operative pain. The improved hemostasis may enable a shift from in-patient to day surgery.     

Tonsillar haemorrhage and measles

A seven-year-old girl presented with life-threatening pharyngeal haemorrhage. This was subsequently found to arise from one tonsil, and a tonsillectomy eventually halted the bleeding. Two days later she developed measles, confirmed by serology and characteristic histology. Spontaneous tonsillar haemorrhage is extremely rare, and not previously reported in measles.     

Bacteremia during tonsillectomy

OBJECTIVE: To investigate bacteremia in patients who underwent tonsillectomy with a dissection method due to chronic tonsillitis, which may lead to dramatic results in patients that have a cardiovascular infection risk. In this study, it was explored whether the tonsil surface and the tonsil tissue interior microorganisms are different or not, and whether these microorganisms carry bacteremia development risk. METHODS: Forty patients were enrolled in the study in ENT Clinic, Firat University. A bacteriological research was performed on patients with no treatment with antibiotics for a month before the operation. Tonsil surface and deep tissue cultures were performed, and venous blood samples were taken for cultures before and after the operation. RESULTS: Surface and deep tissue cultures of tonsils of the cases represented a different result in 27.5% of the patients. No reproduction was observed regarding the blood cultures taken before tonsillectomy. Bacteremia was found in blood samples of ten patients (25%) taken immediately after tonsillectomy. CONCLUSION: Hence, it has been concluded that different microorganisms may be present among the tonsil surface and tonsil deep tissue cultures and that bacteremia may develop after tonsillectomy. Therefore, to prevent the possible dramatic outcomes after tonsillectomy the required measures during the preoperative period should be taken into consideration, especially in patients that have chronic tonsillitis with cardiovascular disease.     

Spontaneous tonsillar hemorrhage

Spontaneous tonsillar hemorrhage (STH) of non-iatrogenic causes occurs most frequently from infection. Infection can lead to erosion into a major vessel, such as the carotid artery or a smaller peripheral tonsil vessel. Whereas fatal erosion into a major vessel from a deep neck abscess was relatively common in the past, it is rare since the advent of antibiotics. Spontaneous tonsillar hemorrhage, when it does occur, appears to occur most commonly in a peripheral tonsil vessel from bacterial tonsillitis. Medical records of 860 patients with conditions considered to be susceptible to STH were reviewed. Ten cases of STH were identified. All were from peripheral tonsil vessel hemorrhage; none was secondary to major vessel erosion. Bacterial tonsillitis was the most common cause of STH and occurred in 8 of 10 cases. This condition accounted for an incidence of STH in tonsillitis of 1.1%. A history of chronic tonsillitis appeared to predispose a patient to STH. Other causes of STH were infectious mononucleosis and neoplasm. Seven of the ten peripheral STHs presented with bleeding from an obvious venous source. The other three patients had significant hemorrhages which led to arteriography. Arteriograms are indicated in patients with clinical features suggesting possible major vessel erosion or in those patients where significant bleeding is not from an obvious peripheral source. A peripheral STH can be successfully managed with local intervention and tonsillectomy.     

Unusual complication of tonsillectomy: taste disturbance and the lingual branch of the glossopharyngeal nerve

Taste disturbance is an unusual complication of tonsillectomy of which there are very few reports in the literature. The possible causes of this rare complication are: (1) direct or indirect damage to the glossopharyngeal nerve or its lingual branch (LBGN), (2) lack of dietary zinc, and (3) habitual drug intake. We report a 41-year-old man, who complained of taste disturbance following tonsillectomy that was performed for chronic tonsillitis and unilateral (left) tonsillar hypertrophy. During surgery, hypertrophic tonsils were found to be sited deeply into the tonsillar bed, especially at the lower pole of the left tonsil. Pathologic examination following tonsillectomy revealed a keratinous cyst and chronic infection at the left tonsil, and lymphoid hyperplasia and chronic infection at the right tonsil. Although his complaint had been getting better, qualitative examination of his taste function revealed bilateral impairment of the sense of sweet taste on the base of his tongue two months after the surgery, and a taste disturbance of sweet taste on the left side persisted the 10th month after the surgery. His serum zinc value was normal, and he did not take any drug that could affect his sense of taste. Depending on the literature data, possible indirect damage to the LBGN was suspected as the cause of the taste disturbance. This symptom may be reversible within two years after tonsillectomy, but it can also be irreversible. Therefore, tonsillectomy should be performed with minimal trauma to the tonsillar bed, especially when there is an additional pathology extending into the lower pole, and such a patient should be informed of the risk of post-operative taste disturbance after tonsillectomy as being one of the rare complications of this surgery.