等离子在扁桃体部分切除术中治疗小儿鼾症的临床研究

The Clinical Efficacy and Advance of Coblation Tonsillotomy in Pediatric OSAHS Patients

目的探讨等离子在扁桃体部分切除术治疗小儿鼾症患者扁桃体手术中的临床疗效及优势。方法进行前瞻、随机、对照研究,收集2010年6月~2011年4月住院治疗需行扁桃体切除术的小儿鼾症患者,随机分成两组,试验组32例,采用等离子行扁桃体部分切除术,对照组30例,行常规扁桃体切除术。对两组患者手术时间、术中出血量,术后疼痛、饮食、活动、发热、出血及扁桃体剥离面（切面）白膜情况进行比较;并于术后3月进行初步疗效评定,进行组间比较。结果术后3月试验组轻微打鼾患儿2例,对照组1例,两组差异无显著性（P=0.690）。试验组手术时间、术中出血量均优于对照组（P=0.000,P=0.000）。试验组术后发热的病例及出血病例数与对照组无明显差别（P=0.561,P=0.561）,恢复正常饮食时间较对照组短（P=0.000）,术后10 d扁桃体剥离面（切面）白膜覆盖面积的中位数较对照组大（P=0.000）,术后疼痛较对照组轻（P=0.000）。结论对小儿鼾症患者,行等离子行扁桃体部分切除术可以获得与传统剥离法同等的临床效果,因保留了扁桃体的部分功能,值得在临床推广。

【Objective】 To evaluate clinical efficacy and advance of coblation tonsillotomy in pediatric obstructive sleep apnea hypopnea syndrome（OSAHS） patients.【Methods】 With a prospective randomized controlled trial adopted,62 pediatric OSAHS cases were recruited and divided randomly into coblation tonsillotomy group and traditional tonsillectomy group.Intraoperative time and bleeding lose,postoperative pain,diet,activity,fever,haemorrhage and tonsillar operative area cover were analyzed.Clinical effect was evaluated 3 month after surgery.【Results】 Snoring had no significant difference（P =0.690）.Coblation tonsillotomy group had advantage on intraoperative time（P =0.000）,intraoperative blood loss（P =0.000）,day return to normal diet（P =0.000）,tonsillar operative area cover（P =0.000）,and postoperative pain（P =0.000）.Two groups had no difference in postoperative hemorrhage（P =0.561） and fever cases（P =0.561）.【Conclusion】 Coblation tonsillotomy is as effective as traditional tonsillectomy for the children suffering from OSASH due to hypertrophic tonsils.Owing to less injure,slightly pain,faster recovery,especially retain partial immune functional of tonsil,it is worthy of promotion.