等离子扁桃体切除术与常规剥离法扁桃体切除术之比较

Coblation tonsillectomy versus blunt dissection tonsillectomy

目的:比较等离子扁桃体切除术与常规剥离法扁桃体切除术对患者术中、术后的影响。方法:随机将56例患者分为等离子组和对照组,等离子组用低温等离子射频消融系统连接EVac70刀头,能量设置为6,切除扁桃体;对照组则采用常规剥离法扁桃体切除术,手术均由同一术者完成。记录两侧扁桃体切除所需时间和出血量;术后第1天至第10天患者每日记录咽部疼痛情况,恢复正常活动时间和正常饮食时间;术后第10天,医师观察并记录扁桃体窝内的白膜状况。结果:等离子组手术时间比对照组短,术中总出血量<10ml,而对照组平均出血量为(119±43)ml;等离子组患者术后疼痛轻于对照组,且比对照组更早恢复正常饮食;2组患者恢复正常活动时间的差异无统计学意义;等离子组较对照组白膜脱落慢。等离子组有1例患者于术后第7天口咽部有活动性出血,需缝扎止血。结论:等离子扁桃体切除术与剥离法相比,患者术后疼痛明显减轻,出血量极少,手术方法容易掌握,但扁桃体窝愈合的时间较长。

Objective：Compare eoblation tonsillectomy with blunt dissection tonsillectomy to see if there is any difference in intraoperative bleeding, operating time, postoperative pain, tonsillar fossae healing and return to normal diet and activities. Method： A randomised control trial was carried out to compare-coblation tonsillectomy with blunt dissection tonsillectomy in 56 patients. The same surgeon operated on them all, using Arthro Care EVac 70 Wand for coblation tonsillectomy, and routine instruments for blunt dissection tonsillectomy. Result：Coblation tonsillectomy was fast and resulted in little intraoperative bleeding. Significant reduction in postoperative pain was found in the patients with coblation tonsillectomy. Patients who had coblation tonsillectomy returned to their normal diet sooner than those who underwent blunt dissection tonsillectomy. Slower healing of the tonsillar fossae was found in the coblation group. One patient in the coblation group suffered from secondary haemorrhage. Condusion：Coblation tonsillectomy is easy to perform with little intraoperative bleeding. It offers significant advantages in the postoperative period, with rapid return to a normal diet and reduction in postoperative pain. But it need more time for healing of the tonsillar fossae.