电视支撑喉镜下低温等离子治疗会厌囊肿

目的探讨支撑喉镜视频监视下低温等离子会厌囊肿切除的优点、疗效及手术体会。方法对采用支撑喉镜视频监视下低温等离子刀进行手术治疗的26例会厌囊肿的术中出血情况、手术时间、术后疼痛程度、住院天数、会厌创面伪膜脱落的时间、术后并发症及效果进行分析。结果患者术中出血情况（3.9±0.8）ml、手术时间（11.8±2.3）min、术后疼痛程度（视觉模拟评分法VAS）2.5±1.0、住院天数（2.4±0.7）d、会厌创面伪膜脱落的时间（11.8±2.6）d。术后患者均无呼吸不畅及会厌创面出血的并发症发生。全部病例随访3个月以上,无一例复发。结论采用电视支撑喉镜下低温等离子行会厌囊肿切除,具有术野清晰,术中出血少,手术时间短,对会厌组织创伤小,术后患者咽痛轻,会厌创面伪膜脱落时间短,无不良反应及并发症,愈后不易复发等优点,值得临床推广使用。     

等离子扁桃体切除术与常规剥离法扁桃体切除术之比较

目的:比较等离子扁桃体切除术与常规剥离法扁桃体切除术对患者术中、术后的影响。方法:随机将56例患者分为等离子组和对照组,等离子组用低温等离子射频消融系统连接EVac70刀头,能量设置为6,切除扁桃体;对照组则采用常规剥离法扁桃体切除术,手术均由同一术者完成。记录两侧扁桃体切除所需时间和出血量;术后第1天至第10天患者每日记录咽部疼痛情况,恢复正常活动时间和正常饮食时间;术后第10天,医师观察并记录扁桃体窝内的白膜状况。结果:等离子组手术时间比对照组短,术中总出血量<10ml,而对照组平均出血量为(119±43)ml;等离子组患者术后疼痛轻于对照组,且比对照组更早恢复正常饮食;2组患者恢复正常活动时间的差异无统计学意义;等离子组较对照组白膜脱落慢。等离子组有1例患者于术后第7天口咽部有活动性出血,需缝扎止血。结论:等离子扁桃体切除术与剥离法相比,患者术后疼痛明显减轻,出血量极少,手术方法容易掌握,但扁桃体窝愈合的时间较长。     

新生儿及婴儿会厌囊肿手术方式的探讨

目的探讨婴幼儿会厌囊肿治疗方法及疗效。方法 1995年7月～2011年7月对69例新生儿及婴儿会厌囊肿患者行手术治疗,其中钳除术17例,剪切术11例,圈套器摘除术35例,低温等离子射频消融术6例,分析其疗效、手术时间、术中出血量和术后恢复时间。结果 17例钳除术患儿术后有2例复发,治愈率88.24%,手术时间平均约25.8分钟,术中出血平均4.2毫升,术后恢复时间平均6.73天;11例剪切术患儿2例复发,治愈率81.82%,手术时间平均约23.7分钟,术中出血平均3.6毫升,术后恢复时间平均5.21天;35例圈套器摘除术患儿术后无一例复发,治愈率100%,手术时间平均约11.6分钟,术中出血平均1.6毫升,术后恢复时间平均3.76天;6例低温等离子射频消融术患儿术后无一例复发,治愈率100%,手术时间平均约13.5分钟,术中无出血,术后恢复时间平均7.56天。结论圈套器摘除术和低温等离子射频消融术是治疗新生儿及婴儿会厌囊肿安全、有效的手术方式。     

麻醉喉镜下低温等离子射频消融显微手术治疗巨大会厌囊肿

目的探讨麻醉喉镜下显微镜下低温等离子射频消融术治疗巨大会厌囊肿的疗效。方法 2013年1月~2016年1月年我科收治的30例巨大会厌囊肿患者,男18例,女12例,年龄26~57岁,均在全麻麻醉喉镜下显微镜下暴露会厌,用低温等离子喉刀头行会厌囊肿射频消融术,观察术后创面恢复情况及有无复发。结果术后创面干净,术后1月假膜完全脱落,无大出血及假膜脱落引起内源性气管异物等并发症,术后随访1年,无1例复发。结论全麻下麻醉喉镜配合显微镜低温等离子射频消融治疗巨大会厌囊肿临床疗效满意,安全可靠,有独特的优势。     

低温等离子消融术与传统术式治疗会厌囊肿的疗效比较观察

目的比较低温等离子消融术与传统手术方法治疗会厌囊肿的临床疗效。方法2012年7月-2014年1月收治的42例会厌囊肿患者,随机分为治疗组和对照组,均在全麻支撑喉镜引导下手术。治疗组采用低温等离子射频消融术,对照组采用喉钳切除术。观察比较两种手术方法的优越性及其临床疗效。结果与传统方法比较,低温等离子手术的手术时间明显缩短、术中出血量明显减少、术后疼痛时间甚短、黏膜修复很快,差异具有统计学意义（P〈0．05）。术后随访1年,对照组病变复发19例,而治疗组无1例出现病变复发。结论低温等离子治疗会厌囊肿临床疗效满意,安全可靠,值得推广。     

低温等离子术后假膜脱落的临床讨论

目的：观察低温等离子术后假膜脱落情况,讨论由此可能带来的一些潜在问题。方法：以2012—1i～2013—06期间行低温等离子手术的481例患者为研究对象,其中行扁桃体切除术116例,腺样体消融术98例,下鼻甲消融术255例,会厌囊肿切除术8例,喉部新生物切除术4例。重点观察术后假膜出现情况、脱落时间、脱落后伤口情况以及有无并发症发生。结果：扁桃体切除术后假膜脱落时间在2周左右,并发出血3例,其中1例与进食不当有关。腺样体消融术后2～3周假膜基本脱落,未出现后鼻孔狭窄及咽腔粘连等。会厌囊肿切除术后4周左右假膜脱落,并发出血1例。下鼻甲消融术后3～4周假膜脱落,1例患者在术后2个月并发大出血。1例左喉室神经鞘瘤患者术后4个月假膜才完全脱落,术区又长出新生物;I例左声带重度不典型增生伴原位癌患者术后4个月假膜还未完全脱落,术区亦可见新生物,术后9个月术区创面平整光滑,愈合好;1例左声门下上皮样血管内皮瘤患者术后第8天假膜完全脱落,随访至术后6个月未见复发;1例左侧杓会厌襞囊肿患者术后失访。前3例患者均未出现出血、内源性气管异物等并发症。结论：低温等离子手术具有明显优势,但术后假膜脱落带来的潜在问题值得引起足够重视,特别是低温等离子喉部新生物术后假膜脱落时间长短不一,与文献报道不完全一致,可能与其作用于周围组织的时间有关。     

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。     

支撑喉镜电视内镜下低温等离子射频治疗会厌囊肿11例

会厌囊肿可引起患者明显吞咽异物感,需及时处理,否则可能出现反复会厌炎发作,甚至发生喉梗塞危及生命.手术治疗常规在直达喉镜下刀片或剪刀切除,电凝止血,但视野局限,损伤重,出血多,术后会厌水肿明显,继发出血多.2008年1月～2010年6月,文登中心医院耳鼻咽喉科经支撑喉镜电视内镜下低温等离子射频切除会厌囊肿11例.     

扁桃体部分切除术治疗儿童阻塞性睡眠呼吸暂停的临床应用

目的分析经低温等离子射频行扁桃体部分(囊内)切除术(Tonsillotomy, TT)治疗儿童阻塞性睡眠呼吸暂停的临床应用效果。方法回顾分析2016年5月至2017年4月因腺样体和扁桃体肥大入院患者122例,年龄3～10岁,均以儿童OSA入院。分为扁桃体部分切除组(TT组72人)、扁桃体全切组(TE组50人),分别行扁桃体部分切除术和全切除术,同时均联合腺样体切除术治疗,对比两组扁桃体手术后患者的治疗效果。TT组和TE组比较内容包括:手术时间;术后疼痛指数;术后恢复进食时间;总住院时间;伪膜脱落时间;术后原发性和继发性出血时间;并对扁桃体部分切除患儿术后7天、14天、1个月、3个月、6个月、12个月分别进行随访,有无扁桃体残体再感染及复发。结果两组患儿在手术时间、术后疼痛指数、住院时间、术后恢复进食时间上有显著性差异(P0.05);患儿的手术时间明显减少,患儿的疼痛指数降低,随访无再感染及复发。在术中术后出血、伪膜脱落时间、扁桃体残体或咽部再感染方面无明显差异。结论经低温等离子射频行扁桃体部分(囊内)切除术治疗儿童OSA不仅患儿术后鼻塞、打鼾症状明显改善,而且对术后生活质量改善有着积极的意义,可作为针对因扁桃体肥大造成OSA患儿的首选手术治疗方案。     

经口入路低温等离子射频辅助手术治疗茎突综合征

目的:比较经口入路低温等离子射频辅助手术治疗茎突综合征与传统经口入路扁桃体切除后治疗茎突综合征两者的区别。方法:选取23例茎突综合征患者,其中13例采用经口入路低温等离子射频辅助行茎突截短,10例采用传统扁桃体切除后行茎突截短,比较2种手术方法的手术时间、术中出血量、术后疼痛评分、假膜脱落时间及疗效评价。结果:2种手术方法的手术时间、术中出血量及术后疼痛评分差异有统计学意义(P<0.01);假膜脱落时间及疗效评价差异无统计学意义(P>0.05)。低温等离子手术术后未出现迟发性出血;传统手术术后出现1例迟发性出血。结论:2种手术方法均为治疗茎突综合征的有效方式。但经口入路低温等离子射频辅助手术治疗茎突综合征具有手术时间短、术中出血少及术后疼痛轻等优点,且保留了扁桃体的形态和功能,手术简单方便,视野清楚,操作安全,符合微创理念。     

Coblation versus unipolar electrocautery tonsillectomy: a prospective, randomized, single-blind study in adult patients

OBJECTIVES: To determine if the coblation tonsillectomy (subcapsular dissection) results in less postoperative pain, equivalent intraoperative blood loss, equivalent postoperative hemorrhage rates, and faster healing compared with tonsillectomy was performed using unipolar electrocautery in adult patients. STUDY DESIGN: The authors conducted a prospective clinical trial. METHODS: Forty-eight patients underwent tonsillectomy and were randomly assigned to have one tonsil removed with coblation and the other with unipolar electrocautery. Outcome measures included time to remove each tonsil, intraoperative blood loss, patient-reported pain, postoperative hemorrhage, and amount of healing 2 weeks after surgery. RESULTS: Mean time to remove a single tonsil with coblation and electrocautery was 8.22 minutes and 6.33 minutes, respectively (P = .011). Mean intraoperative blood loss for each technique was less than 10 mL. Postoperative pain was significantly less with coblation as compared with electrocautery: 18.6% less painful during the first week of recovery. Seventy percent of blinded patients identified the coblation side as less painful during the overall 14-day convalescent period. Postoperative hemorrhage rates (2.1% for coblation and 6.2% for electrocautery) were not significantly different. No difference in tonsillar fossa healing was observed between the two techniques 2 weeks after surgery. During nine of the 48 surgeries, wires on the tip of the coblation handpiece experienced thinning to the point of discontinuity while removing a single tonsil. CONCLUSIONS: Coblation subcapsular tonsillectomy was less painful than electrocautery tonsillectomy in this 48-patient group. On average, intraoperative blood loss was less than 10 mL for both techniques. Postoperative hemorrhage rates and the degree of tonsillar fossa healing were similar between the two techniques. The coblation handpiece experienced degradation of vital wires in 18% of cases necessitating the use of a second, new handpiece.     

A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis.

OBJECTIVES: To compare postoperative recovery in children between 4 and 12 years undergoing tonsillectomy, using either coblation tonsillectomy or dissection tonsillectomy with bipolar diathermy haemostasis. DESIGN: A prospective, single blind, randomised controlled trial. SETTING: ENT clinic, University Teaching Hospital. PARTICIPANTS: Forty paediatric patients, aged between 4 and 12 years and between 16 and 60 kg in weight with standard indication for tonsillectomy. METHODS: Patients were randomly allocated to either coblation tonsillectomy or dissection tonsillectomy groups. Patients, parents, and nurses were blinded for operation method. Parents were asked to fill out a postoperative diary from 1 to 10 days. MAIN OUTCOME MEASURES: Primary outcomes were scored for postoperative pain, nutrition, activity, and use of analgetics for each of the 10 postoperative days. Secondary outcomes were estimated from the nurses' postoperative data and 10-day follow-up statistics regarding crossing of the two-score limit. RESULTS: The groups were statistically comparable by age, weight and operation type. There was no significant difference in operation time in two groups. Intra-operative bleeding was significantly less in the coblation group. Statistically significant differences between dissection tonsillectomy and coblation tonsillectomy were found in the day when a score of two of five was passed in pain scores (9.6 versus 6.2), nutrition scores (8.9 versus 6.6), activity score (8.4 versus 6.6) and medicine intake (9.4 versus 6.4), We found parallelism, between regression lines, that indicates better postoperative life quality for the coblation tonsillectomy group and approximately 2 days' shorter recovery time. CONCLUSION: In our pilot study, patients undergoing coblation tonsillectomy reported less pain, quicker return to normal diet, quicker return to normal activity, and less use of analgetics over a 10-day period than patients undergoing dissection tonsillectomy. Our results indicate that the recovery period for coblation tonsillectomy was approximately 2 days shorter and demonstrated less morbidity.     

甲泼尼龙对扁桃体等离子切除术后并发症的影响

目的　评估静脉输注甲泼尼龙对扁桃体等离子切除术后恢复及术后并发症的影响。方法　观察2015年12月～2016年12月份于我科行双扁桃体等离子切除术的83例患者,采用随机、双盲的原则将低龄、高龄两组观察对象分别分为实验组及对照组,实验组术后静点甲泼尼龙观察患者术后反应,如疼痛程度、活动量、咽部水肿、身体情况、白膜脱落时间、继发性出血等多项指标。结果  ①术后3～5天,甲泼尼龙可减轻低龄组疼痛感（Z =4.42,P =0.00）,增加患者活动量（Z =2.64,P =0.00）、减轻咽部水肿（Z =2.84、3.10,P 均=0.00）。②术后身体情况低龄实验组消化道不适发生率低于对照组（χ2=4.97,P =0.03）;高龄实验组消化道不适（χ2=5.24,P =0.02）、睡眠障碍（χ2=5.03,P =0.03）发生率均低于对照组。③白膜脱落情况在高龄实验组白膜脱落时间晚于对照组（t =2.16,P =0.04）。④继发性出血两组之间无明显差异（χ2=1.29,P =0.26）。结论　扁桃体等离子切除术后静点甲泼尼龙在缓解疼痛、消化道不适、减轻水肿及延迟白膜脱落方面有效。     

Nasal septum suture combined with inferior turbinate coblation after septoplasty: Does it improve quality of life and reduce complications?

ObjectiveNasal packing is routinely applied after septoplasty. Patients, however, report feeling very uncomfortable while the packing is in place. The aim of this study was to compare the effects of nasal septum suture combined with inferior turbinate coblation to the effects of nasal packing after septoplasty.MethodsIn this study, 135 patients undergoing septoplasty were divided into 3 groups: group 1 patients had microdebrider with packing, group 2 received coblation with packing and group 3 had coblation with suture. Early postoperative quality of life and complications were compared between the 3 groups.ResultsThe patients in group 1 experienced the most postoperative nasal pain, headache, dysphagia, sleep disturbance and bleeding on the night of surgery; while the patients in group 3 experienced the fewest symptoms. No difference in epiphora was observed between the 3 groups. More pain and bleeding were experienced when comparing the pack removal (Group 1 and 2) with the clearance of the nasal cavity (Group 3). We noted one case of postoperative bleeding in group 1, one septal hematoma in group 1 and a second septal hematoma in group 2. No such postoperative complications were found in group 3.ConclusionNasal septum suture combined with inferior turbinate coblation was not only associated with less pain, increased patient satisfaction and an improved quality of life; but also reduced postoperative complications. Our results confirm that it is a more comfortable, reliable alternative to the more common nasal packing.     

A double‐blinded randomized controlled trial of coblation versus conventional dissection tonsillectomy on post‐ operative symptoms

Objectives: The aim of this study was to compare postoperative symptoms following coblation tonsillectomy with those experienced following a traditional cold dissection. Design: A prospective randomized controlled trial. Setting: Secondary otorhinolaryngology care. Participants: Ninety‐two adult patients with recurrent tonsillitis meriting tonsillectomy were recruited and randomly allocated into either coblation or cold dissection tonsillectomy groups. Main outcome measures: Primary outcomes were post‐operative pain, otalgia, swallowing and analgesia use at 6–8 hours, 1, 3, 7 and 14 days post‐operative. Secondary outcomes were post‐operative day returned to eating and returned to normal activities/work. Results: No significant differences between the two groups (P ≥ 0.1) were found in any of the above primary outcomes, apart from swallowing at 6–8 hrs post‐operatively where the cold dissection group had less pain. This group also returned earlier to normal eating (P = 0.03). The power of the study was sufficient to show a difference in the visual analogue scores of 2 between groups. Conclusions: The use of coblation to perform tonsillectomy does not confer any symptomatic benefits to the patient over conventional cold dissection tonsillectomy.     

Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage

OBJECTIVES/HYPOTHESIS: Coblation tonsillectomy is a recently introduced surgical technique. To measure its benefits against traditional tonsillectomy techniques, it is necessary to compare their complication rates. The study aims to identify differences in reactionary and secondary hemorrhage proportions, comparing coblation with dissection tonsillectomy. STUDY DESIGN: Prospective observational cohort study. METHODS: Rates of reactionary and delayed postoperative hemorrhage were measured, comparing 844 coblation tonsillectomies with a control group of 743 tonsillectomies performed by blunt dissection with bipolar diathermy hemostasis. RESULTS: The secondary hemorrhage rate with coblation-assisted tonsillectomy was 2.25% compared with 6.19% in the control group (P <.05). The rate of secondary hemorrhage in children following coblation tonsillectomy was 0.95% compared with 4.77% in the control group (P <.05). The difference was also significant (P <.05) in the adult population (4.40% vs. 8.81%, respectively). No difference was found in the reactionary hemorrhage proportions. CONCLUSION: In the study, coblation tonsillectomy was associated with a lesser incidence of delayed hemorrhage, more significantly in the pediatric population. The new technique using tissue coblation for tonsil dissection offers significant advantages in the postoperative period compared with dissection tonsillectomy with bipolar diathermy hemostasis. Coblation is associated with less postoperative pain and early return to daily activities. Also, there are fewer secondary infections of the tonsil bed and significantly lower rates of secondary hemorrhage with coblation. These results and the disposable nature of the coblation equipment promote coblation tonsillectomy as the authors' preferred dissection method.     

儿童扁桃体腺样体低温等离子手术迟发性出血的初步研究

目的 比较低温等离子手术与常规手术方式在儿童扁桃体、腺样体手术后迟发性出血(手术24 h后)率及出血时间点的情况,初步探讨导致低温等离子手术迟发性出血的可能原因.方法 回顾性分析的方法研究采用传统手术和低温等离子手术行扁桃体切除和(或)腺样体刮除术1～14岁患儿术后迟发性出血率及出血时间点的差异.传统组为2005年4月至2006年7月行传统冷法手术(即传统手术刀切除,对周围组织没有热损伤的方法)的患儿,等离子组为2008年4月至2009年9月行低温等离子扁桃体切除和(或)腺样体消融术的患儿.结果 传统组患儿484例,术后迟发性出血2例,迟发性出血率为0.4%,出血时间点1例为术后2 d,另1例为术后3 d.等离子组患儿502例,术后迟发性出血11例,迟发性出血率为2.2%,出血时间点2～12 d,中位数为6.0 d.其中等离子刀初学者主刀手术的迟发性出血率为2.6%(10/385),技术操作熟练者手术的迟发性出血率为0.9%(1/117).等离子组迟发性出血率高于传统组(χ2=5.987,P=0.014),两组出血时间点差异无统计学意义(Mann-Whitney检验U=2.500,P=0.103).13例出血患儿中创面局部或上呼吸道感染者6例,术后进食不当的3例.结论 低温等离子技术应用于儿童扁桃体腺样体手术后迟发性出血的原因可能与手术技能经验不足、止血稳定性欠佳等有关,术后感染和进食不当也会造成迟发性出血,应引起临床重视.     

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。     

成年人扁桃体切除术三种手术方式的临床比较

目的 比较分析成年人3种扁桃体切除术的临床应用价值。 方法 将90例行扁桃体切除术的患者分为等离子扁桃体切除术组(等离子组)、电刀扁桃体切除术组(电刀组)、常规扁桃体剥离术组(剥离组),各30例,记录各组手术时间、术中及术后出血量、术后咽痛程度、住院医疗费用等。 结果 3组手术时间、术中出血量、术后1~4 d咽痛视觉模拟量表(VAS)评分比较差异有统计学意义(P<0.001),其中等离子组和电刀组手术时间、术中出血量及VAS评分明显少于剥离组(P<0.001),而等离子组与电刀组之间差异无统计学意义(P>0.05)。剥离组术后见原发性出血1例,等离子组及电刀组未见术后出血发生。3组护理及检疗费、术后用药费比较差异无统计学意义(P>0.05);电刀组及剥离组住院总费用明显低于等离子组(P<0.001),而电刀组与剥离组比较差异无统计学意义(P>0.05)。 结论 成年人扁桃体切除术各有优势及不足,临床应根据疾病特点、患者意愿和经济能力、手术者技术水平以及医疗器械等因素选择最恰当的,从而达到最佳治疗效果。