Fibrin glue treatment for epistaxis

Our study was made to prove the second-generation surgical fibrin sealant Quixil to be an effective substitute for nasal packing, chemical coagulation and cautery in management of patients with epistaxis. Our series includes 204 patients with anterior epistaxis (186), and with posterior epistaxis (18) as results of trauma, clotting disorders, chronic and/or atrophic rhinitis and upper respiratory infections, and hypertension. Patients were randomly divided into four groups: with fibrin glue (67) (Quixil), with electric cautery (61), with silver nitrate coagulation (60), and with foam nasal packing (16). For the fibrin glue group, hemostasis was achieved by spraying with 0.3 ml Quixil fibrin glue to each bleeding nostril. The results were excellent in all of the 62 (92.5%) patients of the fibrin glue group with complete and immediate hemostasis. We found good healing of bleeding sites, no swelling and secondary bleeding, no inflammation, no plaque or crists. Three months monitoring of atrophic changes of the nasal mucosa proved absence of atrophy of the nasal mucosa. In this group, the bleeding time averaged 2 min 30 sec since the moment of admittance. In the groups where cautery, coagulation, or nasal packing was used, we found local swelling, pain, and slow healing of the bleeding site with accidental atrophy of the nasal mucosa. The rates of these side effects were significantly higher in comparison with the fibrin glue group. The bleeding time was also longer. We found that the fibrin glue is more effective hemostatic in comparison with foam nasal packing, cautery and coagulation, and provides no complications usual for these types of treatment of epistaxis.     

Fibrin sealant reduces pain after tonsillectomy: prospective randomized study

OBJECTIVES: Postsurgical pain in adults following tonsillectomy with fibrin sealant or electrocoagulation was assessed by surface electromyography (sEMG), a dysphagia severity rating scale (DSRS), and a visual analog scale (VAS) pain METHODS: For group 1 (n = 40), hemostasis was achieved by fibrin sealant spraying to the tonsillar fossae. For group 2 (n = 40), hemostasis was achieved by bipolar or needle point electrocautery. The timing of single swallowing and continuous drinking and the mean electrical activity of the masseter, infrahyoid, and submental-submandibular muscles were compared with a normative database during 30 days and with DSRS and VAS scores. RESULTS: Electrical activity of the masseter and infrahyoid muscles was significantly higher in both groups in comparison with the normative database (p < .05 to p < .005), whereas timing was less affected. The combined sEMG, DSRS, and VAS assessment showed that tonsillectomy ended with sealant causes less pain than electrocoagulation (p < .05). The DSRS score data were in strong positive correlation with the sEMG records, whereas the VAS pain score was less informative. CONCLUSIONS: The combined sEMG and pain score data indicate that the electrocautery hemostatic technique is more painful and traumatic than the sealant technique. Surface electromyography of swallowing is a simple, reliable evaluation method for postsurgical odynophagia complaints and might be used as an objective tool for pain assessment.     

Use of fibrin glue as a hemostatic in endoscopic sinus surgery

Endoscopic sinus surgery (ESS), especially when combined with turbinectomy and/or with submucous resection of the septum, may involve postoperative bleeding that might end with nasal packing. Nasal packing causes pain, rhinorrhea, and inconvenience and may not stop the postoperative bleeding. The aim of our study was to compare the hemostatic properties of the second-generation surgical sealant Quixil (Crosseal) with those of nasal packing in ESS. We performed a prospective randomized trial in 64 consecutive patients who underwent ESS and presented excessive intraoperative and/or postoperative bleeding. They were allocated by the sealed-envelope method into two groups. A routine ESS procedure was ended with Merocel nasal packing in group 1, and with aerosol application of Quixil sealant at the operative site in group 2. The hemostatic effects were evaluated objectively in the clinic by anterior rhinoscopy and endoscopy and assessed subjectively by the patients at follow-up visits. In group 1, various types of postoperative bleeding occurred in 25% of patients. In group 2 there was no postoperative bleeding, except for 1 case of late hemorrhage (3.12%). Drainage and ventilation of the paranasal sinuses were not impaired. There were no allergic reactions to the glue. We conclude that aerosol application of fibrin glue can be readily performed in ESS, requires no special treatment (antibiotics), and appears to have an adequate hemostatic effect. The use of this second-generation glue in ESS appears to stop nasal bleeding well and to be relatively safe and convenient.     

The use of fibrin glue as hemostatic in endonasal operations: a prospective,randomized study

Operations like septoplasty, rhinoplasty, nasal septal reconstruction and conchotomy may produce bleeding and postoperative hematoma. Two hundred four patients undergoing septoplasty and conchotomy operations were entered into a prospective study. Patients were randomly assigned to one of three treatment groups: Group I, septoplasty + conchotomy + nasal packing; Group II, septoplasty + conchotomy + fibrin glue; Group III, septoplasty + conchotomy + fibrin glue + transseptal suturing. To stop bleeding, we used the second generation surgical fibrin sealant Quixil and compared it with nasal packing. To increase protection against possible intraseptal hematoma we tried transseptal suturing at the end of a standard septoplasty operation. Our results show that the usage of the Quixil fibrin glue by aerosol spraying in endonasal operations is more effective and convenient than the usage of nasal packing. This combination of fibrin glue and the transseptal suturing substitutes the role of nasal packing in preventing postoperative intranasal hematoma. However, the transseptal suturing combined with the glue is not justified for the patients as no statistical difference was observed between Groups II and III in terms of occurrence of postoperative complications.     

Monopolar Electrocautery in Adenoidectomy as a Possible Risk Factor for Grisel's Syndrome

Objectives/Hypothesis Grisel syndrome is a nontraumatic atlantoaxial subluxation after an inflammatory process in the upper cervical region. It results from a peripharyngeal infection as well as a rare complication following adenotonsillectomy. After the introduction of monopolar suction electrocautery in adenoidectomy, an increased incidence of Grisel's syndrome has been observed. The purpose of the study was to evaluate monopolar suction electrocautery as a possible risk factor. Study Design Retrospective chart review along with current measurements of monopolar and bipolar electrocautery during adenoidectomy. Methods The charts of 1431 consecutive cases of adenoidectomy were reviewed before (n = 710) and after (n = 721) the introduction of monopolar suction electrocautery for intraoperative hemostasis. Moreover, energy of delivered current of electrocautery was measured in 30 pediatric patients during adenoidectomy. Results Three cases of Grisel's syndrome occurred as a postoperative complication in 721 adenoidectomies (0.4%) after the introduction of monopolar suction electrocautery. In contrast, no Grisel's syndrome was observed in 710 procedures before the use of monopolar electrocautery. Current measurements demonstrate an almost fourfold higher level of electrical energy using monopolar electrocautery compared with bipolar coagulation for bleeding control in adenoidectomy. Conclusion Monopolar suction cautery in adenoidectomy may be considered as a risk factor for Grisel's syndrome.     

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.     

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.     

Autologous fibrin sealant reduces pain after tonsillectomy

Objectives/Hypothesis Pain is a major cause of morbidity after tonsillectomy. Although various efforts have been made to reduce pain, the use of oral analgesics, which can have adverse side effects, remains the standard of care. It is hypothesized that fibrin sealant, used to achieve hemostasis and enhance healing in many surgical procedures, might help decrease pain after this operation. Study Design A prospective, randomized, blinded study was performed on 20 children aged 5 to 17 years who were undergoing tonsillectomy, to evaluate the efficacy of FIBRIN SEALANT in reducing postoperative pain. Methods All patients pre‐donated 40 mL of blood from which autologous concentrated fibrinogen was prepared by cryoprecipitation. In the fibrin sealant group, fibrinogen and topical bovine thrombin were sprayed onto the surgical site to form fibrin sealant at the conclusion of tonsillectomy. The 10 patients in the control group (C) received no fibrin sealant. Patients rated their level of pain immediately after surgery and at regular intervals for 3 days after surgery using the Wong‐Baker Faces Pain Rating Scale (1–6). Emesis, postoperative bleeding, medications, and adverse events were also evaluated. Results At 7:00 p.m. on postoperative day (POD) 0, the mean ± SD fibrin sealant group pain score (2.9 ± 0.41 units) was significantly lower than for the C group (4.1 ± 0.43 units;P ≤ .05). There was also a trend in favor of less pain in the fibrin sealant group at 7:00 p.m. on POD 1, with a mean of 3.5 ± 0.43 units versus 2.4 ± 0.48 units for C (P = .15). The odds of a patient in C experiencing emesis were 8.16 times higher, (P ≤ .05) than for patients in the fibrin sealant group. Conclusions Fibrin sealant significantly reduced pain the evening after pediatric tonsillectomy and also decreased the chance of e‐periencing emesis. Thus fibrin sealant may be clinically useful as an adjunct to tonsillectomy.     

Ligasure versus cold knife tonsillectomy

OBJECTIVE: To assess parameters related to ligasure tonsillectomy (LT) versus cold knife tonsillectomy (CKT) procedure. STUDY DESIGN: Prospective randomized study. METHODS: A prospective study was conducted on 200 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with peritonsillar abscess history or bleeding disorders were excluded. Patients were randomly assigned to either the LT or CKT group. Intraoperative bleeding, operative time, postoperative pain using a visual analogue scale, and complication rates were evaluated. RESULTS: The LT and CDT groups consisted of 108 and 92 individuals, respectively. In the LT group, there was no measurable intraoperative bleeding, whereas mean bleeding for CKT group was 125 mL. The mean operative time was 15 +/- 1.43 minutes for the LT group and 21 +/- 1.09 minutes for the CKT group (P < .001). The overall mean pain score for the LT group was 3.63, whereas for the CKT group it was 5.09 (P < .001). Primary hemorrhage occurred in one subject of the CKT group. Secondary postoperative hemorrhage was noticed two subjects of the LT group and two subjects of the CKT group. In 21 subjects of the LT group, limited peritonsillar edema was noticed. No other complication occurred in both groups. CONCLUSION: LT procedure provides sufficient hemostasis, lower postoperative pain, and reduced operative time, as well as safety against Creutzfeld Jakob disease transmission.     

The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection

ObjectiveAlthough tonsillectomy is one of the most common surgeries performed in pediatric, it has potential major complications such as pain and bleeding. This study aimed to compare the bleeding and pain after tonsillectomy in bipolar electrocautery tonsillectomy versus cold dissection.MethodsThis double blind clinical trial was conducted on 70 pediatric patients who were candidate of tonsillectomy. Patients were divided into two groups of including bipolar cautery (BC) and cold dissection (CD). operation time, intraoperative blood loss, and postoperative bleeding and pain were evaluated in the current study.ResultsIn both of the CD and BC groups, no significant difference was found in terms of sex and age. The average amount of the intraoperative blood loss in BC group was 14.086 ± 5.013 ml and in CD group was 26.14 ± 4.46 ml (p. v = 0.0001). The mean time of operation in BC group was 19 ± 2.89 min and in CD group was 29.31 ± 5.29 min (p. v = 0.0001).patients were evaluated in terms of pain on the first, third, fifth, and seventh days after the operation. No statistically significant difference was found between two groups.Moreover, Compared pain scores in all times across two groups, no significant difference was found.In terms of postoperative bleeding, none of the patients in both groups had bleeding during follow-up.ConclusionOur study showed that bipolar electrocautery tonsillectomy can significantly reduce the operation time and intraoperative blood loss; however, postoperative pain and blood loss were similar in both techniques. We recommend bipolar electrocautery as the most suitable alternative method for tonsillectomy, especially in children.     

低温等离子刀对比双极电凝镊在扁桃体切除术中治疗效果观察

目的分析变应性鼻炎(AR)患者接受鼻腔冲洗治疗的临床疗效。方法将2019年6月~2020年8月作为研究时间段,选取期间我院接诊的78例AR患者,另将随机数字表法作为分组依据,将全部病例分为对照组(行常规治疗,纳入39例)、研究组(加用鼻腔冲洗治疗,纳入39例),对组间气道反应性、症状消失时间展开分析。结果(1)组间气道反应性指标在治疗前无明显差异,P>0.05;研究组共振频率(Fres)、中心气道阻力(R20)、气道总阻力(R5)在治疗后低于对照组,P<0.05;(2)研究组鼻塞、流涕、喷嚏、鼻痒消失时间均少于对照组,P<0.05。结论鼻腔冲洗对改善AR患者气道反应、临床症状均有明显效果,值得推广。     

Tonsillectomy using the thermal welding system

OBJECTIVE: To evaluate and introduce a new method of tonsillectomy using the Thermal Welding System (TWS). METHOD: The TWS is a new surgical instrument which uses direct heat and pressure to seal and divide tissues. Fifty consecutive patients underwent tonsillectomy with the use of the TWS. Inclusion criteria were chronic tonsillitis, peritonsilar abscess history and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy or any other procedure together with tonsillectomy and patients with bleeding disorders were excluded. Intraoperative bleeding, operative time, complication rates and return to normal diet were evaluated. RESULTS: There was no measurable bleeding during surgery in any case. No postoperative hemorrhage or other complication occurred. Mean operative time was 23 min. Mean time for return to normal diet was 8.7 days. CONCLUSIONS: The TWS was found quite effective and safe, providing sufficient hemostasis and minimal intraoperative blood loss.     

52例扁桃体术后出血诊治疗效观察

目的探讨扁桃体切除术后出血的多种止血措施疗效,为临床实践提供指导。方法回顾性分析52例等离子扁桃体切除术后出血患者的临床资料,采用双氧水棉球局部压迫、利多卡因稀释液局部肌注间接压迫、双极电凝固、缝合结扎四种处理方式,观察24小时内止血治疗效果。结果本研究中52例患者共计发生出血70次;止血操作成功事件中,双氧水棉球压迫占28例(28/36,77.78%)、利多卡因液肌注压迫5例(5/7,71.43%)、双极电凝固19例(19/19,100%)、缝合结扎8例(8/8,100%),与双氧水棉球压迫、利多卡因液肌注压迫相比,双极电凝固与缝合结扎两种方式的止血成功率显著更高(χ^2=7.355,P=0.037)。结论扁桃体切除术后出血是一常见并发症,采用双极电凝固法或缝合结扎法可以有效的彻底止血。     

Safety and efficacy of pressure-assisted tissue-welding tonsillectomy: a preliminary evaluation

We conducted a retrospective study of the safety and efficacy of a new pressure-assisted tissue-welding technology (ENTceps; Starion Instruments Corp.; Sunnyvale, Calif) for total tonsillectomy, either alone or with adenoidectomy. The use of this instrument was compared in two groups of patients categorized by age. The younger group was made up of 50 patients aged 2 to 12 years who had undergone total tonsillectomy and adenoidectomy (T&A), and the older group was made up of 50 patients aged 13 to 47 years who had undergone either T&A or isolated total tonsillectomy. The primary safety endpoint was the presence or absence of intra- or postoperative complications-particularly the amount of intraoperative blood loss and the incidence of delayed postoperative bleeding. In each group, the mean amount of intraoperative blood loss was no more than 30 ml, and only 2 of the 100 patients experienced postoperative hemorrhage. Among the efficacy parameters were the amount of operating and recovery time and the postoperative appearance of the tonsillar fossae. The mean operating time was 13.0 minutes in the younger group and 19.5 minutes in the older group, and the mean total recovery times were 120.0 and 130.4 minutes, respectively; all tonsillar fossae were well epithelialized by 2 weeks after surgery. Finally, surgical morbidity was determined on the basis of the amount of perioperative pain medication administered, the number of unscheduled patient telephone contacts and clinic visits, and the amount of time needed to return to a normal diet and activities. Nine patients in the younger group and 6 in the older group required no pain medications during recovery; overall, pain was not a significant issue for most patients. Sixteen patients made a total of 20 telephone calls and 8 clinic visits prior to their scheduled postoperative appointment; almost all of these encounters dealt with postoperative pain. Only 1 patient, who had previously undiagnosed von Willebrand disease, had not returned to a normal diet and activities by the end of 1 week. Based on our preliminary findings-and a comparison of our results with those of other studies published in the literature relative to the amount of intraoperative bleeding, the incidence of postoperative bleeding, and operating times--we conclude that pressure-assisted tissue-welding technology is safe and compares favorably with other tonsillectomy techniques. This method of electrocautery is straightforward and relatively easy to learn.     

The hemostatic efficacy of Ankaferd Blood Stopper in adenoidectomy

Objective

To evaluate the efficacy of Ankaferd Blood Stopper (ABS) in the control of intraoperative and postoperative bleeding in adenoidectomy.

Methods

In total, 90 patients underwent traditional cold steel adenoidectomy and were then randomized to receive ABS or 0.9% physiological saline solution to obtain hemostasis. Objective data collected included time of operation and blood loss during operation. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal and ease of operation.

Results

In a comparison between patients in the ABS group (n = 46) and the control group (n = 44), those in the ABS group had significantly shorter operation times (9.11 ± 1.02 vs. 13.16 ± 3.96 min; p < 0.001) and less blood loss during the operation (20.19 ± 8.59 vs. 25.48 ± 12.96 ml; p ≤ 0.05) and a shorter hemostasis time (3.83 ± 0.8 vs. 5.82 ± 1.67 min; p < 0.001). Regarding hemorrhage after tampon removal, 40 patients (87%) in the ABS group and 17 patients (38.6%) in the control group did not suffer from hemorrhage (p < 0.001). Regarding ease of hemostasis, 40 patients (87%) in the ABS group experienced very easy or easy hemostasis while 26 patients in the control group did so (59.1%; p = 0.004). Patients in the ABS group returned to a regular diet earlier and had less use of analgesics at 7 days postoperatively. Use of electrocautery was less in the ABS group than in the control group (10.9 vs. 40.9%; p = 0.001).

Conclusions

The side on which ABS was used showed significant differences in hemostasis time, blood loss, and ease of hemostasis. ABS appears to be safe and effective; it decreases intraoperative bleeding and reduces operating time when compared to traditional hemostasis methods after curette adenoidectomy.     

Harmonic scalpel tonsillectomy: a prospective study

The harmonic scalpel has been in use for tonsillectomy for the last 5–6 years in western Europe and North America. Although some studies have found this technique to be superior to other conventional methods, its use is still not very popular. In this single-blinded prospective study, the intraoperative events and postoperative morbidity after the use of harmonic scalpel in tonsillectomy (HST) was evaluated in 180 cases in two hospitals and compared with conventional steel tonsillectomy (CST) and hemostasis secured by bipolar diathermy or ligatures in 100 cases. Both bipolar diathermy and ligatures were used to control the intraoperative bleeding in all cases of CST and some cases ( n =9) of HST. The study was done in two hospitals. Patients were randomized irrespectively of their age, sex, past history or indication for surgery. The total number of patients operated on was 180 for HST and 100 for CST. The surgical duration, intraoperative blood loss and postoperative pain were compared between the patients who only had tonsillectomy done in either group ( n =120 in HST and n =70 in CST). The mean operative time in the HST group was not longer than the CST group, but the intraoperative blood loss was significantly less in the HST group. Postoperative pain was present in all patients in the HST group, but to a lesser extent than in the CST group. There was no major postoperative hemorrhage in the HST group that required surgical attention. HST has the advantage over CST when secondary hemorrhage after tonsillectomy is considered. Thus, following the results of the National Prospective Tonsillectomy Audit (NPTA), it may be safe to say that HST is superior to most other conventional methods in reducing secondary hemorrhage. The use of disposable blades in CST certainly reduces the risk of the transmission of Cruetzfield-Jacob disease (CJD).     

Post-tonsillectomy and -adenoidectomy hemorrhage in nonselected patients

This retrospective study was undertaken to evaluate the incidence of hemorrhage in nonselected patients requiring surgical treatment after adenoidectomy (group 1; 7,785 patients) or tonsillectomy with or without adenoidectomy (group 2; 6,794 patients). Postoperative bleeding from the tonsillar fossae occurred in 200 patients (2.94%). Primary hemorrhage (< 24 hours) clearly prevailed in groups 1 (86%) and 2 (78%). There was 1 case with a lethal outcome following tonsillectomy (0.007%). Bleeding from the epipharynx occurred in 17 patients of group 1 (0.21%). A total of 5 patients received blood transfusions, all of them belonging to group 2 (0.07%). The latest bleeding occurred 6 days (adenoidectomy) and 18 days (tonsillectomy) after surgery. Hemorrhage following both procedures is a rare complication predominantly occurring several hours after surgery and in nonselected patients. Male gender, age over 70 years, infectious mononucleosis, and a history of recurrent tonsillitis were found to be risk factors for posttonsillectomy hemorrhage.     

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。     

儿童扁桃体切除术后出血率及出血程度分级的初步探讨

目的　统计儿童扁桃体切除术后出血率,根据Windfuhr分级法衡量儿童扁桃体术后出血的程度。方法 统计2010年3月～2013年3月在深圳市儿童医院行扁桃体切 除或扁桃体加腺样体切除患儿资料,统计术后出血发生率。结果　1672例患儿扁桃体切除术后出血16例,出血率为0.96%。女童术后出血率1.8%明显高于男童出血率0.53%,差异有统计学意义（χ 2=5.545,P <0.05）;原发性出血6例,继发性出血10例。出血程度1级9例,2级7例。结论 儿童扁桃体切除术后出血率很低,遇有活动性出血者应手气管插管全麻下止血。     

Analysis of postoperative hemorrhage after adenoidectomy and tonsillectomy in children in own material

Hypertophy of pharyngeal tonsil and palatine tonsils is the most common cause of nasal obstruction in children. When the obstruction of the nasopharynx causes recurrent infections of upper respiratory tract, chronic otitis media secretoria or sleep apnoea, then adenoidectomy with or without tonsillectomy is indicated. The purpose of the study was analysis of postoperative hemorrhage after adenoidectomy with or without tonsillectomy. The influent of frequent infections of upper respiratory tract, disorders of blood clotting, chronic diseases, seasons of the year, operation time and general anesthesia on postoperative hemorrhage was estimated. A group of 1184 children after adenoidectomy with or without tonsillectomy was studied. Postoperative hemorrhage occurred in 59 children (4.98%). Early bleeding was frequently occurred after adenotonsillectomy and late bleeding after adenoidectomy. There was relationship between the time of general anesthesia and incidences of postoperative bleeding. Food or inhalation allergy, recurrent infections of upper respiratory tract and male sex are risk factors of postoperative hemorrhage after adenoidectomy with or without tonsillectomy.