单极电刀扁桃体切除术的临床应用

近年来,随着科学技术的发展,激光、低温等离子射频、超声刀等方法被应用于扁桃体切除术,在控制术中出血,缩短手术时间方面显示出一定的优势,但也各有其优缺点,而单极电刀行扁桃体切除术在临床上报道并不多。为了进一步探讨单极电刀行扁桃体切除术的临床应用价值,我科自2008年3月～2009年1月对66例行扁桃体切除术患者随机进行了传统剥离法和单极电刀法行扁桃体切除术,并就两种手术方法术中出血量、手术时间、术后伪膜生长、术区疼痛反应等进行了对照观察,现报道如下。     

缝扎法在儿童扁桃体切除术中的应用

儿童扁桃体切除术后出血一直是耳鼻咽喉科临床棘手问题之一,无论是原发性或继发性出血在临床实践中都存在较大困难,如何预防术后出血是儿童扁桃体手术的关键。     

超声刀在扁桃体肿瘤切除术中的应用体会

目的 探讨超声刀在扁桃体肿瘤切除术中的应用体会.方法 选择70例成人单侧扁桃体形态异常考虑肿瘤的患者,随机分为超声刀组(35例)和电刀组(35例),记录患者的一般情况、手术时间、术中出血、术后咽痛及并发症等情况,将两组患者的资料进行比较.结果 两组患者男性居多,扁桃体以肥大或增生多见,且多为Ⅱ°大小.两组患者术后病理均...     

双极电凝器在扁桃体切除术中的应用

20 0 0年 6月～ 2 0 0 2年 7月 ,我科在 2 1 8例扁桃体切除术中应用双极电凝器 (上海沪通电子有限公司ＧＤ3 5 0 Ｓ3型 )止血 ,取得了良好效果。报告如下。1　资料与方法1 .1 　 临床资料2 0 0 0年 6月～ 2 0 0 2年 7月行扁桃体切除术2 1 8例 (电凝组 ) ,男 1 2 2例 ,女 96例 ;年龄 5～ 5 2岁。病程 3个月～ 1 0年。局部麻醉 1 41例 ,全身麻醉 77例。1 998年 5月～ 2 0 0 0年 5月行扁桃体切除术1 93例 (对照组 ) ,男 1 0 3例 ,女 90例 ;年龄 6～ 5 5岁。病程 4个月～ 1 6年。局部麻醉 1 2 4例 ,全身麻醉 6 9例。1 .2 　 手术方法两组病例术…     

扁桃体手术后应用“好得快气雾剂”止血,止痛效果的临床观察

扁桃体切除术伤口出血和疼痛在临床上非常多见,如何尽快早止痛、止血并促进伤口愈合,使病人早日恢复健康,医者责无旁贷。本文就此独辟溪径,用“好得快气雾剂”进行局部喷雾治疗,取得显著效果,特报告如下。     

冷、热止血法与扁桃体切除术后疼痛关系的比较研究

目的观察电凝器喷凝止血法（热止血法）和压迫缝扎止血法（冷止血法）与扁桃体切除术后疼痛的相关性。方法行扁桃体摘除术的慢性扁桃体炎患者100例，分为2组，术中分别采用冷止血法和热止血法进行创面止血。分别记录术中出血量，术后每天观察进食情况以记录正常进食时间；采用McGill疼痛量表法，于术后第3天进行疼痛评分并作组问比较分析。结果热止血法组病例的术中平均出血量及术后进食时间分别为10．26±0．69ml和H2．52±0．42d，而冷止血法组病例则分别为12．52±0．45ml及2．12±0．63d（P〈0．05）；比较术后疼痛持续时间，热止血法组病例有3个指标明显大于冷止血法组，仅1个指标明显短于后者（均P〈0．05），其余指标组间差异无统计学意义（P〉0．05）。结论热止血法手术操作较安全，术中出血量较少，但术后疼痛较明显。因而，应根据患者术中的具体情况灵活选择止血方法。     

等离子扁桃体切除术与单极电刀扁桃体切除术的Meta分析

目的通过Meta分析的方法对等离子与单极电刀扁桃体切除术的效率、疗效及安全性进行比较,为临床治疗选择提供依据。方法电子检索Pubmed、Embase、Cochrane Library、维普、清华同方、万方、中国生物医学等数据库,获取等离子扁桃体切除术与单极电刀扁桃体切除术前瞻性随机对照研究的相关资料。用RevMan5．2统计软件对两种术式的术后出血、术后疼痛、手术时间、术中出血、术后恢复等指标进行分析比较,并进行系统评价及Meta分析。结果共有10篇文献（合计病例716例）纳入本研究。合并统计结果表明,两种术式的术后出血率[OR=1．02,95％C1（0．51,2．03）]、术后疼痛[SMD=-0．55,95％CI（-1．19,0．08）]、手术时间[SMD=0．60,95％C1（-0．08,1．28）]及术中出血量[SMD=0．34,95％c,（-0．02,0．69）]比较,差异均无统计学意义。术后活动恢复两者相当,等离子组患者能更快恢复正常饮食。结论相对单极电刀扁桃体切除术,等离子扁桃体切除术后饮食恢复较快;在术后出血、术后疼痛、手术时间、术中出血及术后活动恢复等方面无显著优势。     

剥离法与挤切法结合在成人扁桃体切除术中的应用

目的 探讨剥离法与挤切法相结合实施成人扁桃体手术临床效果。方法 慢性扁桃体炎成人患者238例,130例采用剥离与挤切相结合(治疗组)的手术方法,108例采用传统的剥离法(对照组)。结果 治疗组手术时间较对照组短,术中出血量较对照组少,差异有统计学意义(P＜0.01);治疗组无原发性出血病例,对照组2例原发性出血病例;两组均无继发性出血病例。结论 采用剥离与挤切相结合的方法切除成人扁桃体,简便易行,术中出血少,术时短,痛苦小。     

低温等离子联合血管缝扎在扁桃体切除中的临床应用

扁桃体切除术是耳鼻咽喉科常见手术之一,切除方法多种,但“作易精难”[1],存在术后出血多,术后疼痛剧烈及伤口愈合差等诸多并发症。因此临床上一直在探讨一种术式能够减轻患者的疼痛,减少术中及术后出血,使创面尽早恢复。低温等离子技术是近几年发展的一项新技术,已广泛应用于扁桃体的切除,与传统的手术方法相比,低温等离子射频消融术具有微创、出血少、疼痛程度低、康复周期短等优点[2],但国内文献报告扁桃体术后出血发生率仍为2%～8%,因此借助低温等离子技术,寻求一种既微创又可以减少并发症的术式值得临床探讨。本文回顾性分析比较采用低温等离子联合血管缝扎切除扁桃体与单纯低温等离子切除扁桃体病例,观察患儿术后出血情况,以期为临床选择更优化的手术方式提供依据。     

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。     

人凝血酶对扁桃体手术创面止血的安全性和有效性研究

目的:评价人凝血酶对扁桃体手术创面的止血作用和安全性。方法:采用前瞻、随机、对照的方法,80例行双侧扁桃体摘除手术的患者随机分为研究组和对照组,在研究组自身对照观察有效性,即右侧创面局部给予人,左侧0.9%氯化钠溶液,对比观察创面出血的止血时间、出血量和单位面积出血量。对照组和研究组间比较观察凝血相和肝肾功能等安全性指标。结果:使用人凝血酶创面止血时间为(62.8±24.6)s,创面出血量(4.9±6.7)g,创面单位面积出血量(0.79±0.98)g.cm-2;明显低于使用生理盐水创面的(94.7±36.9)s,(7.3±13.4)g,(1.14±1.95)g.cm-2;两者比较均差异有统计学意义。研究期间,所有患者未出现任何局部或全身不良事件;凝血指标和肝肾等主要脏器功能的变化也不明显,且2组结果相似。10例研究组患者观察HBsAg、抗HCV、HIV抗体和梅毒抗体等指标3个月无异常。结论:人凝血酶对扁桃腺手术创面毛细血管出血有较好的止血作用和安全性。     

Efficacy of pillar suture for post-tonsillectomy morbidity in children: a meta-analysis

IntroductionSeveral surgical techniques have been used during tonsillectomy to reduce complications.ObjectivesTo assess the effects of pillar suture in conjunction with tonsillectomy as compared to tonsillectomy without suture in children.MethodsTwo authors independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2018. Of the included studies, we compared tonsillectomy and pillar suture in combination (suture groups) with tonsillectomy alone,without suture, (control group). Postoperative pain intensity and other morbidities (e.g., postoperative bleeding, palatal hematoma, discomfort, and pillar edema) were measured during the postoperative period.ResultsPostoperative bleeding [primary (OR = 0.47 [0.27; 0.81]) and secondary (OR = 0.14 [0.02; 0.78]) were significantly decreased in the pillar suture group compared to the control group. There were no significant differences between the two groups in postoperative pain at day 7 (SMD = −0.39 [−0.79; 0.00]), palatal hematoma (OR = 5.00 [0.22; 112.88]), palatal discomfort sensation (OR = 2.62 [0.60; 11.46]), site infection (OR = 5.27 [0.24; 113.35]), and velopharyngeal insufficiency (OR = 2.82 [0.11; 74.51]). By contrast, pillar edema (OR = 9.55 [4.29; 21.29]) was significantly increased in the pillar suture group compared to the control group.ConclusionsPillar suture combined with tonsillectomy may reduce postoperative bleeding incidence despite increasing pillar edema in pediatric tonsillectomy. Postoperative pain-relief, palatal hematoma, palatal discomfort sensation, site infection, and velopharyngeal insufficiency were not significantly altered compared to tonsillectomy alone. However, further studies are needed to corroborate the results of this study.     

The effect of tonsillectomy on neutrophil chemotaxis in adults with chronic tonsillitis

Neutrophil random motility and chemotactic responsiveness were determined in 17 healthy adults and 19 adult patients with chronic tonsillitis before and 10 days after tonsillectomy, using a modified Boyden chamber method. The mean chemotactic index values of the healthy controls were significantly higher when compared with the chronic tonsillitis patients before tonsillectomy. The postoperative mean chemotactic values were increased, and there was a statistically significant difference between the mean chemotactic index of neutrophils in preoperative and postoperative patients. The authors conclude that this change in host defense mechanism may be the reason for frequent attacks of acute tonsillitis in these patients.     

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。     

Histological study of routine tonsillectomy specimen

Introduction  Palatine and nasopharyngeal tonsils are lymphatic flesh clusters of tissue of the respiratory and digestive tract’s epithelium. There is not much literature pertaining to the histological assessment of resected tonsils though anecdotal case reports of choristoma, squamous cell cysts of the tonsil have been reported which mimicked chronic tonsillitis. Tonsils also are an important site for head and neck cancer in adults. Aim & objective  To study the histological features of routine tonsillectomy specimens and to study for the presence of choristomatic tissue or any other benign pathology as a cause of chronic tonsillitis. Patients & methods  Fifty consecutive tonsillectomy specimens, which were received in the department of Pathology, Gandhi Medical College, were evaluated with regards to clinical information. Among 50 patients, a slight predominance of men (56 %) over women (44 %) was observed. Conclusion  The mesenchymal tissue consisted mainly of epithelium and lymphoid tissue with cartilage in a single case and fat in three cases. The role of imaging techniques, in assessing the need for early surgical intervention in cases with chronic tonsillitis, can be determined by assessing the micropathology of tonsillectomy specimens and is an arena for further research. We discussed the role of FDG-PET scan in the assessment of the same.     

双极电凝镊在扁桃体摘除术中的应用

目的：通过比较采用双极电凝镊与传统的剥离法实施扁桃体摘除的手术效果,探讨双极电凝镊在扁桃体摘除术中的应用效果。方法：选取行扁桃体手术摘除的患者100例,前瞻性地分为两组,比较手术时间、术中出血量及术后患者并发症、疼痛程度及恢复时间。结果：用双极电凝镊行扁桃体摘除与普通法扁桃体摘除相比,手术时间短,术中出血少,术后并发症发生率低,患者痛苦轻。结论：采用双极电凝镊扁桃体摘除手术效果明显优于普通剥离法扁桃体摘除,两方法术后恢复时间无统计学差别。     

Bipolar electrodissection tonsillectomy in children

The purpose of this study was to compare bipolar electrodissection tonsillectomy with traditional cold dissection tonsillectomy in the pediatric population. Forty children with recurrent tonsillitis and/or obstructive symptoms were included in the study. The study population was randomly divided into two groups, and the two techniques were compared with regard to operative time, intraoperative and postoperative bleeding and postoperative pain. There were 23 children in the bipolar electrodissection tonsillectomy group (mean age, 8.1 years; range, 5–12 years), and 17 children in the cold dissection tonsillectomy group (mean age, 6.7 years; range, 5–12 years). The average operative times were 15.2±8.5 min for bipolar electrodissection tonsillectomy and 29.06±13.5 min for cold dissection tonsillectomy (P<0.05). The blood loss in bipolar electrodissection tonsillectomy and cold dissection tonsillectomy was 5.0±4.2 ml and 32.1±11.3 ml, respectively (P<0.05). Postoperative hemorrhage was not observed. Bipolar electrodissection tonsillectomy was less painful the first 30 min postoperatively (P<0.05). Bipolar electrodissection tonsillectomy in children is a useful technique, with results comparable to traditional cold dissection tonsillectomy.     

电刀切除扁桃体236例

目的：改进扁桃体切除术剥离方法,减轻患者术后疼痛,减少术后出血。方法：于患者全麻状态下,置入张口器,用电刀沿扁桃体包膜切除扁桃体,观察术中及术后出血量、术后疼痛、术腔白膜生长情况。结果：术中术后均无大出血,出血量均＜20?ml,腭弓、悬雍垂肿胀轻,伪膜于12～18?h后萌出,术后12?h后进半流质饮食。结论：电刀切除扁桃体术在施术中、后出血少,术时短,能有效减少患者痛苦,值得临床推广应用。     

超声刀在扁桃体切除手术中的应用

目的 通过与常规扁桃体剥离术比较,探讨超声刀辅助扁桃体切除术的优缺点.方法 88例成人扁桃体切除适应证患者分为超声刀组(42例)和对照组(46例).超声刀组通过超声刀行扁桃体切除术,对照组则采用常规扁桃体剥离术.记录完整切除扁桃体所用的时间和术中出血量、术后咽痛等情况.结果 超声刀组平均((x-)±s,下同)手术时间(14.7 ±4.0) min比对照组(28.9 ±.7.6)min短,术中出血量(3.1±1.1)ml较对照组(19.0 ± 5.2) ml少,差异均具有统计学意义(t值分别为-10.691和-19.544,P值均＜0.05).超声刀组术后当天10 h内疼痛轻于对照组,但术后3d后咽痛较对照组明显,多数患者持续时间较长(秩和检验P值均＜0.05).常规剥离法扁桃体白膜脱落平均时间为术后8d,而超声刀组平均为11d,两者比较差异有统计学意义(t=5.115,P＜0.05).结论 超声刀扁桃体切除术具有手术时间短、术中出血量少等优点,但术后咽痛症状存留时间较长,且白膜脱落时间迟,需避免饮食不当造成继发性出血.     

Role of Bupivacaine in reducing post tonsillectomy pain

Pain following tonsilleclomy is of major concern to both the surgeons and the Anesthesiologists. Pre-incisional Bupivacaine infiltration into the tonsillar fossa has been used as a method of relieving post-operative pain in children. In this study pre-incisional Bupivacaine infiltration into the tonsillar fossa resulted in immediate post-operative pain lasting four to six hours.