两种切除术对慢性扁桃体炎患者围术期指标及并发症的影响  

Effects of two kinds of resection operation on perioperative indexes and complications in patients with chronic toncillitis

作　　者：郑跃彬 鄢斌成 蔡永聪[2] 杨羿容 余建洪[3] ZHENG Yuebin;YAN Bincheng;CAI Yongcong;YANG Yirong;YU Jianhong(Department of Otolaryngology Head and Neck Surgery,Zigong First Municipal People′s Hospital,Zigong,Sichuan 643000,China;Department of Head and Neck Tumor Surgery,Sichuan Provincial Tumor Hospital,Chengdu,Sichuan 610041,China;Department of Clinical Laboratory,Zigong Municipal First People′ s Hospital,Zigong,Sichuan 643000,China)

机构地区：[1]四川省自贡市第一人民医院耳鼻咽喉头颈外科,643000 [2]四川省肿瘤医院头颈肿瘤外科,成都610041 [3]四川省自贡市第一人民医院检验科,643000

出　　处：《重庆医学》2021年第12期2045-2049,共5页Chongqing medicine

基　　金：四川省科技厅重点研发项目(2019YFS0337)。

摘　　要：目的探讨等离子扁桃体切除术与传统扁桃体剥离切除术对患者围术期指标、术后疼痛及并发症的影响。方法选取252例慢性扁桃体炎(CT)患者分为对照组和观察组,每组126例。对照组采用传统扁桃体剥离切除术,观察组采用等离子扁桃体切除术。对比两组患者的围术期相关指标、术后并发症、术后不同时间点的术区疼痛程度,观察两组手术前后血清应激指标和炎症介质水平。结果观察组手术时间、恢复正常饮食时间及白膜覆盖时间明显短于对照组(P<0.05),术中出血量明显少于对照组(P<0.05),白膜完全消退时间明显长于对照组(P<0.05)。观察组术后并发症总发生率9.52%明显低于对照组19.05%(P<0.05)。术后6 h~7 d,两组视觉模拟评分法(VAS)呈逐渐降低趋势,组内不同时间点比较差异有统计学意义(P<0.05),其余时间点均明显低于术后6 h(P<0.05),观察组术后不同时间点VAS评分均低于对照组(P<0.05)。术后1 d,两组血清降钙素原(PCT)、皮质醇(Cor)水平较术前明显升高(P<0.05),血清前列腺素E2(PGE2)、前列腺素F2α(PGF2α)水平较术前明显降低(P<0.05),观察组均明显低于对照组(P<0.05)。术后1 d,两组血清单核细胞趋化蛋白-1(CCL2)、次级淋巴组织趋化因子(CCL21)水平较术前明显降低(P<0.05),观察组变化幅度大于对照组(P<0.05)。结论等离子扁桃体切除术治疗CT,有手术时间短、术中出血量少、创伤小、并发症少等优点,能有效缓解患者的术后疼痛程度,减轻其创伤应激反应和炎症介质水平。Objective To explore the effects of plasma tonsillectomy and traditional tonsillectomy on perioperative indexes,postoperative pain and complications.Methods Totally 252 patients with chronic tonsillitis(CT)were selected and randomly divided into the control group and observation group,126 cases in each group.The control group adopted the traditional tonsillectomy,and the observation group was treated with plasma tonsillectomy.The perioperative indexes,postoperative complications and pain degree of surgical site at postoperative different time points were compared between the two groups.The levels of serum stress indicators and inflammatory mediators were observed before and after surgery in the two groups.Results The surgical time,normal diet time and tunica albuginea coverage time in the observation group were obviously shorter than those in the control group(P<0.05),the intraoperative blood loss amount was significantly lessthan that in the control group(P<0.05),and the complete regression time of tunica albuginea was significantly longer than that in the control group(P<0.05).The total incidence rate of postoperative complications in the observation group was significantly lower than that in the control group(9.52%vs.19.05%,P<0.05).The visual analogue score(VAS)at postoperative 6 h-7d in two groups showed a gradually decreasing trend,and there was a statistically significant difference in the group among different time points(P<0.05),and the score at other time points was significantly lower than that at postoperative 6 h(P<0.05),and the VAS score at different time points after surgery in the observation group was lower than that in the control group(P<0.05).The levels of serum procalcitonin(PCT)and cortisol(Cor)on postoperative 1 d in the two groups were significantly increased compared with those before surgery(P<0.05),while the levels of serum prostaglandin E2(PGE2)and prostaglandin F2α(PGF2α)were markedly decreased compared with those before surgery(P<0.05),and the observation was significantly lower tha

关 键 词：慢性扁桃体炎 等离子扁桃体切除术 传统扁桃体剥离切除术 围术期指标 术后疼痛 并发症 应激指标 炎症介质 

分 类 号：R762[医药卫生—耳鼻咽喉科]