单极电刀不同模式切除儿童扁桃体的临床应用  

Clinical application of different patterns of monopolar electrocautery to tonsillectomy in children

作　　者：周永[1] 李重[2] 宾翔[1] 黄轶[1] 林玲[1] 

机构地区：[1]广西医科大学第一附属医院耳鼻咽喉头颈外科,广西南宁530021 [2]成都市第一人民医院耳鼻咽喉头颈外科,四川成都610041

出　　处：《中国耳鼻咽喉颅底外科杂志》2015年第4期300-303,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：广西医疗卫生适宜技术研究与开发项目(S201414-02)

摘　　要：目的通过对单极电刀电凝模式(凝切法)与单极电刀切割模式(电切法)切除儿童扁桃体的比较,探讨不同模式切除儿童扁桃体的优缺点与合理性。方法对40例需行双侧扁桃体切除术的患儿,以随机方法对其中一侧扁桃体采用电凝切法切除,另一侧采用电切法切除。记录两种手术方法的完成情况,并对出血量、手术时间等相关指标进行比较分析。结果 40侧电凝切法全部顺利完成,40侧电切法仅5侧(12.5%)能顺利完成;另35侧由于出血不能完成,改用电凝法完成(混合法)。术中出血量和手术总时间的比较中,电凝法明显优于电切法与混合法(P<0.05),电切法与混合法相比,两种术式无明显差异(P>0.05)。3种方法术后白膜生长情况比较无明显差异(P>0.05)。结论运用单极电刀切除儿童扁桃体时,由于术中出血,单纯电切模式难以完成手术。单极电刀低功率电凝模式切除儿童扁桃体是安全和高效的,是最为合理的应用条件。Objective To explore the advantages, disadvantages and rationality of different patterns of monopolar electrocautery in pediatric tonsillectomy via comparing monopolar electric coagulation （electroeoagulation） with monopolar electric scalpel （electrotomy）. Methods 40 children for whom bilateral tonsillectomy was necessary were included. For each patient, tonsils were randomized to have electrotomy on one side and electroeoagulation on the other. Relevant indexes including volume of blood loss, time of operation of the two methods were recorded and analyzed. Results Electrocoagulation was finished successfully in all the 40 tonsils. Electrotomy was successfully completed in 5 of the 40 tonsils （ 12.5% ）. Due to poor hemostasis, tonsillectomy in the other 35 was finished with assistance of electrocoagulation （mixed method ）. The blood loss volume and time of operation by electrocoagulation were both superior to those by electrotomy and mixed method （ all P 〈 0.05 ）. The differences of above-mentioned indexes between electrotomy and mixed method were statistically insignificant （ both P 〉 0.05 ）. Postoperative white membrane formation was similar in the three methods. Conclusion It is a hard task to perform tonsillectomy with monopolar electrotomy alone due to its poor hemostasis. With advantages of safety and effectiveness, monopolar electrocoagulation with low power is the most reasonable pattern for tonsillectomy in children.

关 键 词：儿童 扁桃体切除术 单极电刀 电凝模式 电切割模式 

分 类 号：R766.5[医药卫生—耳鼻咽喉科]