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.     

双极电凝止血在全麻扁桃体手术中的应用

双极电凝止血在全麻扁桃体手术中的应用孙士铭，邵湘云扁桃体切除术中扁桃体床的有效止血，是预防术后出血的关键。结扎和电凝止血是两种常用的处理方法。我们於１９９０～１９９３年间应用双极电凝处理２５例扁桃体手术出血患儿，止血效果可靠，明显缩短手术和麻醉时间，...     

射频治疗扁桃体切除术中及术后出血42例

自１９９７年１０月至２０００年１０月，我科采用射频治疗扁桃体切除术中及术后出血４２例，效果良好，现将体会报告如下。1 临床资料4２例扁桃体剥离切除手术，男２５例，女１７例；年龄５～4８岁，其中６例为幼儿，在静脉复合麻醉下手术，其余均在局麻下施行；２例为鼾症行悬雍垂腭咽成形术；病史３～２０年；术前出、凝血时间检查正常。术中射频止血３６例，术后止血６例。2 治疗方法采用华南牌ＳＨＰ－Ⅰ型射频治疗仪，输出功率２５～６５Ｗ可调，时间设定７ｓ。选择直径为３ｍｍ的治疗探头。先用纱球压迫扁桃体窝出血部位，明确出血点…     

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。     

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。     

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。     

“预防性缝扎法”在扁桃体切除术中的止血效果

＂预防性缝扎＂是外科手术中比较有效、可靠的止血方式。一般的扁桃体手术都是先切除扁桃体,再止血。但是扁桃体下极的出血,再合并小颌、肥胖等特殊口腔结构的患者,会给止血带来很大的困难。我们应用＂预防性缝扎法＂,并配合电刀应用,在扁桃体切除术中止血效果良好,且预防了术后出血,报道如下。1资料与方法1.1临床资料2012年2月至2015年2月,烟台市北海医院耳鼻喉科共收治慢性扁桃体炎患者60例,其中男32例,女28例;5～68岁,平均28岁;病程1～6年;分成研究组（30例）和对照组（30例）。     

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。     

扁桃体术后出血的原因分析

目的：探讨扁桃体术后出血的常见原因,并提出相应的预防措施。方法：选取扁桃体切除术患者1192例,根据其是否发生术后出血分为两组,对两组患者的基本资料和治疗情况进行统计学分析。结果：扁桃体术后出血者中成年、男性患者,合并高血压、肝脏疾病,术前长期服用阿司匹林,术前长期使用肾上腺皮质激素,局部麻醉,术中采取纱球压迫止血,术后剧烈咳嗽,不合理进食,以及围手术期存在焦虑情绪的患者所占比例明显高于未发生出血者,两组比较差异有统计学意义（P〈0．05）。而患者是否合并糖尿病对其术后出血影响不大（P〉0．05）。经Logistic回归分析,焦虑,合并高血压、肝脏疾病,使用纱球压迫止血,术后剧烈咳嗽以及不合理饮食都是患者发生扁桃体出血的原因（P〈0．05）。结论：扁桃体术后出血与多方面的因素密切相关,在临床工作中应给予针对性的预防。     

ZT粘涂胶治疗扁桃体切除术后出血的临床观察

我科扁桃体切除术后出血率为8．7％（229／2632）．为寻找简易有效的止血方法，于1993年3月至1995年3月用ZT粘涂胶处理扁桃体切除术后出血178例，效果良好，报告如下．一、方法取净扁桃体南内凝血块，查明出血部位，先用干棉球压迫啻时止皿；后用干燥的小吸管吸ZT胶直接滴在创面上，这用明胶海绵涂薄，5～7秒钟即形成柔软而富有弹性的聚合体与组织粘合。用量为Icm21滴（约0．0259）。二、临床观察随机分下列3组，观察48小时中再出血例数．1．第一组为扁桃体切除术126例，其中63例创面涂ZT胶，无一例出血（0／63，0％）；另63例接传统法局…     

Sorbalgon藻酸钙敷料在功能性鼻内镜手术中的应用

目的：选择有效的鼻腔堵塞止血材料。方法：比较功能性鼻内镜手术凡士林纱条和Sorbalgon藻酸钙敷料鼻腔堵塞止血效果及堵塞后鼻腔反应情况。结果：应用Sorbalgon藻酸钙敷料止血效果好，头痛及鼻腔疼痛较轻，抽除堵塞物时鼻腔很少出血，术后鼻粘膜反应轻。结论：Sorbalgon藻酸钙敷料是一种良好的鼻腔，鼻窦手术后堵塞止血材料。     

扁桃体大小对悬雍垂腭咽成形术疗效的影响

目的：研究扁桃体大小对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者UPPP疗效的影响。方法：回顾性分析我科行UPPP手术的OSAHS患者54例,术后1年以上复查PSG确定疗效。结果：不同扁桃体大小组术前的各项指标（年龄、AHI、BMI、最低SpO2）;总体均数间差异无统计学意义（P〉0．05）,但术后各扁桃体组间疗效差异有统计学意义;扁桃体Ⅲ度患者最低SpO2提高明显;在重度OSAHS中,不同疗效组间的扁桃体大小构成差异有统计学意义。结论：扁桃体较大患者手术有效率较高,其最低SpO2也有显著改善;对于重度OSAHS亦应根据个体差异采取不同的治疗措施。     

扁桃体大小对悬雍垂腭咽成形术疗效评估的意义

目的：探讨扁桃体大小对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行悬雍垂腭咽成形术（UPPP）疗效评估的意义。方法：分析主要存在腭咽平面狭窄而行UPPP手术的60例OSAHS患者术后1年以上疗效、Epworth 嗜睡评分(ESS）、PSG主要指标的变化。结果：不同扁桃体大小组术前的各项指标(年龄、AHI、BMI、最低SaO2)总体均数间差异无统计学意义(P＞0.05)，但术后各扁桃体组间疗效差异有统计学意义(χ2＝4.28，P=0.039)；扁桃体Ⅰ度肿大组（A组28例）临床症状明显改善（包括显效和有效）17例，扁桃体Ⅱ、Ⅲ度肿大组（B组32例）临床症状明显改善27例。Epworth嗜睡评分：A组由术前的13.7±4.6下降为8.5±3.8(t=4.61,P=0.000?0),B组由术前的14.2±4.5下降为7.5±3.3(t=6.79,P=0.000?0)；但两组之间比较无明显差异（t=1.091?2,P=0.279?7）；多导睡眠监测（PSG）指标B组AHI下降更明显，两组比较有统计学差异（t=2.37,P=0.021）。两组最低SaO2及微觉醒指数提高明显，但两组之间比较无统计学差异。结论：扁桃体较大的OSAHS患者行UPPP手术有较好的治疗效果，其AHI也有更显著的改善。     

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.     

Malignant Melanoma Metastatic to the Tonsil

Metastasis to the oral cavity from melanoma arising in distant sites is very rare. The authors present three cases of melanoma metastatic to the palatine tonsil: two were cutaneous melanomas and one arose from the mucous membrane of the hard palate. Fewer than 30 cases of metastatic melanoma to the palatine tonsil have been reported, and none have been from mucosal melanoma originating from another mucosal primary site in the head and neck. From this perspective, one of the cases in this article is unique. The authors present clinical histories of the three cases of melanoma metastatic to the palatine tonsil. Two patients were still alive a substantial time after treatment. The case presentations indicate that careful examination of the head and neck should be part of the routine follow-up examination in all melanoma patients.     

Pediatric coblation total tonsillectomy: intracapsular or extracapsular?

Objectives: To compare the results of coblation intracapsular total tonsillectomy (CITT) with those of conventional coblation extracapsular total tonsillectomy (CETT) in the treatment of tonsillar hypertrophy in children with regards to efficacy and complications.

Methods: Ninety children with adenotonsillar hyperplasia underwent tonsillectomy?±?adenoidectomy (48 CITT and 42 CETT). Intraoperative situation was observed and recorded. Patients were reexamined regarding recovery condition and tonsil regrowth, and were followed for at least one year.

Results: Significant differences were observed in four clinical features when the CITT group was compared with the CETT group: intraoperative bleeding score, intraoperative tonsillar fossa score, color of white membrane one day postoperatively, and visual analogue scale (VAS) value one week postoperatively (p?p?p?Conclusions: Compared with conventional extracapsular tonsillectomy, CITT has the advantages of decreased pain and bleeding, and promote healing of wounds. No tonsillar regrowth was observed after at least one year of follow-up.     

The historical review of the adenotomy

The opinions of famous foreign and also such Polish physicians as Jan Sedziak, W?adys?aw Wr6blewski, Zdzis?aw Dmochowski on problem of removal of hypertrophic pharyngeal tonsil are presented first of all. An unsuccessful trials of conservative treatment are pointed out. Adenotomy was preformed in general anaesthesia, especially by chloroform, in "half-anaesthization", in local anaesthesia. The problems of anaesthesia are presented widely. The various method of removal of hypertrophic pharyngeal tonsils by forceps, by curettes, by loops, by nail are depicted with full particulars. The Loewenberg's forceps in various modifications, the Gottstein's curette and later the Beckmann's and La Force's adenotoms were best. The problem of rinsing of nose after the operation and influence of this rinsing on complications in auditory organ, the problem of postoperative relapses are discussed. The postoperative complications after adenotomy, bleeding and haemmorhage early and late, running of bits of tonsil into larynx, the inflammations of upper respiratory tract are also presented. The Jan Miodoński's and Jan Danielewicz's modern opinions at a performance of problem of adenotomy are depicted finally.     

Bacteremia during tonsillectomy

OBJECTIVE: To investigate bacteremia in patients who underwent tonsillectomy with a dissection method due to chronic tonsillitis, which may lead to dramatic results in patients that have a cardiovascular infection risk. In this study, it was explored whether the tonsil surface and the tonsil tissue interior microorganisms are different or not, and whether these microorganisms carry bacteremia development risk. METHODS: Forty patients were enrolled in the study in ENT Clinic, Firat University. A bacteriological research was performed on patients with no treatment with antibiotics for a month before the operation. Tonsil surface and deep tissue cultures were performed, and venous blood samples were taken for cultures before and after the operation. RESULTS: Surface and deep tissue cultures of tonsils of the cases represented a different result in 27.5% of the patients. No reproduction was observed regarding the blood cultures taken before tonsillectomy. Bacteremia was found in blood samples of ten patients (25%) taken immediately after tonsillectomy. CONCLUSION: Hence, it has been concluded that different microorganisms may be present among the tonsil surface and tonsil deep tissue cultures and that bacteremia may develop after tonsillectomy. Therefore, to prevent the possible dramatic outcomes after tonsillectomy the required measures during the preoperative period should be taken into consideration, especially in patients that have chronic tonsillitis with cardiovascular disease.     

儿童阻塞性睡眠呼吸暂停低通气综合征的治疗

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome，OSAHS)患儿的治疗方法和疗效观察。方法经多道睡眠监测(polysomnography，PSG)确诊的4～12岁OSAHS患儿59例：扁桃体切除和(或)经口内镜(内窥镜，下同)引导下腺样体刮除54例；选择长期正压通气治疗(continue positive airway pressure，CPAP)2例；保守治疗3例。采用儿童OSAHS生活质量调查表(quality of life for children with obstructive sleep apnea 18 items，OSA-18)对患儿进行治疗前后的随访。结果围手术期无术后出血、急性呼吸道梗阻发生。随访12～18个月，手术患儿无鼻咽闭锁、咽鼓管功能障碍、腺样体残留等并发症；OSA-18调查评分显示：治疗后76．3％(45例)的患儿生活质量总体指标，88．1％(52例)的患儿睡眠呼吸障碍，67．8％(40例)的患儿身体症状得到显著改善。长期CPAP治疗的有效治疗压力在5．6～7．8cm H2O左右。3例保守治疗者略有改善。结论手术切除引起上气道阻塞的肥大的扁桃体和(或)腺样体是儿童OSAHS有效的治疗手段之一，纤维鼻咽镜检查、头颅侧位X线摄片有助于手术适应证的确定。经口内镜引导下腺样体刮除术具有直视下操作，视野清晰，切除彻底，可避免损伤周围重要结构的特点。