低温等离子刀、超声刀及传统方式行扁桃体切除术的比较

目的：探讨运用低温等离子刀、超声刀及传统手术方式行扁桃体切除术的优、缺点，并对三种术式特点和应用价值进行评价。方法需行扁桃体切除术的患者117例，分为低温等离子刀组、超声刀组及传统组，每组各39例，记录双侧扁桃体切除术的手术时间和术中出血量、术后咽部疼痛、术后原发性及继发性出血等。结果等离子刀组、超声刀组的手术时间及术中出血量均较传统组降低，差异有统计学意义（P ＜0．05）；等离子刀组手术时间（9．92±4．04）min]较超声刀组手术时间（15．86±1．36）min]短，差异有统计学意义（P ＜0．05），两组术中出血量差异无统计学意义（P ＞0．05）。等离子刀组、超声刀组分别与传统组在术后前3天的疼痛评分差异均有统计学意义（P ＜0．05），此后三组疼痛评分差异无统计学意义（P ＞0．05）；等离子刀组较超声刀组术后疼痛轻，但是两者疼痛评分差异无统计学意义。等离子刀组与传统组各出现1例术后原发性出血的病例。等离子刀组1例、超声刀组1例、传统组2例出现继发性出血。三组伪膜开始脱落时间差异无统计学意义（P ＞0．05）。三组术后24 h 咽部水肿评分差异有统计学意义（P ＜0．05），等离子刀组及超声刀组咽部水肿轻于传统组，但等离子刀组与传统组咽部水肿差异无统计学意义（P ＞0．05）。结论低温等离子刀切除扁桃体是较为安全、有效的手术方法，但其费用相对较高。对于慢性扁桃体炎病程长且瘢痕粘连较重的患者，建议选用超声刀切除扁桃体。

Comparison of coblation,ultrasonic knife and conventional approach in tonsillectomy

Objective To evaluate the advantages and disadvantages of coblation,ultrasonic knife and conventional ap-proach in tonsillectomy.Methods A total of 1 17 cases in need of tonsillectomy were collected and divided into 3 groups:coblation tonsillectomy group (group A,n =39),ultrasound knife tonsillectomy group (group B,n =39)and the traditional tonsillectomy group (group C,n =39).The operation time,blood loss,postoperative sore throat situa-tion,postoperative primary and secondary bleeding and so on were recorded and compared.Results The operation time was shorter,and intraoperative blood loss was less in group A and B than in group C (P <0.05).The operation time in group A (9.92 ±4.04)min]was shorter than that (15.86 ±1.36)min]in group B,(P <0.05).There was no difference in intraoperative blood loss between group A and B (P >0.05).The degree of the pain in the first three days after surgery in group A and in group B was significantly lower than that in group C (P <0.05),but no sta-tistically significant differences were observed after three days (P >0.05).Postoperative throat pain in group A was lighter than that in group B,but there was no significant difference (P >0.05 ).Postoperative primary hemorrhage occurred in 1 case in group A and C,while secondary hemorrhage occurred in 1,1 and 2 cases in group A,B and C, respectively.There was no significant difference in the time of pseudo-membrane defulvium among the three groups (P >0.05).Pharyngeal edema score 24 hours after operation in group A and group B was significantly lower than in group C (P <0.05),but there was no statistically significant difference between group A and group B (P >0.05). Conclusion Coblation tonsillectomy is the more safe and effective method,but its cost is relatively high.It is suitable for patients with good economic conditions and high quality of life.Ultrasonic knife tonsillectomy is suggested to be appropriate for patients with adhesive tonsillitis of long duration.