鼻内镜对减少低温等离子扁桃体切除术后出血的疗效观察

目的　研究手术结束前应用70°鼻内镜检查扁桃体术腔与常规检查扁桃体术腔两种方法对低温等离子扁桃体切除术后出血的影响。方法　我院2008年1月～2018年1月行全麻下低温等离子扁桃体切除术的患者1249例,采用回顾性临床病例对照研究方法,分为手术结束前应用70°鼻内镜检查扁桃体术腔组635例（治疗组）与常规检查扁桃体术腔组614例（对照组）,比较两组的术后出血发生率和术后出血量等。结果　手术结束前应用70°鼻内镜检查扁桃体术腔,可减少低温等离子扁桃体切除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　手术结束前应用70°鼻内镜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。     

儿童扁桃体腺样体低温等离子射频消融术后出血特点分析及应对策略

目的　探讨低温等离子射频消融和传统手术行儿童扁桃体腺样体切除术在术后出血方面存在的差异特点,并提出应对策略。方法　选取2014年于我科行扁桃体腺样体射频消融术999例为等离子组,2010年于我科行扁桃体腺样体切除术1275例为传统组。比较两组总出血率、原发性及继发性出血的发生率、出血部位、出血程度和治疗方法的差异。结果　等离子组术后总出血率、出血部位分布、出血程度和治疗方法分布上与传统组相比差异无统计学意义。等离子组术后原发性出血少于传统组,而继发性出血多于传统组,差异有统计学意义。结论　等离子手术与传统手术相比并不增加术后出血几率,在出血部位分布、治疗方法分布上亦无明显差别;但术后原发性出血减少,而继发性出血升高,分析等离子手术后出血的常见原因,并针对性提出应对策略     

3%电解质液对等离子刀切除扁桃体手术患者术后出血的影响

目的分析3%电解质液对等离子刀切除扁桃体手术的患者术后出血的影响。方法回顾性分析在我院2014年5月~2015年4月940例行低温等离子扁桃体切除手术的病人,随机分为治疗组和对照组各470例,对照组术中采用生理盐水为电解液行扁桃体切除术,治疗组采用3%高渗盐水为电解质溶液行扁桃体切除术。结果对照组470例,术后出血11例,出血发生率为2.34%。治疗组470例,术后出血4例,出血发生率为0.85%。     

儿童扁桃体、腺样体低温等离子切除术后出血的临床研究

目的 探讨应用低温等离子手术或者传统手术方式行儿童扁桃体、腺样体切除术在术后出血方面存在的差异。方法 回顾性分析1597例接受手术治疗的儿童慢性扁桃体炎、腺样体肥大的患者资料,行等离子射频辅助的扁桃体和(或)腺样体切除术者793例(等离子组),行传统扁桃体切除和(或)腺样体者804例(传统组)。比较两组原发性及继发性出血的发生率、出血程度和出血部位的差异。结果 等离子组发生术后出血25例(3.2％),传统组出血19例(2.4％),两组间差异无统计学意义(χ2=3．34,P>0．05);其中等离子组原发性出血9例(1.1％),继发性出血16例(2.0％);传统组原发性出血11例(1.4％),继发性出血8例(1．0％),两者比较差异有统计学意义(χ2=9．45,P<0．01)。两组术后的出血部位经卡方检验,出血程度经Wilcoxon秩和检验,P值均>0．05,差异均无统计学意义。结论 低温等离子辅助行儿童扁桃体、腺样体切除术,在术后出血的发生率、程度、部位三个方面相对于传统的手术方法治疗,二者差异无统计学意义。     

儿童低温等离子扁桃体切除术后迟发性出血的原因分析

目的:探讨低温等离子手术方式行儿童扁桃体切除术后迟发性出血的原因。方法:回顾性分析2~14岁行低温等离子扁桃体切除手术与传统扁桃体切除手术术后出血时间及出血率的差异性。等离子组患儿2012-03-2013-08期间行低温等离子扁桃体切除术,传统组患儿于2005-03-2006-08期间行冷器械扁桃体切除术。结果:低温等离子手术方式组1 000例,术后出血19例,出血率为1.9%。其中原发性出血4例,原发性出血率为0.4%,出血时间均在手术后8h内。迟发性出血15例,迟发性出血率为1.5%,出血时间在2~13d,平均7.5d。15例迟发性出血患儿中,存在感染因素者9例,术后进食不当者6例。进食不当者中在出血前有4例患儿有进食水果及坚硬食物,2例患儿因进食多少导致体重减轻。传统手术方式组患儿860例,术后出血29例,出血率为3.37%,其中原发性出血26例,原发性出血率为3.02%。术后迟发性出血3例,迟发性出血率为0.35%,出血时间在2~6d,平均4d。结论:儿童扁桃体切除术更适宜选择低温等离子的手术方式。其术后迟发性出血可能与术后感染,术后感染引发的刺激性干咳,饮食不当,主刀医师手术技术的差异,手术中止血的方式不同,患儿术后恢复期的护理,患儿及家长的对医嘱的依从性等因素相关。     

低温等离子刀扁桃体切除术与传统扁桃体剥离术疗效的比较

目的:比较分析低温等离子刀扁桃体切除术与传统扁桃体剥离术的疗效。方法:将64例慢性扁桃体炎患者随机分为传统扁桃体剥离术(传统手术组)和低温等离子刀扁桃体切除术(等离子手术组)2组。传统手术组39例采用传统扁桃体剥离术治疗,等离子手术组25例采用低温等离子刀扁桃体切除术治疗。分析2组手术方式在手术时间、术中出血量、术后疼痛时间、术后出血发生概率上有无差异。结果:传统手术组与等离子手术组在手术时间、术中出血量、术后疼痛时间上差异有统计学意义(P<0.05);2组术后出血发生概率差异无统计学意义(P>0.05)。结论:低温等离子刀扁桃体切除术较传统扁桃体剥离术手术时间短,术中出血少,术后疼痛轻,恢复快,安全性高。     

低温等离子手术与常规手术方式治疗儿童扁桃体、腺样体术后迟发性出血情况分析

目的 比较等离子手术与常规手术方式治疗儿童扁桃体、腺样体术后迟发性出血情况。方法 选取本院耳鼻咽喉科2018年1月～2020年1月收治的扁桃体、腺样体切除手术患儿80例，随机分为观察组和对照组，每组各40例。观察组患儿采用低温等离子手术，对照组则采用常规电刀手术方式施术，然后比较两组患儿手术过程指征（手术时间、术中出血量）、术后疼痛、术后创口周围软组织水肿程度等。结果 观察组手术时间、术中失血量以及术后疼痛评分等指标均显著低于对照组（P<0.05），麻醉苏醒后进食时间、住院时间均显著低于对照组（P<0.05），但术后伪膜脱落时间显著高于对照组（P<0.05）；继发性出血发生率高于对照组，原发性出血率则低于对照组（P<0.05），但总出血量对照组略高于治疗组，差异不具有统计学意义（P>0.05）。结论 与常规手术方式比较，低温等离子手术各项手术后相关指标及后期恢复状况更佳，但其术后迟发性出血发生率较高，临床应用中需引起注意。     

探讨低温等离子技术在儿童OSAHS手术中的应用价值

目的探讨低温等离子技术在儿童OSAHS的临床应用疗效及并发症。方法选择2017年3月～2018年2月行手术治疗的89例OSAHS患儿,随机数字法分为观察组和对照组。观察组51例,用低温等离子刀行扁桃体切除术及腺样体消融术。对照组38例,行常规扁桃体切除术及腺样体切除术。对比观察两组患儿治疗有效率、手术持续时间、术中出血量,术后再出血率。结果观察组有效率为98.04%,对照组有效率为84.21%,差异有统计学意义(P=0.039),观察组有效率高于对照组。在手术时间、术中出血量等方面,低温等离子手术组均优于常规手术组。观察组无术后出血病例,再出血率为0.00%;对照组有4例术后出血,再出血率为10.53%,差异有统计学意义(P=0.030),观察组术后出血率低于对照组。结论低温等离子技术在儿童OSAHS手术中,具有疗效好、术中出血量少、手术时间短,术后再出血率低等优点,值得在临床中广泛推广应用。     

扁桃体周围脓肿行扁桃体切除术的术后出血分析

目的　比较扁桃体周围脓肿患者采用两种不同治疗方法,再行扁桃体切除术的术后出血差异。方法　回顾性分析2009年9月~2019年9月福建医科大学第二临床医学院收治的579例扁桃体周围脓肿行全麻下扁桃体切除术治疗的患者,分为脓肿期手术（观察组）297例和常规择期手术（对照组）282例,比较两组患者扁桃体切除术后出血发生率及术后出血量情况。结果　相较于对照组,观察组患者手术有助于减少扁桃体切除术后原发性出血率,差异有统计学意义（χ2=6.59,P <0.05）,继发性出血率,差异无统计学意义χ2=0.26,P >0.05）。结论　扁桃体周围脓肿患者在脓肿期行扁桃体切除术可以有效减少扁桃体切除术后原发性出血概率。     

扁桃体低温等离子射频消融术术后出血的对照研究

目的　比较阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿行扁桃体低温等离子射频消融术与扁桃体传统剥离术术后出血发生情况,为扁桃体切除术的选择 提供参考。方法　采用回顾性临床病例对照研究方法,从2015年10月～2017年10月行扁桃体切除患儿682例,其中采用传统剥离术342例（对照组）,低温等离子射频消融术340例（观察组）,比较两组术后出血发生率、出血类型和出血分级的差异。结果　观察组术后出血发生率为3.51%,对照组为7.35%,两组间差异有统计学意义（P＜0.05）;观察组术后继发性出血率为75%,对照组为32%,两组间比例差异有统计学意义（P＜0.05）;术后出血分级构成比差异无统计学意义（P＞0.05）。结论　观察组与对照组对比,具有术后出血发生率低,术后继发性出血发生率高,尤其在处理小动脉性出血时,若单靠等离子刀低温电凝止血,可能发生严重的术后出血,可联合使用传统结扎或电凝等止血方法。     

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。     

缝合腭弓对扁桃体术后出血影响的临床研究

目的 客观评价缝合腭弓在减少扁桃体术后出血中的作用.方法 回顾性分析2013年1月至2019年10月行成人扁桃体切除术患者234例,所有患者均在全麻下行低温等离子扁桃体切除术,其中125例患者为预防术后出血行双侧腭弓缝合(观察组),另109例患者未行腭弓缝合(对照组),观察与记录术后出血情况.结果 观察组和对照组原发性...     

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.     

Coblation vs. Electrocautery Tonsillectomy: A Prospective Randomized Study Comparing Clinical Outcomes in Adolescents and Adults

Objectives

Coblation is operated in low temperature, so it is proposed that tonsillectomy with coblation involves less postoperative pain and allows accelerated healing of the tonsillar fossae compared with other methods involving heat driven processes. However, the results of the previous studies showed that the effect of coblation tonsillectomy has been equivocal in terms of postoperative pain and hemorrhage. Though, most of the previous studies which evaluated coblation tonsillectomy were performed in children. Recently, electrocautery tonsillectomy has been used most widely because of the reduced intraoperative blood loss and shorter operative time compared to other techniques. This prospective study compared intraoperative records and postoperative clinical outcomes in adolescents and adults following coblation and electrocautery tonsillectomies.

Methods

Eighty patients over 16 years of age with histories of recurrent tonsillitis were enrolled. The patients were randomly allocated into coblation (n=40) and electrocautery tonsillectomy groups (n=40). All operations were performed by one surgeon who was skilled in both surgical techniques. Intraoperative parameters and postoperative outcomes were checked.

Results

Postoperative pain and otalgia were not significantly different between the two groups; however, there was a tendency towards reduced pain and otalgia in the coblation group. More cotton balls for swabbing the operative field were used introoperatively in the electrocautery group (P=0.00). There was no significant difference in postoperative hemorrhage, wound healing, commencement of a regular diet, and foreign body sensation between the groups.

Conclusion

Only cotton use, which represented the amount of blood loss, was less in the coblation tonsillectomy group. Coblation tonsillectomy warrants further study with respect to the decreased postoperative pain and otalgia.     

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.     

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。     

低温等离子刀、超声刀及传统方式行扁桃体切除术的术后两年随访比较

目的 通过对低温等离子刀、超声刀及传统方式行扁桃体切除术的患者进行2年随访,探讨三种手术方式的术后疗效差异。 方法 对行上述三种手术方式的86例患者在扁桃体切除术后6个月、1年及2年进行随访,观察术后扁桃体残体大小及黏膜炎症情况,并使用自制问卷调查咽部症状及满意度等信息。 结果 术后1年及2年随访时,低温等离子刀组和传统组的扁桃体上极残体评分较超声刀组要低,而低温等离子刀组和超声刀组的扁桃体下极残体评分则较传统组要低;术后6个月随访时低温等离子刀组和超声刀组的咽干症状均较传统组明显;术后2年随访时低温等离子刀组和超声刀组的患者满意度较传统组更高,而且传统组患者的咽部异物感更为明显;以上差异均有统计学意义(P<0.05)。另外术后1年及2年随访时,三组患者的咽干症状、扁桃体窝黏膜慢性炎症程度、咽痛频率及术后下呼吸道感染发生次数均无统计学差异(P>0.05)。 结论 相较于传统方式而言,使用低温等离子刀切除扁桃体的患者术后扁桃体残体发生率低,除短期术后易发生咽干外,中长期咽部不适症状较轻,患者满意度较高。超声刀方式优点与低温等离子刀相近,但在术中要注意对扁桃体上极的处理,防止其残留。     

低温等离子辅助下儿童扁桃体全切除与部分切除的比较

目的 探讨应用低温等离子辅助下治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)时扁桃体全切除与部分切除的疗效比较.方法 回顾性分析应用等离子技术手术治疗的4311例儿童OSAHS患者病历资料.根据术式分为两组:A组358例,行低温等离子辅助下扁桃体全切除和腺样体切除术;B组3953例,行低温等离子辅助下扁桃体切部分...