Ligation vs. bipolar diathermy for haemostasis in tonsillectomy—a comparative study

The use of diathermy for haemostasis in Tonsillectomy remains controversial. A thorough scan of English literature comparing the ligation with diathermy has been presented. The reasoning of using Bipolar instead of Unipolar is explained. A prospective randomized study of 376 tonsillectomy is being presented. This is the first study in India where Bipolar instead of Unipolar diathermy is being used. No significant difference was found in P.O. Hg. rates when either diathermy or ligatures were used. Diathermy is significantly faster method of securing haemostasis resulting in shorter operative a & anesthetic time, thus saving on cost. Long term follow-up has shown better results with diathermy & is associated with less pharyngitis, hyper-trophied nodes & resulis in more smooth tonsillar fossae.     

双极电凝镊在扁桃体摘除术中的应用

目的：通过比较采用双极电凝镊与传统的剥离法实施扁桃体摘除的手术效果,探讨双极电凝镊在扁桃体摘除术中的应用效果。方法：选取行扁桃体手术摘除的患者100例,前瞻性地分为两组,比较手术时间、术中出血量及术后患者并发症、疼痛程度及恢复时间。结果：用双极电凝镊行扁桃体摘除与普通法扁桃体摘除相比,手术时间短,术中出血少,术后并发症发生率低,患者痛苦轻。结论：采用双极电凝镊扁桃体摘除手术效果明显优于普通剥离法扁桃体摘除,两方法术后恢复时间无统计学差别。     

双极电凝在全身麻醉下扁桃体摘除术中的应用

目的 探讨双极电凝在全身麻醉下扁桃体摘除术中的应用效果。方法 全身麻醉下采用双极电凝、单极电刀与传统剥离法实施扁桃体摘除,三种术式共实施扁桃体摘除65例。比较各术式对应的手术时间、术中出血量及术后并发症、疼痛程度及恢复时间。结果 用双极电凝镊行扁桃体摘除在包埋型扁桃体、扁桃体周围明显粘连患者中与单极电刀及传统的剥离法扁桃体摘除相比,术时短,术中出血少,术后并发症发生率低。结论 全身麻醉下,采用双极电凝扁桃体摘除手术尤其适用于包埋型扁桃体以及扁桃体周围明显粘连的患者。     

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.     

Blunt dissection versus electronic molecular resonance bipolar dissection for tonsillectomy: operative time and intraoperative and postoperative bleeding and pain

OBJECTIVE: To compare operative time, intraoperative and postoperative bleeding and pain using two different techniques for tonsillectomy: electronic molecular resonance bipolar tonsillectomy and blunt dissection tonsillectomy. METHODS: From January 2005 to December 2006, a prospective, randomised study was performed in 800 children, aged from 3 to 10 years, admitted to the ENT (Ear Nose Throat) Unit of Giannina Gaslini Institute, Genoa, Italy to undergo tonsillectomy. Patients were randomised into two surgical groups, Group A (electronic molecular resonance tonsillectomy, EMRBT) and Group B (blunt dissection tonsillectomy). Operative time, intraoperative blood loss and postoperative complications were recorded. During 10 days after surgery, children and their parents were also asked to provide a rating of the patients' current pain intensity using a visual analogue scale. In this period, the parents were also asked to note the analgesic drugs administered. RESULTS: Duration of surgery and blood loss were significantly much lower in the group undergoing electronic molecular resonance bipolar tonsillectomy (p<0.0001). Postoperative pain scores resulted significantly different between the two methods on days 5 (p=0.05) and 8 (p=0.001) in evaluations by mothers. Moreover, in evaluations by patients pain scores resulted significantly different between the two methods on days 3 (p=0.02), 8 (p=0.005) and 9 (p=0.01). We found no difference between boys and girls in pain scores in the 10 days considered, nor between children older than 5 yrs and children younger than or aged 5 years. No statistically significant differences between the two techniques were found in the use of analgesics in all postoperative evaluations. CONCLUSIONS: This study showed that the use of electronic molecular resonance bipolar tonsillectomy, compared to blunt dissection, has several advantages. Reduced operative time and intraoperative bleeding make EMRBT more cost effective and allow an increased number of operations. Concerning postoperative pain, the two techniques did not present significant differences in the use of analgesics. The number of postoperative bleeding episodes was also similar in the two groups of patients.     

Randomized study comparing postoperative pain between coblation and bipolar scissor tonsillectomy

Coblation tonsillectomy has shown promising results with respect to postoperative pain when compared with other techniques. Our study was designed to compare this technique with bipolar scissor tonsillectomy. Forty adult patients with a history of chronic or recurrent tonsillitis referred for standard tonsillectomy were recruited and randomized into two groups. Twenty were operated with Coblator and 20 with bipolar scissors. Exclusion criteria were a history of quinsy, bleeding disorder, or any major health problems. All participants completed the study. Postoperative pain, return to normal diet, and estimated need for sick leave were utilized as parameters. Data on operative time, difficulty of tissue removal, and hemostasis were also analyzed. Operative time was longer (P < 0.001) and tissue removal as well as hemostasis control were more difficult (P = 0.005, P = 0.013) with Coblator than with bipolar scissors. Participants in Coblator group assessed higher pain scores 1 and 3 h postoperatively (P = 0.044, P = 0.036). From the time of extubation, patients had access to an opioid (fentanyl) via a self-controlled analgesia device. The number of doses of analgesics needed during the hospital stay was significantly higher in the Coblator group (P = 0.020). During the 14-day follow-up, no significant differences were found in pain scores, return to solid food or subjective working ability between the groups. Considering the overall outcome of the patients the results did not favor coblation technique over bipolar scissors.     

Post-operative bleeding is less after partial intracapsular tonsillectomy than bipolar total procedure

Objective

To compare bleeding after partial intracapsular tonsillectomy (PIT) and bipolar diathermy tonsillectomy (BDT).

Design

Retrospective chart review.

Setting

Stollery Children's Hospital, tertiary pediatric referral centre.

Patients

All children (≤17 years of age) who had tonsillectomy. Patients who had incomplete information or less than 2-weeks follow-up were excluded.

Main outcome measure

(1) Post-tonsillectomy bleeding, (2) other data collected included demographics, length of follow-up, indication(s) for surgery, other procedures performed, and co-morbidities.

Results

Over a 4.5-year period 677 patients (333 BDT, 344 PIT) were identified in our search, and 77 (38 BDT, 39 PIT) were excluded. The mean age was 7.7 ± 3.8 years in the BDT group and 6.5 ± 3.2 years in the PIT group. Sex distribution was similar in the 2 groups (chi square p = 0.61). Twenty (6.8%) BDT patients experienced post-tonsillectomy bleeding, compared to three (0.98%) of PIT patients (p = 0.0001, 95% CI 1.52-2.18, OR = 7.32). Over 3 times as many PIT patients (153) had co-morbid conditions than BDT patients (44); this was statistically significant (chi square p < 0.00001, 95% CI 1.78-2.38).

Conclusion

PIT results in significantly less post-tonsillectomy bleeding than BDT. These findings favor partial over total techniques with respect to reducing this important complication.     

地塞米松在成人扁桃体切除术后镇痛中的应用研究

目的 研究地塞米松在成人扁桃体切除术后镇痛中的应用效果。方法 选取行双侧扁桃体切除术的成人患者97例为研究对象,随机分为实验组（应用地塞米松）和对照组（不应用地塞米松组）。记录患者自手术当天至术后第6天的每日局部疼痛情况并进行评分。结果 在手术当天至术后4天,实验组的术后局部疼痛程度比对照组有较明显的减轻,差异有统计学意义;但在术后第5、6天,两组差异无统计学意义。结论 成人扁桃体切除术后应用地塞米松,可以较好地减轻手术当天至术后第4天的疼痛。     

A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis.

OBJECTIVES: To compare postoperative recovery in children between 4 and 12 years undergoing tonsillectomy, using either coblation tonsillectomy or dissection tonsillectomy with bipolar diathermy haemostasis. DESIGN: A prospective, single blind, randomised controlled trial. SETTING: ENT clinic, University Teaching Hospital. PARTICIPANTS: Forty paediatric patients, aged between 4 and 12 years and between 16 and 60 kg in weight with standard indication for tonsillectomy. METHODS: Patients were randomly allocated to either coblation tonsillectomy or dissection tonsillectomy groups. Patients, parents, and nurses were blinded for operation method. Parents were asked to fill out a postoperative diary from 1 to 10 days. MAIN OUTCOME MEASURES: Primary outcomes were scored for postoperative pain, nutrition, activity, and use of analgetics for each of the 10 postoperative days. Secondary outcomes were estimated from the nurses' postoperative data and 10-day follow-up statistics regarding crossing of the two-score limit. RESULTS: The groups were statistically comparable by age, weight and operation type. There was no significant difference in operation time in two groups. Intra-operative bleeding was significantly less in the coblation group. Statistically significant differences between dissection tonsillectomy and coblation tonsillectomy were found in the day when a score of two of five was passed in pain scores (9.6 versus 6.2), nutrition scores (8.9 versus 6.6), activity score (8.4 versus 6.6) and medicine intake (9.4 versus 6.4), We found parallelism, between regression lines, that indicates better postoperative life quality for the coblation tonsillectomy group and approximately 2 days' shorter recovery time. CONCLUSION: In our pilot study, patients undergoing coblation tonsillectomy reported less pain, quicker return to normal diet, quicker return to normal activity, and less use of analgetics over a 10-day period than patients undergoing dissection tonsillectomy. Our results indicate that the recovery period for coblation tonsillectomy was approximately 2 days shorter and demonstrated less morbidity.     

超声刀在扁桃体切除手术中的应用

目的 通过与常规扁桃体剥离术比较,探讨超声刀辅助扁桃体切除术的优缺点.方法 88例成人扁桃体切除适应证患者分为超声刀组(42例)和对照组(46例).超声刀组通过超声刀行扁桃体切除术,对照组则采用常规扁桃体剥离术.记录完整切除扁桃体所用的时间和术中出血量、术后咽痛等情况.结果 超声刀组平均((x-)±s,下同)手术时间(14.7 ±4.0) min比对照组(28.9 ±.7.6)min短,术中出血量(3.1±1.1)ml较对照组(19.0 ± 5.2) ml少,差异均具有统计学意义(t值分别为-10.691和-19.544,P值均＜0.05).超声刀组术后当天10 h内疼痛轻于对照组,但术后3d后咽痛较对照组明显,多数患者持续时间较长(秩和检验P值均＜0.05).常规剥离法扁桃体白膜脱落平均时间为术后8d,而超声刀组平均为11d,两者比较差异有统计学意义(t=5.115,P＜0.05).结论 超声刀扁桃体切除术具有手术时间短、术中出血量少等优点,但术后咽痛症状存留时间较长,且白膜脱落时间迟,需避免饮食不当造成继发性出血.     

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。     

Evaluation of early postoperative morbidity in pediatric tonsillectomy with the use of sucralfate

OBJECTIVE: The objective of this study is to evaluate the efficacy of sucralfate in alleviating posttonsilectomy morbidity in a pediatric group of patients. METHODS: A prospective, double-blind, randomized, and placebo-controlled study comparing the irrigation of a solution containing either 1g of sucralfate (study group) or 1g of lactulose (control group) was performed on 69 children aged 3-12 years, who underwent tonsillectomy at the University Hospital of Brasilia Medical School. The children were randomly assigned and each one used a solution containing sucralfate or lactulose to swish and swallow four times daily during 7 days. Eleven patients were excluded. The anesthetic was standardized and no premedication was used. Pain magnitude using an "Oucher" scale, nausea, vomiting, bleeding, earache, analgesic drug intake, changes in the interincisor teeth distance, and changes in the weight and temperature were assessed by the surgeon 6, 24h, and 7 days after the surgery. RESULTS: Patients in the study group had significantly lower pain scores in the initial 6 postoperative hours (p<0.05). The difference between the two groups was not statistically significant for the other periods following the procedure or on the evaluation of the other indices. CONCLUSIONS: The use of the sucralfate in pediatric patients undergoing tonsillectomy was not effective in reducing the postoperative morbidity according to the parameters used in this study. The surgical technique with careful mucosal dissection associated with postoperative caries could be more important in the reduction of posttonsilectomy morbidity.     

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。     

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。     

部分或整体扁桃体等离子射频切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征疗效对比

目的 探讨利用等离子射频技术切除部分或全部扁桃体,以治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的可行性及疗效观察。方法 将参与对比的儿童OSAHS患者239例分为两组。A组183例,行等离子射频扁桃体切除术和腺样体切除术;B组56例,行等离子射频扁桃体部分切除术和腺样体切除术。分别对比两组手术时间、术后3d内每天的疼痛度、恢复正常进食的时间。结果 B组在手术时间、术后疼痛度、恢复正常进食时间均低于A组(U=2.685, 582.00, 84.00, 2519.00, 306.00, P<0.05)。随访6～12个月,两组患者睡眠打鼾、张口呼吸均消失。结论 利用等离子射频方法,部分扁桃体切除术比全部扁桃体切除治疗儿童OSAHS疗效较好。     

Histological study of routine tonsillectomy specimen

Introduction  Palatine and nasopharyngeal tonsils are lymphatic flesh clusters of tissue of the respiratory and digestive tract’s epithelium. There is not much literature pertaining to the histological assessment of resected tonsils though anecdotal case reports of choristoma, squamous cell cysts of the tonsil have been reported which mimicked chronic tonsillitis. Tonsils also are an important site for head and neck cancer in adults. Aim & objective  To study the histological features of routine tonsillectomy specimens and to study for the presence of choristomatic tissue or any other benign pathology as a cause of chronic tonsillitis. Patients & methods  Fifty consecutive tonsillectomy specimens, which were received in the department of Pathology, Gandhi Medical College, were evaluated with regards to clinical information. Among 50 patients, a slight predominance of men (56 %) over women (44 %) was observed. Conclusion  The mesenchymal tissue consisted mainly of epithelium and lymphoid tissue with cartilage in a single case and fat in three cases. The role of imaging techniques, in assessing the need for early surgical intervention in cases with chronic tonsillitis, can be determined by assessing the micropathology of tonsillectomy specimens and is an arena for further research. We discussed the role of FDG-PET scan in the assessment of the same.     

The use of dexamethasone to reduce pain after tonsillectomy in adults: a double-blind prospective randomized trial

OBJECTIVES/HYPOTHESIS: To determine the effectiveness of dexamethasone to reduce pain after tonsillectomy in adults by at least 13 mm on the visual analogue scale. The secondary objective was to reduce the use of narcotics by at least 20%. STUDY DESIGN: This multicentric study is a prospective double-blind randomized controlled trial. METHODS: A total of 102 patients were enrolled and received a 4-day trial either of dexamethasone in decreasing doses or placebo. The patients were asked to note the level of pain on the visual analogue scale daily for 7 days. They also had to record their consumption of analgesic and any eventual side effects. RESULTS: There were no statistically or clinically significant differences between the two groups for the level of pain noted on the visual analogue scale for the first 4 and 7 days. There were no statistical differences for the consumption of hydromorphone between the two groups. CONCLUSION: We cannot recommend the use of dexamethasone on a routine basis following tonsillectomy in adults for the reduction of pain or narcotics consumption.