低温等离子扁桃体消融术与常规扁桃体剥离术在儿童手术中的对比研究

Low-temperature coblation-assisted versus conventional dissection tonsillectomy in surgeries for children

目的:比较低温等离子扁桃体消融术与常规扁桃体剥离术对患儿术中、术后的影响。方法:92例患儿,随机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EVac 70 T&A刀头,能量设置为7,消融扁桃体;对照组则采用常规扁桃体剥离术,分别记录2种方法所需时间和出血量;使用Wong-Baker FACES疼痛评分表记录术后第1天至第10天患儿每日咽部疼痛情况,恢复正常饮食和正常活动时间;记录术后并发症。结果:等离子组手术时间比对照组短(分别为10.2min和36.5min,P<0.01),等离子组术中平均出血量为(6.83±3.36)ml,而对照组为(30.07±7.04)ml;等离子组患儿术后第1、2、3天疼痛轻于对照组,第4～10天两组差异无统计学意义;等离子组比对照组更早恢复正常饮食,但恢复正常活动时间相似。对照组有1例患儿于术后第6天口咽部有活动性出血,需缝扎止血。结论:低温等离子扁桃体消融术与常规扁桃体剥离术相比,手术时间缩短,出血量极少,手术方法容易掌握,恢复正常饮食时间早,术后前3天疼痛较轻。

Objective：To compare low temperature coblation assisted tonsillectomy with conventional dissection tonsillectomy intraoperation and afteroperation. Method： Ninty-two pedia-patients were randomly divided into coblation-assisted tonsillectomy group and the control group. Arthrocare EVac 70 T＆A Wand was used for coblation-assisted tonsillectomy, and the energy set was 7. Conventional dissection tonsillectomy was operated in control group. The operating time, bleeding, tonsillar fossae healing and return to normal diet and activities, intraoperative complications were recorded seperately. Postoperative pain of the pedia-patients was recorded daily using Wong Baker FACES pain scale for 10 days of afteroperation. Result： Coblation assisted group had a shorter operative time than the control group （10.2min vs. 36.5min, P〈0. 001）. The average amount of intraoperative bleeding of Coblation assisted group was（6.83 ± 3.36） ml, while the control group was（30.07± 7.04）ml. Pedia-patients of Coblation group had a better pain score on 1, 2, 3 days after operation than in control group, and there was no statistically significant difference on 4 to 10 days between the two groups. Coblation group ones returned to normal diet earlier than the control group, but both group required similar time returned to normal activities. There was one patient in control group,who required suturing to stop bleeding for active oropharyngeal bleeding on the 6th day after operation. Conclusion： Comparing with traditional dissection, Coblation assisted tonsillectomy is easy to perform with less intraoperative bleeding,shorter operation time,earlier return to normal diet, less pain on 1st to 3th day postoperatively.