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。

Comparison of three surgical methods in adult patients undergoing tonsillectomy

Objective To compare and analyze the clinical application value of three surgical methods in adult patients undergoing tonsillectomy.Methods Ninety patients who received tonsillectomy were divided into coblation tonsillecto-my (coblation group,n=30),electrocautery tonsillectomy (electrocautery group,n=30),and conventional tonsillec-tomy (conventional group,n=30 ).The duration of the entire operation,amount of intraoperative and postoperative bleeding,postoperative sore throat assessed using a visual analogue scale(VAS),and hospital costs were all recorded in three groups.Results Significant difference was shown among three groups by comparison to the operation time, amount of blood loss and the VAS scores of postoperative pain 1-4 d after surgery (P<0.001),in which the above in-dexes of coblation group and electrocautery group were all superior to those of conventional group (P<0.001 ),but there was no statistical significance between coblation group and electrocautery group (P>0.05).One patient encoun-tered primary hemorrhage after surgery in conventional group,whereas no postoperative hemorrhage in coblation group and electrocautery group.There was no statistical significance among three groups by comparison to the nursing and ex-amination/treatment expenses as well as postoperative charges for medicine(P>0.05).The total hospital cost in elec-trocautery group and conventional group was obviously lower than that in coblation group (P<0.001),but no signifi-cant difference was shown between electrocautery group and conventional group (P>0.05).Conclusion Each of the three surgical methods in adult tonsillectomy has its own advantages and disadvantages.In the clinical practice,the most appropriate surgical method should be selected so as to achieve the optimal therapeutic effect based on the disease char-acteristics,willingness and economic capability of patients,technical level of surgeons and medical instruments.