低温等离子射频消融术行成人扁桃体切除的疗效观察

目的对比研究低温等离子射频消融术切除成人扁桃体的临床疗效和安全性。方法选择该院2013年6月至2016年8月收治的行双侧扁桃体切除术的60例成人患者为研究对象。将其列为观察组33例和对照组27例。对照组患者行传统双扁桃体剥离切除术治疗。观察组采用双扁桃体低温等离子射频消融切除术治疗。比较两组患者手术时间、术中出血量、疼痛消退时间,及术后并发症发生情况,并随诊六个月评价疗效。结果观察组患者在术中出血量、手术时间、疼痛消退时间及术后并发症的发生率均低于对照组,差异均有统计学意义(P0.05)。结论低温等离子射频消融术切除成人扁桃体具有手术时间短、术中出血量少、疼痛消退快、安全高效等优点,比传统手术有优势。     

低温等离子刀扁桃体切除术与传统扁桃体剥离术疗效观察及对炎性因子水平的影响

目的探讨低温等离子刀扁桃体切除术与传统扁桃体剥离术的疗效及对炎性因子水平的影响。方法分析2017年2月到2017年8月80例在我院接受扁桃体剥离术患者的临床资料,按照手术方法的不同分为两组,观察组(低温等离子刀剥离术组)40例,对照组(传统扁桃体剥离术)40例,比较两组患者术后临床指标、并发症发生情况及手术前后血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及超敏C-反应蛋白(hs-CRP)水平。结果观察组患者手术时间、出血量、住院时间、恢复正常饮食时间、术后VAS评分、平均疼痛时间明显低于对照组,观察组患者伪膜脱落时间长于对照组,差异均具有统计学意义(P0.05);观察组患者术后并发症发生率明显低于对照组,差异具有统计学意义(4/40,10%vs 14/40,35%;χ2=7.168,P=0.007);观察组患者术后IL-6、TNF-α及hs-CRP水平明显低于对照组,差异均具有统计学差异(P0.05)。结论与传统扁桃体切除术相比,低温等离子刀扁桃体切除术可以明显减少手术时间、术中出血量,减轻术后疼痛感及炎症反应,有助于患者术后恢复,具有较好的推广价值。     

扁桃体术后味觉障碍的原因分析

目的　探讨扁桃体术后患者味觉障碍的危险因素。方法　回顾性分析2016年5月～2019年7月宁波大学附属人民医院行扁桃体切除术患者318例,其中男性163例,女性155例,年龄12～75岁。结果　60岁以下患者味觉障碍的发生率为12.2%,显著高于60岁以上味觉障碍发生率1.8%,差异有统计学意义（χ2=5.238,P＜0.05）。33例（10.4%）在扁桃体切除术后3个月出现味觉障碍,术后6个月后仍有7例（2.2%）患者存在味觉障碍。味觉障碍阳性组和阴性组之间年龄、手术时间、血红蛋白、手术适应证及微量元素含量比较均无统计学意义（P 均＜0.05）。结论　女性和60岁以下的患者在扁桃体切除术后出现味觉障碍比率较高,建议术前告知患者可能出现的味觉障碍并发症的风险。     

日间扁桃体腺样体切除术可行性探讨

目的 比较日间手术模式下与住院手术模式下扁桃体腺样体切除术后并发症的发生率，探讨日间手术模式下行扁桃体腺样体切除术的安全性及可行性。方法 将395例接受扁桃体腺样体切除术的患者分为日间手术组与住院手术组两组，采取相同麻醉方式与手术方式，比较两组患者术后出血率与术后发热率的差异。结果 日间手术组术后出血率及术后发热率高于住院手术组，但差异无统计学意义。结论 日间手术模式行扁桃体腺样体切除术不会明显增加患者术后出血及术后发热风险，选择病例行日间扁桃体腺样体切除术是可行的。     

手术结束前升高血压对减少低温等离子扁桃体切除术后出血的疗效观察

目的　比较手术结束前升高血压检查扁桃体术腔与常规检查扁桃体术腔两种方法对扁桃体切除术后出血的影响。方法　对我院2008年1月～2016年1月行全麻下低温 等离子扁桃体切除术的患者1069例,采用回顾性临床病例对照研究方法,分为手术结束前升高血压检查扁桃体术腔组546例（治疗组）与常规检查扁桃体术腔组523例（对照组）,比较两组的术后出血发生率、术后出血量等。结果　治疗组原发性出血6例,发生率1.10%,继发性出血9例,发生率1.65%。对照组原发性出血17例,发生率3.25%,继发性出血5例,发生率0.96%。扁桃体切除后手术结束前升高血压检查扁桃体术腔,可减低术后原发性出血概率,而与术后继发性出血无明显相关。结论　手术结束前升高血压检查扁桃体术腔能有效减少低温等离子扁桃体切除术后原发性出血发生概率。     

电凝法扁桃体切除术180例

目的 探讨电凝法扁桃体切除术的可行性。方法 对180例接受电凝法扁桃体切除术（A法）、35例接受低温等离子射频扁桃体切除术（B法）的患者资料进行回顾性研究。结果 所有患者手术顺利完成,术中出血量实施A法组约5～50mL,平均10mL; B法组约5～200mL,平均为50mL。1例B法组的患者出现术后扁桃体窝出血,两组均没有出现术后扁桃体窝感染或咽旁间隙感染患者。结论 电凝法扁桃体切除术术中出血较少,可使手术更易完成。术后出血机会减少,不会增加术后并发症的发生。     

日间手术模式开展儿童扁桃体腺样体切除术的可行性分析

目的探讨日间手术模式开展儿童扁桃体腺样体切除术的可行性及安全性。方法回顾性分析2018年7月~2020年12月我院开展的扁桃体腺样体切除术病例,其中日间手术2172例,常规住院手术6175例。比较两组的手术时间、住院天数,住院总费用、术后疼痛及术后并发症发生率等情况。结果日间手术组的手术时间,住院时间和住院费用明显低于常规住院组,差异有统计学意义;术后疼痛及术后并发症发生率二组相似,差异无统计学意义。结论日间手术模式开展儿童扁桃体腺样体切除术,可以明显缩短住院时间、减少住院费用,不增加术后疼痛程度及术后并发症的发生率。在做好术前患儿评估,充分做好家长围手术期的指导宣教,日间手术模式开展儿童扁桃体腺样体切除术是安全、可行的。     

扁桃体切除术后出血的分类

扁桃体切除术在世界范围内均是耳鼻咽喉科最多的手术 ,术后出血为最常见的并发症 ,可危及生命 ,尽管各种努力 ,术后出血似乎不可避免且发生率较高。据文献记载 ,扁桃体切除术后出血主要按时间进行分类 ,较为公认的分类为原发性和继发性出血 ,前者为 2 4小时以内出血 ,后者发生于 2 4小时以后。基于目前尚无合理的方法对扁桃体切除术的出血程度加以分类 ,该作者回顾 1999年来行扁桃体切除术的 6 0 2例病人 ,提出一种全新的分类方法 ,并与记载的分类加以比较。术后出血 38例发生率为 3.8%。按出血的程度分为 5度 ,1度为术后出血可自止 ,冰敷治…     

儿童扁桃体切除术后早期的并发症:门诊手术的含义

腺样体扁桃体切除术和扁桃体切除术是最常见的外科手术之一 ,此类手术在英国绝大多数是为住院手术 ,相反 ,在美国和加拿大等国则常在门诊进行。该文回顾性分析门诊扁桃体切除术后早期反应性出血、发热和呕吐的发生率 ,并讨论其对门诊手术的含义。总共52 1例患儿参与本研究 ,其中男 2 59例 ,女 2 6 2例。 392例接受扁桃体切除术 (2 4 2例伴腺样体切除术 ) ;12 9例仅接受腺样体切除术。年龄 13个月～ 16岁 (平均 7.3岁 )。手术均在全麻下以常规方法进行 ,术后观察体温、脉搏、呕吐、所用的止痛剂和出血情况。出血又分为轻微 (不需处理 )和严重…     

过敏性紫癜患者行扁桃体手术的围手术期处理

目的 :探讨过敏性紫癜患者行扁桃体切除术的围手术期处理方法。方法 :7例手术均选择在过敏性紫癜的缓解期、扁桃体的急性炎症控制后 3～ 4周进行 ,口服抗组胺药及降低血管渗透性药物。术前、术后常规抗炎治疗。结果 :7例患者经正确的处理 ,术中、术后均无明显出血 ,痊愈出院。结论 :在过敏性紫癜的缓解期、扁桃体的急性炎症控制后进行手术 ,避免各种可疑的诱因 ,围手术期给予口服抗组胺药、抗炎及降低血管渗透性药物 ,可有效防止术中、术后出血     

Tonsillectomy under local anesthesia: a safe and effective alternative

Tonsillectomy using local anesthesia (local tonsillectomy) is a safe and effective alternative to general anesthesia in the healthy cooperative teenage or adult patient. This retrospective analysis involved 64 local tonsillectomies performed over the past 7 years in a minor operating room using only local anesthesia with intravenous sedation. Operations were performed by residents in training as well as by experienced head and neck surgeons. Blood loss, morbidity, complications, and patient satisfaction were reviewed and compared with tonsillectomies done under general anesthesia. The average blood loss was 42 mL in the local tonsillectomy group with no cases of postoperative hemorrhage, compared with 198 mL in the general anesthesia group with two cases of postoperative hemorrhage. There was one major complication related to postoperative antibiotic use in the local anesthesia group, and follow-up interviews revealed that patients were satisfied with the procedure and would recommend and choose local anesthesia again. We conclude that local tonsillectomies have high patient acceptance and are associated with minimal morbidity and complications. Furthermore, they are cost-effective.     

Immediate tonsillectomy for peritonsillar abscess.

OBJECTIVE: Peritonsillar abscess (PTA) is one of the most common infectious diseases of the head and neck region requiring surgical intervention to relieve symptoms such as severe throat pain, fever, dysphagia, and trismus. However, the appropriate management of PTA is still controversial. In Europe and the US, immediate tonsillectomy under general anesthesia has been accepted as the treatment for PTA. But in Japan, immediate tonsillectomy has been regarded as contraindicated for PTA because of difficulties encountered in the operation during the acute stage, as well as possible postoperative complications. METHODS: A total of 103 cases of PTA treated at our clinic during the past 16 years were reviewed; immediate tonsillectomies had been performed in 99 of them. Surgical findings, postoperative course, and bacteriological examination were surveyed. RESULTS: The results showed that immediate tonsillectomy under general anesthesia was carried out safely without complications. Dramatic relief of the symptoms was obtained within a few days following each operation. A high incidence of anaerobes was observed by bacteriological examination, suggesting that sufficient drainage is required to treat this disease. CONCLUSION: We conclude that immediate tonsillectomy should be performed for peritonsillar abscess.     

Tonsil cryptolysis usingCO2 Swiftlase

Treatment for inflammation of the tonsils has taken a variety of therapeutic forms over the years, ranging from the application of iodine and massage in the preantibiotic era to the tonsillectomy, which prevails today. The architecture of the cryptic tonsil, its clinical implications, and the rationale for a conservative, yet effective treatment modality focusing on the tonsillar crypts are addressed in this article. Also described are the procedures and results of a retrospective clinical study in which conventional tonsillectomy was compared with CO₂ SwiftLase cryptolysis. Although our observations are not based on a prospective, controlled study, the information disseminated here may be useful to otolaryngologists who routinely perform tonsillectomy in their practice, using conventional surgical dissection methods or the CO₂ laser. According to our experience with a population of 120 patients, cryptolysis offers some clear advantages, particularly when performed with the SwiftLase apparatus. The procedure can be performed safely in an ambulatory surgery or office setting under local anesthesia. The cooperative patient avoids the cost and risks of general anesthesia. Limited tissue destruction significantly reduces operative and postoperative complications, discomfort, and recovery time. To conclude, CO₂ SwiftLase cryptolysis is a safe and cost-effective method of treating tonsil pathology without unnecessary sacrifice of the organ, and undue risks and expenses to the patient.^11,12     

A prospective study on pros and cons of electrodissection tonsillectomy

OBJECTIVE: Hemorrhages are main complications after tonsillectomy, whatever technique is used. This prospective study aimed at revealing pros and cons associated with monopolar electrodissection tonsillectomy. STUDY DESIGN: A prospective study. METHODS: A prospective study on all patients undergoing tonsillectomy or adenotonsillectomy in Central Hospital of Central Finland in 1997. Operation time and bleeding, as well as perioperative and postoperative complications, were recorded. RESULTS: Inpatient tonsillectomy was performed in 440 patients (mean age, 17.9 y). Primary post-tonsillectomy hemorrhage (within 24 h) occurred in 2.3%. A total of 15.9% of patients searched for medical help because of secondary post-tonsillectomy hemorrhage, 7.7% receiving active treatment and 8.2% not. Post-tonsillectomy hemorrhages proved to be most common in older patients and when peritonsillar abscess was in patient history. CONCLUSIONS: Monopolar electrodissection tonsillectomy was fast and resulted in little intraoperative bleeding. However, postoperative hemorrhages were common, and the mean use of analgesics was for more than 10 days. Preoperative counseling must be thorough and realistic. Our results indicate that better methods for tonsillectomy still need to be developed.     

Radiofrequency treatment for obstructive tonsillar hypertrophy

OBJECTIVE: To evaluate the safety and efficacy of in-office, temperature-controlled radiofrequency submucosal tissue volume reduction using the Somnoplasty procedure for the treatment of symptomatic chronic obstructive tonsillar hypertrophy. DESIGN: A prospective, nonrandomized, 3-phase protocol using in vitro and in vivo studies associated with operative tonsillectomy and clinical procedures performed in-office. SETTING: Hospital operating room and private practice otolaryngology office. STUDY POPULATION: In vitro studies of 14 tonsil specimens following tonsillectomy; in vivo studies of 11 tonsils before tonsillectomy; and clinical procedures performed on 9 adults, ages 24 to 47 years, with symptomatic chronic tonsillar hypertrophy. OUTCOME MEASURES: For phase 1, histologic tissue sections; for phase 2, histologic tissue sections and clinician and patient questionnaires regarding procedure morbidity; and for phase 3, measurements of oropharyngeal airway size and clinician and patient questionnaires regarding procedure morbidity and symptom improvement. RESULTS: A 2-needle radiofrequency probe ablated tonsil stromal tissue while leaving overlying mucosa and underlying structures intact. On average, oropharyngeal airway was enlarged 12 mm, with a 70.8% calculated reduction in tonsil size. Procedures were well tolerated and had only minimal pain and dysphagia. There were no episodes of hemorrhage, and patients resumed normal activity within 1 to 2 days. Substantial improvement was reported in daytime sleepiness, snoring, voice clarity, swallowing, and throat irritation. CONCLUSIONS: Temperature-controlled radiofrequency submucosal tissue volume reduction is a safe and effective method of treating symptomatic obstructive tonsillar hypertrophy. It is well tolerated by the patient under local anesthesia in the physician's office and has minimal postprocedure pain and dysphagia, with rapid return to normal activity. The procedure reduces tonsil size and increases airway size, leading to a reduction in symptoms.     

Efficacy of tonsillectomy and adenoidectomy as an outpatient procedure: a preliminary report

One of the recent trends in medical practice has been the use of ambulatory surgery for a substantial number of surgical procedures. A prospective evaluation of tonsillectomy and tonsillectomy with adenoidectomy as outpatient procedures at the Children's Hospital Medical Center in Cincinnati, OH, is reported. Patients who were felt to be inappropriate candidates for adenotonsillectomies as outpatients included patients under 3 years of age, patients who lived more than one hour from the hospital and patients who demonstrated obstructive sleep apnea or who had other significant medical problems. A review of this 9-month experience indicates that outpatient surgery for adenotonsillectomy is both safe and cost-effective in most circumstances. In an analysis of complications requiring readmission to the hospital (bleeding, dehydration, poor social situation), patients who had their original surgery performed on an ambulatory basis had no more complications than patients who were hospitalized following their surgery. Excluding the professional fees for the surgeon and anesthesiologist, a savings of approximately 50% can be expected from the performance of a tonsillectomy and adenoidectomy on an outpatient basis.     

Does topical lidocaine with adrenaline have an effect on morbidity in pediatric tonsillectomy?

OBJECTIVE: To evaluate the efficacy of lidocaine with adrenaline on post-operative morbidity in pediatric patients after tonsillectomy. STUDY DESIGN: A double blind prospective randomized controlled clinical study. METHODS: The study is consisting of two groups of pediatric patients following tonsillectomy performed in a university hospital. One group received lidocaine with adrenaline soaked swabs packed in their tonsillar fossae while the control group received saline-soaked swabs. Chi-square and two-tailed unpaired Student's t-tests were used to compare the two independent groups. p<0.05 was accepted as statistically significant. RESULTS: No significant pain-relieving effect was seen in the lidocaine with adrenaline group (p>0.05) and also the other post-operative parameters such as nausea, fever, vomiting, odor, bleeding, otalgia and trismus were not statistically different between the two groups based on chi-square analysis (p>0.05). There were no complications associated with lidocaine and adrenaline. CONCLUSION: We suggest that application of topical lidocaine with adrenaline seems to be a safe and easy medication for local anesthetic use. However, in our study, lidocaine with adrenaline offered no advantage over placebo in the control of post-operative pain and other morbidity related factors following pediatric tonsillectomy. We therefore do not recommend topical application of lidocaine with adrenaline for reducing morbidity in pediatric tonsil surgery.     

Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults: a pilot study

OBJECTIVES: To assess the morbidity and efficacy of bipolar radiofrequency thermal ablation tonsillectomy and compare it with traditional cold dissection tonsillectomy with diathermy hemostasis. DESIGN: Prospective, randomized, single-blinded, controlled clinical study. SETTING: Helsinki University Central Hospital, Department of Otorhinolaryngology-Head & Neck Surgery, Helsinki, Finland. PATIENTS: Forty healthy volunteer patients aged 18 to 65 years admitted for elective tonsillectomy with recurrent or chronic tonsillitis, obstructive tonsillar hypertrophy, or history of quinsy. Two patients were excluded from the study and 1 patient cancelled the operation. INTERVENTIONS: Nineteen patients underwent a traditional cold dissection tonsillectomy with diathermy hemostasis, and 18 patients underwent a bipolar radiofrequency thermal ablation tonsillectomy. There was no intergroup difference in age, sex, weight, and indications for tonsillectomy. The subjects were not informed of the type of procedure until the telephone interview 3 weeks after the operation. MAIN OUTCOME MEASURES: Operating time and intraoperative blood loss; need for anesthetics during the operation; different recovery indicators in the recovery room (ie, duration and medications administered), surgical ward (ie, medications administered, use of corticosteroids, general condition, and status of the uvula on the first postoperative day), and in the 2 weeks following surgery (ie, visual analog scale scores on 6 symptoms, medications needed, the day patients returned to work, use of antibiotics, and retreatment acceptance); and complications and certain laboratory parameters. RESULTS: There was a statistically significant but clinically insignificant difference in operating time and intraoperative blood loss in favor of the traditional tonsillectomy group. The other outcome measures showed no statistically significant differences. CONCLUSION: Bipolar radiofrequency thermal ablation and traditional tonsillectomy were associated with similar postoperative morbidity.     

Laser tonsil cryptolysis: In-office 500 cases review

Objectives

Tonsilloliths, proven to be tonsillar biofilms cause symptoms of halitosis, foreign body sensation and recurrent sore throats. Laser Tonsil Cryptolysis (LTC) performed in the office may represent an alternative to tonsillectomy in selected cases of persistent tonsilloliths with cryptic infections.

Study Design

A retrospective chart analysis using CPT codes.

Setting

Office and hospital.

Methods

A retrospective complications review consisting of bleeding, the need for an additional procedure, patient satisfaction and conversion rate to complete tonsillectomy was documented.

Results

Five hundred consecutive LTCs performed in the office under local anesthesia with a CO2 or diode laser were identified. Energy delivery was in continuous mode with power settings of 18W and 10W respectively. Bleeding occurred in 6 patients requiring unscheduled return office visit for evaluation. Eighty patients required a second procedure, comprising total of 1.16 procedures per patient. Eighteen (3.6%) patients underwent complete tonsillectomy. Patient satisfaction was high with an overall incidence of 0–2 days of work absence. Follow-up was 1–8 years.

Conclusions

With a small tonsil size, controllable gag reflex and cooperative adult patient LTC allows several advantages compared to conventional tonsillectomy. Benefits of LTC include avoidance of general anesthesia and limited ablation of cryptic pockets, resulting in reduced post-operative pain, bleeding, shorter recovery time and the convenience and cost advantage of an office procedure. With 1.16 sessions required per patient, low conversion rate to standard tonsillectomy and minimal complication rate LTC can be considered an alternative option to a patient suffering from recurrent cryptic tonsillitis with or without tonsilloliths.     

Safety of cold ablation (coblation) in the treatment of tonsillar hypertrophy of the tongue base

The treatment of diseases of the lingual tonsils is still under debate, and surgical interventions are often associated with significant morbidity and complications. The aim of the present study was to evaluate the safety of lingual tonsillectomy using cold ablation (coblation) as a new treatment of lingual tonsil diseases. In this retrospective, bicentric study, we included all patients between 2005 and 2012 who underwent cold ablation (Coblation^®) of the lingual tonsils. We assessed the frequency of postoperative complications based on the patients’ charts. A total of 108 patients (47 ± 13, 6 years) underwent lingual tonsillectomy using coblation. All patients were operated on under general anesthesia as inpatients. Intraoperative complications did not occur. Three patients (2.8 %) needed revision surgery due to postoperative hemorrhage, and in one of those cases, three revisions were necessary. There was no postoperative airway compromise and no need for tracheostomy. There was no hypoglossal nerve paralysis, but in the case needing multiple revisions, a weakness of the hypoglossal nerve persisted. In all the cases, oral intake was possible with adequate analgesia. Coblation of the tongue base is a safe procedure with a relatively low rate of postoperative complications. Postoperative hemorrhage is the most relevant complication that occurred in our series of patients. Future studies are needed to evaluate the efficacy of the procedure in the treatment of obstructive sleep apnea.