扁桃体电切术后出血分度与相关因素研究

目的 探讨扁桃体电切除手术后出血的分度情况与相关因素.方法 选择2005年6月～2013年10月温州医科大学附属温岭医院耳鼻咽喉科行高频电刀扁桃体切除手术患者1134例,分析术后出血病例的出血程度、出血时间、出血部位、出血原因与止血方法.结果 扁桃体术后出血共21例,出血发生率为1.85％,其中出血程度1度6例,2度4例,3度10例,4度1例,5度0例;原发性出血3例,继发性出血18例;出血部位扁桃体上极1例、下极9例、扁桃体窝10例、弥漫性出血1例;出血原因为止血不彻底3例,饮食不当6例,剧烈咳嗽3例,过度活动2例,创面感染7例;治疗方法单纯药物止血6例,压迫止血2例,电凝止血8例,缝扎止血4例,介入止血1例.所有病例经相应治疗后均得到治愈出院.结论 高频电刀下扁桃体切除术后出血的发生率较低,术后出血程度以3度为主,出血时间以继发性为主,出血原因以创面感染和饮食不当为主,治疗方法以电凝止血为主.探讨术后出血分度及各型特点对防治扁桃体术后出血有指导意义.

Study of maginitude and related factors of post-tonsillectomy hemorrhage by high-frequency electric surgical knife

Objective To evaluate the magnitude and related factors of post-tonsillectomy hemorrhage by high-frequency electric surgical knife.Methods From June 2005 to October 2013,a total of 1134 patients with the indications of tonsillectomy were treated with high-frequency electric surgical knife in Department of Otolaryngology,the Affiliated Wenling Hospital of Wenzhou Medical University.Retrospective analysis of the bleeding degree,bleeding time,bleeding position,bleeding causes and haemostasis were performed among these cases.Results 21 cases of post-tonsillectomy hemorrhage were found among 1134 cases,the incidence was 1.85%.Among these,6 subjects with 1 degree of bleeding,4 subjects with 2 degree of breeding,10 patients with 3 degree of breeding,1 case with 4 degree of breeding were found,no 5 degree of breeding was found.Moreover,3 subjects were diagnosed with essential hemorrhage,and 18 cases were diagnosed with secondary hemorrhage.Furthermore,the breeding located at the upper pole,lower pole and fossa of tonsil were found in 1,9 and 10 subjects,respectively; diffuse hemorrhage was observed in 1 subject.Of the 21 patients,3 cases of halfway hemostasis,6 cases with improper diet,3 cases with severe coughing,2 cases of excessive activity,7 cases of wound infection were found according to the bleeding reason.6 cases with drug hemostasis,2 cases with compression hemostasis,8 cases with electric coagulation hemostasis,4 cases with transfixion hemostasis,1 case with DSA hemostasis were carried out.All patients were cured and discharged according to these treatments.Conclusion Tonsillectomy by high-frequency electric surgical knife has lower incidence of hemorrhage.The hemorrhage after the operation are mainly in degree 3,belonging to secondary and the major reasons are wound infection and improper diet,and the effective treatment is electro-coagulation.Our findings may provide valuable information on the prevention of post-tonsillectomy hemorrhage.