成年人显微镜下等离子扁桃体手术与超声刀扁桃体手术的临床对照研究  

作　　者：庞宇峰[1] 龚静蓉[1] 黄娟[1] 田露芳[1] 何双珠 

机构地区：[1]复旦大学附属上海市第五人民医院耳鼻咽喉科,200240

出　　处：《浙江临床医学》2017年第2期260-261,263,共3页Zhejiang Clinical Medical Journal

基　　金：上海市闵行区卫生和计划生育委员会科研项目（2015MW06）

摘　　要：目的探索研究成年人显微镜下等离子扁桃体手术与显微镜下超声刀扁桃体手术的方法与技巧，并对两种手术进行临床对照研究。方法选取行显微镜下等离子扁桃体切除术或显微镜下超声刀扁桃体切除术的成年患者共160例，其中显微镜下等离子扁桃体切除术79例，显微镜下超声刀扁桃体切除术81例。记录两组患者的各项临床数据，并进行统计分析。结果显微镜下等离子扁桃体组与显微镜下超声刀扁桃体组所有手术术中出血均〈1ml。显微镜下等离子扁桃体组术后24h内出血2例（2．5％），术后24h继发出血7例（8．9％）。显微镜下超声刀扁桃体组术后24h内与24h后无一例出血，在24h后继发出血方面超声刀组明显好于等离子组（P〈0．05）。同时计算了两组术后每日疼痛评分，选用多元线性回归的方法比较两组数据的术后疼痛情况。结果显示等离子组相比超声刀组在休息时的疼痛评分达到3分的天数缩短了1．75d，而在吞咽时的疼痛评分达到3分则减少了1．32d。结论在术后24h继发出血方面，超声刀扁桃体手术术后24h继发出血概率明显小于等离子扁桃体手术。而在疼痛方面，显微镜下等离子扁桃体手术患者术后疼痛好转情况相比超声刀扁桃体手术患者快1．5d左右。Objective To explore the technology of coblation tonsillectomy and harmonic scalpel tonsillectomy under microscope in adult patients and to carry out a clinical controlled study on the two surgery methods. Methods A total of 160 cases of adult patients were included in this study, all of whom were admitted by the same doctor in our hospital with coblation tonsillectomy or harmonic scalpel tonsillectomy under microscope. Among the 160 cases, 79 cases were given coblation tonsillectomy under microscope while 81 cases were given harmonic scalpel tonsillectomy under microscope. The two groups of patients were recorded and analyzed on their clinical data. Results Intraoperative bleeding in any group （ no matter coblation tonsillectomy group or harmonic scalpel tonsillectomy group ） was less than 1 ml. In coblation tonsillectomy group, 2 cases （ 2.5% ） appeared postoperative bleeding within 24 hours while 7 cases （ 8.9% ） appeared postoperative bleeding after 24 hours. No bleeding within 24 hours or after 24 hours was found in harmonic scalpel tonsillectomy group, and after 24 hours bleeding was superior to that of the coblation tonsillectomy group （ P〈0.05 ） . And postoperative VAS scores of the two groups were calculated. Multiple linear regression was used to compare the postoperative pain of the two groups. Corresponding equations were used to calculate the duration when the two kinds of postoperative pain index reached mild pain （ 3 points ） . And the results showed that compared to harmonic scalpel tonsillectomy group, the duration when the resting pain score reached 3 point of coblation tonsillectomy group was shortened by 1.75 day, and the duration when the swallowing pain score reached 3 point of coblation tonsillectomy group was shortened by 1.32 day. Conclusions Our study shows that in terms of postoperative bleeding after 24 hours, harmonic scalpel tonsillectomy has obviously smaller bleeding probability than that of the coblation tonsillectomy. While in respect of the pain, patients

关 键 词：显微镜 扁桃体手术 等离子 超声刀 

分 类 号：R766.9[医药卫生—耳鼻咽喉科]