腺样体肥大四种手术方式比较

目的 总结138例腺样体肥大患者手术方式，评价四种手术方式的特点。方法 对138例腺样体肥大患者分别采用四种术式进行治疗，其中传统的腺样体刮除术20例(A组)，腺样体刮除+鼻内镜下残余腺样体咬切术63例(B组)，鼻内镜下腺样体切吸术25例(C组)，鼻内镜下腺样体等离子融切术30例(D组)，统计各组的治疗效果、腺样体残留率、并发症、手术时间、出血量等，比较不同术式的优缺点。结果 A组的有效率为90%，其余三组均达到100%；残留率以A组最高，为60%，D组残留率为6.67%，B、C两组无残留；共有4例术后出血(A组1例、B组2例、C组1例)，鼻腔粘连共出现6例(B组4例，C组2例)；在手术时间的比较上，A组和D组无显著性差异，B组和C组无显著性差异，其余两两比较均有显著性差异，即A组和D组在手术时间上优于B组和C组。在出血量的比较上， D组出血量最少，A组和B组次之，C组出血量最多。结论 传统的刮除术因残留率过高需摒弃；等离子融切术虽然手术时间短、出血少，但价格昂贵，可用于经济条件好、对失血要求高的患者；一般患者可选用腺样体刮除+鼻内镜下残余腺样体咬切术或鼻内镜下腺样体切吸术，相对而言前者更为简单易行，经济实惠。

Comparison of 4 surgical methods of adenoidectomy

Objective To evaluate four surgical methods of adenoidectomy. Method Clinical data 138 cases of adenoid hypertrophy were reviewed. Four different surgical methods were applied, including conventional transoral adenoidectomy with a currete(group A, 20 cases), conventional transoral adenoidectomy with a currete plus punch forceps (group B, 63 cases), endoscopic adenoidectomy (group C, 25 cases), and plasma ablation(group D, 30 cases). The effects, residue, complication, operation time and blood loss were evaluated among the methods. Result The effective rate was 90% for group A, but 100% for the other three groups. The residual rates in descending order were 60% in group A, 6.67% in group D， and zero in both group B and C. Post-op hemorrhage occurred in 4 cases (1 in group A, 2 in group B, and 1 in group C). 6 cases presented nasal synechia (4 in group B, 2 in group C) . Operation time of group A and group D were longer than the other two groups. There was no significant difference in blood loss between the group A and B. The maximal loss was noted in group C, however the minimal loss was in group D. Conclusion The conventional transoral adenoidectomy with a currete should be abandoned because of the high rate of residue. Though plasma ablation shows the advantages, including short operation time and little blood loss, cost of this method is one big concern. It can only be applied in the patients who can afford it and give much attention to the blood loss. For the majority of patients, conventional transoral adenoidectomy plus punch forceps or endoscopic adenoidectomy are desirable , which are relatively simple and affordable.