扁桃体术后封闭术腔的止血方法效果分析

目的 探讨扁桃体切除术后有效的止血方法.方法 总结我院2006年5月-2010年9月286例全麻下行扁桃体切除术患者的临床资料,所有患者均行扁桃体剥离术,其中男性182例,女性104例,年龄6-55岁,扁桃体切除后全层间断缝合法封闭扁桃体窝146例,棉球压迫止血45例,电凝止血95例.结果 全层间断缝合法封闭扁桃体窝术后24小时无一例出血,棉球压迫止血术后24小时出血6例,电凝止血术后24小时出血2例.结论 以全层间断缝合法封闭扁桃体窝对预防扁桃体切除术后出血效果较好,术后恢复更快,并对防止术腔感染、保持扁桃体窝的形态有积极意义.     

多点电凝消融治疗扁桃体肥大为主所致儿童鼾症的体会

目的观察多点电凝消融法治疗扁桃体肥大为主所致儿童鼾症的疗效。方法44例扁桃体肥大为主所致鼾症患儿,21例接受扁桃体多点电凝消融手术治疗(A组),另23例实施传统扁桃体剥离术做为对照(B组)。所有患儿术后均随访1年以上,比较分析2组的疗效及术式优缺点。结果 A组显效76%,有效24%,未见扁桃体残留;手术时间(15±2)分钟;出血量(3.0±0.5)ml。B组显效87%,有效13%;手术时间(28±2)分钟;出血量(35±4)ml。两组比较差异有明显统计学意义(P0.01)。术后创面白膜脱落时间两组无明显差异(P0.05),术后疼痛等不适反应B组明显重于A组(P0.01),且B组并发术后出血可能较大。结论多点电凝消融治疗扁桃体肥大具有操作简便、手术时间短、出血少、术后不适反应轻,疗效显著等优点,并能保留扁桃体免疫功能,值得临床推广应用。     

三种不同扁桃体切除术疗效比较

目的 探讨比较冷器械切除+缝合术、单极电凝切除术、等离子射频术三种不同手术方法切除扁桃体的疗效。 方法 将扁桃体切除术患者分为三组,冷器械切除+缝合术(A组)65例;单极电凝切除术(B组)40例;等离子射频切除术(C组)38例。记录扁桃体切除手术总时间、术中出血量、疼痛评分,术后复查时观察扁桃体白膜状况。 结果 A、B、C三组的平均手术时间分别为58.8 min、27.0 min、23.7 min;术中平均出血量分别为34.2 mL、16.1 mL、12.5 mL;术后3 h和术后第1天的疼痛评分之间,差异均有统计学意义。 结论 与冷器械切除+缝合术和单极电凝切除术相比,等离子射频术切除扁桃体费用较高,但其手术时间短,术中出血量少,术后疼痛程度小。     

扁桃体切除术后24小时回家?

在英格兰和威尔士,扁桃体切除术后平均留院3.8天,而扁桃体切除后早期出现的唯一严重并发症是反应性出血,本文研究旨在说明扁桃体切除术后可提前到什么时候能安全地回家。利物浦的 Alder Hey 儿童医院在1970～1982年间大约作了4500例扁桃体切除术。随机抽取250名儿童作为样本,年龄范围2～15岁,平均7.8岁,40%在6岁以下。其中有36名患儿曾因反应性出血回手术窄止血,有9例资料丢失,余27例可供分析。24例出血是在扁桃体窝,3例在腺样体窝,无一死亡。27例中有24例出血发生在术后5小时以内,24小时后无出血者。     

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。     

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。     

超声刀扁桃体切除术的临床病理研究

目的　探讨超声刀扁桃体切除术的临床应用价值。方法　将40例需行扁桃体切除术的患者分为2组,采用自身对照。A组30例,患者右侧行超声刀扁桃体切除术,左侧行传统扁桃体剥离术;B组10例,右侧行超声刀扁桃体切除术,左侧行针式电刀扁桃体切除术。记录患者左右两侧的手术时间、术中出血量、白膜开始脱落的时间、术后出血发生率及疼痛评分。光学显微镜下观察扁桃体组织的损伤程度并测量其损伤深度。结果　A组超声刀的术中出血量、手术时间、术后疼痛均优于传统手术,但白膜开始脱落的时间稍延迟,差异有统计学意义;B组超声刀的术中出血和手术时间优于针式电刀,而术后疼痛、白膜开始脱落时间两者相比差异无统计学意义;两组患者的术后原发性及继发性出血率差异无统计学意义;3种术式对扁桃体组织的热损伤深度中位数分别为0.60、0.25、0.53 mm,差异有统计学意义。结论　超声刀扁桃体切除术是一种安全、有效的手术方式,值得临床推广应用。     

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。     

运用单极电刀与传统方法实施扁桃体切除术治疗睡眠呼吸暂停综合征疗效比较

目的 比较分析单极电刀扁桃体切除术与传统扁桃体剥离术的疗效,区别优缺点。方法 由于扁桃体肥大引起阻塞性睡眠呼吸暂停低通气综合征(OSAHS)或慢性扁桃体炎而需要切除双侧扁桃体的患儿80例,实施双侧扁桃体切除治疗。其中行单极电刀扁桃体切除术40例（A组）,行传统扁桃体切除术40例（B组）。分析两个组在手术时间、术中出血量、术后疼痛程度方面的差异。结果 两组在手术时间、术中出血量方面差异有统计学意义（P<0.05）;疼痛程度差异无统计学意义。两组患儿术后均未发生出血。结论 单极电刀切除儿童扁桃体安全,术中出血量少,手术效率提高。     

等离子扁桃体切除术与常规剥离法扁桃体切除术之比较

目的:比较等离子扁桃体切除术与常规剥离法扁桃体切除术对患者术中、术后的影响。方法:随机将56例患者分为等离子组和对照组,等离子组用低温等离子射频消融系统连接EVac70刀头,能量设置为6,切除扁桃体;对照组则采用常规剥离法扁桃体切除术,手术均由同一术者完成。记录两侧扁桃体切除所需时间和出血量;术后第1天至第10天患者每日记录咽部疼痛情况,恢复正常活动时间和正常饮食时间;术后第10天,医师观察并记录扁桃体窝内的白膜状况。结果:等离子组手术时间比对照组短,术中总出血量<10ml,而对照组平均出血量为(119±43)ml;等离子组患者术后疼痛轻于对照组,且比对照组更早恢复正常饮食;2组患者恢复正常活动时间的差异无统计学意义;等离子组较对照组白膜脱落慢。等离子组有1例患者于术后第7天口咽部有活动性出血,需缝扎止血。结论:等离子扁桃体切除术与剥离法相比,患者术后疼痛明显减轻,出血量极少,手术方法容易掌握,但扁桃体窝愈合的时间较长。     

Bleeding following tonsillectomy. A study of electrocoagulation and ligation techniques.

The efficiency of electrocoagulation (spot or zonal) and ligation for the control of bleeding was compared in 376 patients with tonsillectomy. Electrocoagulation and ligation was used in the same number of patients (188) in each group. A notable reduction in operative time (40%) was seen in cases in which spot or zonal electrocoagulation was employed. More morbidity was found in cases treated with zonal electrocoagulation. Both techniques were concluded to be equally effective in the control of bleeding following tonsillectomy.     

Harmonic scalpel tonsillectomy using the curved shears instrument versus cold dissection tonsillectomy: a retrospective study

OBJECTIVES: We compared operating time, intraoperative blood loss, and rate of postoperative bleeding in harmonic scalpel (HS) tonsillectomy using the curved shears instrument to those in cold dissection (CD) tonsillectomy. METHODS: The charts of 560 patients who underwent tonsillectomy were retrospectively reviewed. Three hundred nineteen patients underwent CD tonsillectomy between the years 1998 and 1999, and 241 patients underwent HS tonsillectomy using the curved shears instrument between the years 2001 and 2005. For the purpose of evaluation of postoperative bleeding rates, the groups were further stratified by age (11 years of age or less versus 12 years of age or more). RESULTS: For the HS group, the mean operating time was shorter (7 minutes versus 17.57 minutes) and the intraoperative blood loss was lower (0 mL versus 42.12 mL). These differences were statistically significant (p < .05). There was no significant difference in the overall postoperative bleeding rates between the two groups. The postoperative bleeding rate in the HS patients 11 years of age or younger was lower than that in the equivalent age group in the CD group (0.56% versus 2%, respectively), although this difference did not reach statistical significance. The postoperative bleeding rate in the HS patients 12 years of age or older was significantly higher than that in the equivalent age group in the CD group (7.93% versus 1%, respectively; p < .05). CONCLUSIONS: Harmonic scalpel tonsillectomy using the curved shears instrument offers advantages over CD tonsillectomy regarding operating time and intraoperative blood loss. In our patients more than 12 years of age, HS tonsillectomy using the curved shears instrument was associated with an increased postoperative bleeding rate compared to CD tonsillectomy.     

Postoperative pain in tonsillectomy: comparison of ultrasonic tonsillectomy versus blunt dissection tonsillectomy

Intraoperative blood loss, postoperative pain, and postoperative appetite were compared between 15 adult patients who underwent tonsillectomy using an ultrasonically activated scalpel (UT) and 15 adult patients who underwent blunt dissection tonsillectomy with cold steel instruments (BT). The average intraoperative blood loss of the UT group was 4.6 +/- 1.9 ml (mean +/- standard deviation), while that of BT group was 41.9 +/- 12.9 ml. This difference was highly statistically significant (p < 0.0001). In contrast, there were no significant differences in the VAS pain and appetite scores between patients who underwent UT and those who underwent BT on any day in the 6-day postoperative period. Our current results show that UT is a safe technique, and we believe that it should be considered a useful alternative for tonsil surgery.     

Nachblutungsrisiko bei Tonsillektomie Ein Vergleich zwischen Vollnarkose und lokaler Betäubung

BACKGROUND: Postoperative bleeding after tonsillectomy is still a life-threatening problem. The incidence of postoperative bleeding, as well as many factors (kind of surgery, hemostasic problems) affecting this risk have been investigated. A possible factor that has not been well studied is the used anaesthetic procedure. METHODS: A prospective study was completed comparing the risk of postoperative bleeding in patients operated in local vs. general anaesthesia. RESULTS: The study enrolled 1063 patients, who consecutively underwent tonsillectomy. In 16 (4.12%) of 388 patients operated under general and 51 (7.55%) of 675 patients operated under local anaesthesia postoperative bleeding occurred. After local anaesthesia postoperative bleeding was seen mainly at the day of operation (46 of 51), there was no late bleeding after the 6th postoperative day. After general anaesthesia in 6 of 16 cases postoperative bleeding occurred after the 6th postoperative day. DISCUSSION: Postoperative bleeding occurs more frequent in patients who underwent tonsillectomy in local anaesthesia. The risk of late postoperative bleeding however is higher with tonsillectomy in general anaesthesia.     

低温等离子刀辅助内镜下儿童扁桃体和腺样体切除术临床效果分析

目的:比较低温等离子刀辅助内镜下切除儿童扁桃体和腺样体(rT+A)和传统剥离法切除扁桃体、刮匙法刮除腺样体(cT+A)的手术效果差异.方法:47例扁桃体肥大伴腺样体肥大的患儿,其中24例采用rT+A术式,23例采用cT+A术式,采用t检验比较两组手术时间、术中出血量、术后疼痛时间和假膜脱落时间的差异.随访患儿手术前后听...     

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。     

Local bupivacaine-epinephrine infiltration combined with general anesthesia for adult tonsillectomy

CONCLUSION: Use of a solution of bupivacaine (5 mg/ml)-epinephrine (5 microg/ml) (BE) is beneficial in reducing intraoperative bleeding and decreasing the operation time in adult (adeno)tonsillectomy patients. OBJECTIVE: Pain and intra- and postoperative bleeding are problems associated with tonsillectomy/adenotonsillectomy. In order to make tonsillectomy/adenotonsillectomy better suited to outpatient surgery, solutions to these problems should be found. One possibility may be the combination of local and general anesthesia. The aim of this study was to find out if such a combination is beneficial in tonsillectomy/adenotonsillectomy. MATERIAL AND METHODS: We performed a prospective, randomized, double-blind, controlled study on 64 adult (adeno)tonsillectomy patients to investigate the possible benefits of infiltrating the peritonsillar space with a BE solution. RESULTS: In the recovery room, the BE group experienced less pain than a control group infiltrated with saline; subsequently there was no significant difference between the groups concerning pain. The average volume of intraoperative bleeding and the operation time were significantly smaller in the BE group. Postoperative bleeding from the tonsillar fossae occurred in 19% (6/31) of the patients in the BE group and in 18% (6/33) in the saline group.     

自制金属圆棒与双极电凝治疗鼻中隔偏曲矫正术中腭大动脉出血的疗效比较

目的 探讨自制金属圆棒与双极电凝在鼻中隔矫正术中腭大动脉出血止血的疗效。 方法 选取2013年5月至2016年8月住院行鼻中隔矫正手术的患者60例,符合入选标准的患者按照入院顺序,采用随机数字表法分为两组,A组(30例)采用圆棒砸平上颌骨棘突腭大动脉处,B组(30例)采用双极电凝止血上颌骨棘突腭大动脉处。比较两组腭大动脉出血量、止血时间及两组因腭大动脉出血形成血肿的例数。 结果 A组患者止血时间为(1.93±0.94)min;B组止血时间为(5.96±1.62)min。A组出血量为(25.5±10.5)mL, B组为(72.0±17.6)mL。 A组未出现血肿,B组血肿3例。 结论 自制金属圆棒砸平鼻中隔上颌骨鼻棘腭大动脉处止血时间较双极电凝组少,出血量少,术后腭大动脉继发性出血少,经济性高,值得在临床上推广应用。     

Immediate abscess tonsillectomy — a safe procedure?

Objective: Peritonsillar abscess is the most common infection involving deep neck planes to be treated by otolaryngologists with varying management strategies. In some countries, like Japan, immediate tonsillectomy is considered only for selected cases due to the risk of post-operative complications. Post-tonsillectomy bleeding is considered as the major complication following surgery and serves as a landmark for the safety of the operation. The purpose of this study was to evaluate if there is an increased risk of post-tonsillectomy haemorrhage following immediate tonsillectomy in non-selected patients. Methods: A retrospective study was performed on 6329 patients who underwent tonsillectomy, with or without adenoidectomy, in St. Anna Hospital, Duisburg, between January 1988 and August 2000 to evaluate the complication rate following 1481 immediate tonsillectomies (group A) compared to 4848 patients who underwent elective tonsillectomy (group B). 56.9% (group A) were male, the youngest patient was 18 months, the oldest 87 years old. Patients of group B were younger in general (mean age: 18.7 vs. 32.9 years), 49.9% were male, between 5 months and 93 years of age. Patients of both groups underwent surgery under general anaesthesia and were observed for 6 days. The incidence of post-tonsillectomy haemorrhage in both groups was compared using χ²-test, the age distribution was compared by Mann-Whitney U-test. Results: Bleeding occurred in 43 patients of group A (2.9%) and 138 patients (2.8%) of group B. Excessive bleeding requiring ligature of the external carotid artery became necessary in one patient of group A (0.13%) and four patients of group B (0.08%). A 42-month-old patient (group B) died due massive haemorrhage at home 6 days after surgery. The latest bleeding occurred 12 (group B) and 13 days (group A) after surgery. Statistical evaluation (Pearson χ²-test P=0.908) shows no significant difference of post-operative bleeding between the compared groups. Post-tonsillectomy haemorrhage occurred with statistical significance (P<0.001) in elder patients after immediate tonsillectomy. Conclusions: We conclude, that immediate tonsillectomy can be recommended as a safe surgical procedure in non-selected patients to evacuate quinsy without an additional risk of bleeding thus making a second hospital stay unnecessary.