间接喉镜下刮除术和鼻内镜下切吸术治疗腺样体肥大的手术效果比较

Comparison on the surgical therapeutic effect of adenoidectomy performed under indirect laryngeal mirror with that performed under nasal endoscope bymicrodebris with direct visualization

目的比较间接喉镜下腺样体刮除术和鼻内镜直视下腺样体切吸术治疗腺样体肥大的效果。方法118例患者分为A组(64例)和B组(54例),全身麻醉,用导尿管悬吊软腭,分别行间接喉镜下腺样体刮除术或鼻内镜直视下腺样体切吸术。结果所有患者术后打鼾症状明显改善,显效率分别为A组93.8%(60/64),B组94.4%(51/54);78例伴有渗出性中耳炎或复发性中耳炎,术后A、B组平均听阈提高分别为16±4.2dB和15±5.8dB;伴有鼻窦炎的患者,术后症状改善率分别为A组78.3%(18/23),B组88.9%(24/27)。术中平均出血量分别为A组20m1,B组25m1;平均手术时间分别为A组9分钟,B组7分钟。所有患者均无术后并发症发生。A组的手术费用明显低于B组。结论间接喉镜下腺样体刮除术和鼻内镜直视下腺样体切吸术均为安全、有效术式,但间接喉镜下腺样体刮除术简单易行、经济实惠。

Objective To compare the surgical therapeutic effect of adenoidectomy erformed under indirect laryngeal mirror by conventional surgery with that perfomed by microdebris under nasal endoscope with direct visualimtion, Methods One hundred and eighteen patients with adenoid hypelamphy were divided into 2 groups, with 64 in group A and 54 in group B. They were all operated on under general anesthesia with soft palate retracted by a catheter, with the cases in group A undergone adenoidectomy under indirect laryngeal mirror with oonventional procedures and those in group B undergone the surgery under nasal ndoscope with direct visualization by microdebris. Results All the cases in tither group were significantly improved in their snore following the surgery, with the rate of significant effectiveness being 93.8 % （60/64） in group A and it being 94.4 % （51/54） in group B. A mong this group of cases, 78 were seen with secretary otitis media or recurrent otitis media before the surgery. After the operation, the averaged hearing improving levels were 16 ± 4.2dB and 15± 5.8dB for cases of group A and ones of group B respectively the patients with chronic sinusitis, the improving rates of symptoms following the surgery, like nasal obstruction and discharge, were 78.3%（18/23） in group A and 88.9% （24/27） in group B respectively. The averaged volume of bleeding during the operation was 20ml for cases in group A and it was 25ml in group B, while the averaged time length needed in the surgical performance was 9 min. for group A and it was 7 min for group B respectively, with no patients suffering from postoperative bleeding. However the finandal rest for the whole sugery was significantly less for cases of grip A than that for group B. Conclusions Both surgical procedures, either perfomed with conventional surgery under indirect laryngeal mirror or perfomed with direct visualization under nasal endoscope by microdebfis, am all effective and safe to perform. However, the procedure perfomed under indirect laryngeal mirror is a simple and easy operating one, with lower oost and more benefits.