等离子扁桃体手术与超声刀扁桃体手术组织损伤与疼痛的对照研究  

A controlled study on tissue injury and pain of coblation tonsillectomy and harmonic scalpel tonsillectomy

作　　者：庞宇峰[1] 龚静蓉[1] 黄娟[1] 邹阳[1] PANG Yufeng;GONG Jingrong;HUANG Juan;ZOU Yang(The Fifth People’s Hospital of Shanghai,Fudan University,Shanghai 200240,China)

机构地区：[1]复旦大学附属上海市第五人民医院

出　　处：《现代中西医结合杂志》2020年第3期239-242,294,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

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：目的比较低温等离子扁桃体手术与超声刀扁桃体手术的效果,为临床应用提供参考。方法选取2014年1月—2017年4月在复旦大学附属上海市第五人民医院耳鼻喉科行扁桃体切除术的成年患者共304例,采用电脑生成随机数方法随机分为等离子手术组155例和超声刀手术组149例。记录2组患者手术时间、手术出血情况、住院时间,测量组织损伤深度,对2组患者术后1~10 d每天休息时与吞咽时的VAS疼痛评分进行多元线性回归分析。结果等离子手术组手术时间为(20.2±7.5)min,超声刀手术组为(16.7±6.3)min,超声刀手术组手术时间明显短于等离子手术组(P<0.05)。2组术后近期出血(<24 h)发生率分别为3.2%(5/155)、1.3%(2/149),远期出血(>24 h)发生率分别为7.7%(12/155)、1.3%(2/149),等离子手术组远期出血发生率明显高于超声刀手术组(P<0.05)。2组组织损伤深度及术后住院时间比较差异均无统计学意义(P均>0.05)。等离子手术组休息时疼痛评分达到3分的时间相比超声刀手术组缩短了1.94 d,吞咽时疼痛评分达到3分的时间则缩短了2.02 d。结论超声刀扁桃体手术术后远期出血概率明显小于等离子扁桃体手术,但等离子扁桃体手术患者术后疼痛减轻时间相比超声刀扁桃体手术患者约快2 d。Objective It is to compare the effects of coblation tonsillectomy or harmonic scalpel tonsillectomy in order to provide a reference for clinical application.Methods A total of 304 adult patients who underwent tonsillectomy at the Department of Otorhinolaryngology,in the Fifth People's Hospital of Shanghai from January 2014 to April 2017 were randomly divided into coblation tonsillectomy group(n=155)and harmonic scalpel tonsillectomy group by computer-generated random number methods.The surgical time,surgical bleeding,hospital stay,and tissue damage depth were recorded in the two groups.Multiple linear regression analysis was performed on the VAS pain scores at rest and swallowing every day from 1 to 10 days after surgery.Results The operation time of the coblation tonsillectomy group was(20.2±7.5)minutes,and that of harmonic scalpel tonsillectomy group was(16.7±6.3)minutes.The operation time of the coblation tonsillectomy group was significantly shorter than that of the harmonic scalpel tonsillectomy group(P<0.05).The incidence of short-term bleeding(<24 h)in the two groups was 3.2%(5/155)and 1.3%(2/149),and the incidence of long-term bleeding(>24 h)was 7.7%(12/155),and 1.3%(2/149)respectively,the incidence of long-term bleeding in the coblation tonsillectomy group was significantly higher than that of the harmonic scalpel tonsillectomy group(P<0.05).There was no significant difference in the tissue injury depth and postoperative hospital stay between the two groups(both P>0.05).Compared with the harmonic scalpel tonsillectomy group(P<0.05),the time for the pain score at rest reached 3 points was shortened by 1.94 days,and the time for the pain score reached 3 points when swallowed was shortened by 2.02 days.Conclusion The probability of long-term bleeding after harmonic scalpel tonsillectomy is significantly less than that of coblation tonsillectomy,but the relief time of pain of patients treated with coblation tonsillectomy is about 2 days faster than that of patients with harmonic scalpel tonsillectomy.

关 键 词：等离子手术 超声刀手术 扁桃体切除术 

分 类 号：R766.18[医药卫生—耳鼻咽喉科]