外用重组人碱性成纤维细胞生长因子对低温等离子扁桃体切除术后的效果观察

目的　观察外用重组人碱性成纤维细胞生长因子（recombiant human basic fibroblast growth factor，rhbFGF）对低温等离子扁桃体切除术后扁桃体窝创面的愈合及患者疼痛减轻作用的效果观察。方法　将因慢性扁桃体炎或者扁桃体肥大需行双侧扁桃体切除术的患者共36例，随机分为治疗组和对照组，治疗组术后喷涂rh-bFGF及常规 治疗，对照组仅作常规治疗。结果　在创面假膜形成时间的比较上治疗组和对照组无统计学差异（t =0.13，P＞0.05），假膜完全脱落时间比较上治疗组和对照组有统计学差异（t =7.03，P＜0.001），术后疼痛主观评分的差异有统计学意义（t 术后24小时=2.03，P＜0.05；t 术后48小时=3.22，P＜0.01；t 术后72小时=4.17，P＜0.001）。结论　rh-bFGF对低温等离子扁桃体切除术后的创面。     

两种扁桃体切除方法的临床观察

目的比较两种不同扁桃体切除及止血方法的优缺点。方法将诊治的90例扁桃体切除术患者随机分为等离子手术组（A组）和传统手术组（B组）,每组各45例,所有手术均由同一术者完成。等离子手术组用低温等离子法切除扁桃体并止血;传统手术组则采用常规扁桃体剥离并用双极电凝止血。记录切除双侧扁桃体所需时间和出血量;术后第1天起每日记录患者咽部疼痛评分情况,连续10 d;术后第10天观察并记录扁桃体窝内的白膜状况。结果A、B两组手术总时间分别为（18.0±1.6）min、（43.5±3.4）min,术中总出血量分别为（9.3±1.3）ml、（53.8±5.5）ml,两组间差异均具有统计学意义（P〈0.05）;两组患者术后1周内疼痛指数差异比较具有统计学意义（P〈0.05）,1周后疼痛指数比较差异无统计学意义（P〉0.05）;A、B两组术后出血发生病例数分别为3例、4例,出血发生率比较差异具有统计学意义（P〈0.05）,术后比较,A、B两组白膜与扁桃体窝面积比分别为（43.8±6.6）%、（40.5±5.1）%,两组之间差异无统计学意义,但等离子组白膜较为清洁。结论与传统扁桃体剥离法比较,低温等离子法切除扁桃体具有手术损伤小、术中出血少、术后疼痛轻、恢复好等优点,可作为扁桃体切除手术的首选。     

低温等离子射频消融术切除扁桃体的安全性及可行性Meta分析

目的　评价低温等离子射频消融术切除扁桃体的安全性及可行性。方法　计算机检索Medline数据库、Pubmed、中国生物医学数据库（CBM）、CNKI及万方数据库国内外关于低温等离子射频消融术与传统扁桃体剥除术的随机对照试验及临床对照试验。运用RevMan 5.1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20个随机对照试验和5个临床对照试验,共4162例患者。低温等离子射频消融术与传统扁桃体剥除术相比,显著缩短了手术时间[MD=-16.04,95%CI（-20.24,-11.84）,P <0.00001],减少了术中出血量[MD=-50.07,95%CI（-66.03,-34.11）,P <0.00001],缩短了住院时间[MD=-3.18,95%CI（-5.72,-0.63）,P =0.01],加快了恢复进食时间[MD=-1.98,95%CI（-3.11,-0.85）,P =0.0006],减轻了患者疼痛程度（术后6、24、48、72 h）（VAS评 分）（P <0.05）,减少了术后并发症发生率[MD=0.65,95%CI（0.46,0.93）,P =0.02],同时延长了白膜脱落时间[MD=1.84,95%CI（0.24,3.44）,P =0.02],而平均疼痛时间无显著差别。结论　现有的研究表明,低温等离子射频消融术切除扁桃体在应用价值上具有创伤小、恢复快,更加安全和有效,但是由于数量少,期待更多高质量的试验提供高质量的证据。     

外用重组人表皮生长因子对扁桃体术后疗效的观察

目的　观察外用重组人表皮生长因子（recombinant human epidermal growth factor for external use，rhEGF）对扁桃体切除术后创面愈合及疼痛程度的疗 效。方法　60例因慢性扁桃体炎或扁桃体肥大行扁桃体切除的患者随机分成两组，试验组于扁桃体术后创面喷洒rhEGF治疗，对照组扁桃体术后创面未用任何药物。观察两组患者创面白膜形成与完全脱落时间，创面愈合情况及疼痛程度。结果　与对照组比较，试验组创面白膜完全脱落时间更短，创面愈合情况更好，术后第3、5、7天创面疼痛程度更轻（P＜0.05），而创面白膜形成时间和术后第1天疼痛程度两组无统计学差异（P＞0.05）。结论　扁桃体术后局部应用rhEGF可以加快创面愈合，减轻患者痛苦。     

鼓室注射地塞米松磷酸钠注射液与注射用甲泼尼龙琥珀酸钠治疗突发性聋疗效观察及不良反应分析

目的　探讨地塞米松磷酸钠注射液与注射用甲泼尼龙琥珀酸钠鼓室内注射治疗突发性聋的临床疗效并分析两种注射治疗后的不良反应。方法　2018年9月~2019年12月收治的单侧突发性聋患者94例,按数字表法随机分为A组（注射用甲泼尼龙琥珀酸钠组）和B组（地塞米松磷酸钠注射液组）各47例,分别行鼓室内注射注射用甲泼尼龙 琥珀酸钠和鼓室内注射地塞米松磷酸钠注射液治疗,分析两组患者治疗前后纯音听阈值变化情况,并观察两组不良反应和空腹血糖变化情况。结果　两组患者治疗后纯 音听阈较治疗前均有明显改善（A组：t =9.86,P =0.001;B组：t =2.91,P =0.005）,A组总有效率82.9%,B组总有效率为63.8%,两组总有效率比较,差异有统计学意义（χ²=4.41,P =0.036）;两组总体不良反应率比较,差异无统计学意义（P＞0.05）;两组治疗前后空腹血糖变化比较,差异无统计学意义（P＞0.05）。结论　两种治疗方法均能改善突发性聋患者的纯音听阈,但注射用甲泼尼龙琥珀酸钠效果较地塞米松磷酸钠注射液更佳,两者的不良反应情况基本相仿。     

咽腭弓肌黏膜瓣闭合扁桃体等离子术后创面的临床疗效

目的 对扁桃体等离子切除术的术式进行改进,分析咽腭肌黏膜瓣闭合扁桃体等离子术创面对术后疗效的改善情况。 方法 对需行扁桃体等离子切除术患者进行随机分组。105例行常规扁桃体等离子切除术(大多数囊内切除),94例在扁桃体等离子切除后制作局部咽腭肌黏膜瓣闭合扁桃体窝创面。对两组患者的术后疼痛、创面反应及出血情况进行分类统计,分析比较应用咽腭肌黏膜瓣修复的临床效果。 结果 在术后第1至第7天,实验组与对照组患者间的疼痛程度、创面反应情况及出血并发症的发生均有差异。实验组不同层次疼痛程度的病例数明显少于对照组,术后创面反应观察中,实验组白膜脱落时间较对照组明显缩短,出血概率明显减低。 结论 应用咽腭肌黏膜瓣闭合扁桃体等离子切除后创面操作简便,可明显改善患者术后疼痛,促进创面愈合,减少创面术后出血概率。     

全麻下单极电刀切除扁桃体90例疗效观察

目的 探讨全麻下运用单极电刀实施扁桃体切除术的临床疗效。方法 将行扁桃体切除术的患者180例随机平均分为两组,术前全身麻醉,实验组（A组）行单极电刀全程切除双侧扁桃体,对照组（B组）采用传统扁桃体剥离术,对两组的手术时间、出血量、白膜脱离时间及术后疼痛程度等进行比较。结果 A组术中出血量、手术时间较B组明显减少,术后疼痛时间也较B有所降低,但是白膜脱落时间稍长。结论 全麻下单极电刀扁桃体切除术有操作简便、视野清楚、手术时间短、术中出血极少等优势。     

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。     

不同途径给药后血浆和外淋巴液中甲泼尼龙的代谢动力学特征

目的：探讨心内注射、鼓室内灌注、明胶海绵圆窗给药后血浆、外淋巴液中甲泼尼龙的代谢动力学特征。方法：心内注射甲泼尼龙（4mg／kg）;鼓室内灌注甲泼尼龙（40g／L）,浸满40g／L溶液的明胶海绵颗粒放置在圆窗龛内分别给药,采集3种途径给药后1～6h的血液和鼓阶外淋巴液,应用高效液相色谱仪分别检测其中的甲泼尼龙浓度。结果：心内注射给药后每个时间点血浆中的甲泼尼龙浓度均高于外淋巴液,两者相比差异有统计学意义,4～6h时外淋巴液中已经检测不到甲泼尼龙。无论鼓室内灌注或明胶海绵圆窗给药后,在外淋巴液中检测到的甲泼尼龙浓度均明显高于心内注射给药者;鼓室内灌注或明胶海绵圆窗给药后,血浆中无可检测的甲泼尼龙。鼓室内灌注或明胶海绵圆窗给药后外淋巴液中甲泼尼龙的最高浓度出现于给药后1h 20min;在取材的每个时间点,鼓室内灌注给药后外淋巴液中的甲泼尼龙浓度均高于明胶海绵圆窗给药者,除4、6h外,两者相比差异有统计学意义。鼓室内灌注给药后外淋巴液中甲泼尼龙的生物半衰期t1／2=1．51 h,明胶海绵圆窗给药后甲泼尼龙t1／2=1．55h。结论：局部给药后甲泼尼龙能够有效地经圆窗膜渗透进入外淋巴液,并能达到明显高于全身给药后外淋巴液中的浓度。鼓室内灌注给药后外淋巴液中的甲泼尼龙浓度较高。     

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。     

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、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。     

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.     

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.     

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。     

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。     

等离子射频消融术在儿童阻塞性睡眠呼吸暂停中的应用和进展

精准微创的科学理念推动耳鼻咽喉头颈外科手术方式不断进步,等离子射频消融术的应用与发展为典型代表.分析等离子射频消融术在儿童阻塞性睡眠呼吸暂停手术(扁桃体腺样体切除术)中的使用特点,包括操作简便,手术时间短;术野清晰,出血量少;温度较低,避免热灼伤且创面光滑平整,术后疼痛轻,恢复正常饮食较早;术后白膜形成早,但在炎性细胞...     

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.     

Postoperative tonsillectomy bleed: coblation versus noncoblation

OBJECTIVE: To examine the incidence of postoperative bleeding after coblation and noncoblation tonsillectomy and to use postoperative bleeding as an outcome measure to determine the presence of a learning curve with this new surgical technique. STUDY DESIGN: A retrospective review of records from January 1999 to April 2003 to determine type of tonsillectomy performed and the presence of postoperative bleeding. A chi-square analysis was used to determine a statistical difference between the postoperative bleed rate of coblation and noncoblation procedures. The examined time period was divided into 3-month intervals, and the coblation postoperative bleeds were tallied for each interval. The Cochraine-Armitage test of linear trend was used to assess change in the postoperative bleeds. RESULTS: One thousand seven hundred sixty-two tonsillectomies were performed. The postoperative bleed rate for noncoblation tonsillectomy was 6.1% (74/1,216). The bleeding rate for coblation tonsillotomy was 5.9% (18/303) and 5.4% (13/239) for coblation tonsillectomy. There was no statistical difference (P = .93) between bleed rates for coblation versus noncoblation techniques. There was no difference in the need for operative intervention to control postoperative bleeding: 16.2% (12/74) for noncoblation technique and 25.85 (8/31) for coblation procedures (P = .25). The postoperative coblation bleed rates for the 3-month periods did not reveal an increasing or decreasing trend in the postoperative bleed rate (P = .49). CONCLUSION: Coblation is a safe procedure for performing tonsil surgery with no significant difference in postoperative bleeding from previous techniques and no increased need for operative intervention to control postoperative bleeding. A learning curve could not be identified when using postoperative bleeding as an outcome measure for coblation tonsillectomy.