低温等离子扁桃体切除术临床分析

Clinical Analysis of Coblation 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的临床效果。【方法】随机将86例扁桃体肥大儿童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档，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，并且术者之前已完成该类手术30例以上。记录两侧扁桃体切除所需时间和出血量；恢复正常活动时间和正常饮食时间；术后d10，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（105±37）mL；等离子组患者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例术后出血，需手术止血，2例分别于术后d7、d10口咽部有活动性出血，压迫后能止血。【结论】等离子扁桃体切除术与剥离法相比，术中出血量极少，手术时间明显缩短，但扁桃体窝愈合的时间较长，有术后出血的趋向。

[Objective]To compare the effect of coblation tonsillectomy vs routine blunt dissection tonsillectomy on intraoperation and postoperation of patients. [Methods] Totally 86 pediatric patients with tonsillar hypertrophy were ran- domly divided into eoblation group and control group. The coblation group underwent tonsillectomy by using hypothermia plasma ablation system connected to EVac 70 bit with 6 powers. The control group underwent routine blunt dissection tonsillectomy. The operation was performed by the same surgeon. Thirty patients had undergone the operation by the surgeon. The operation time, blood loss and recovery time of normal activity and diet 10 days after operation were recor- ded. Physicians observed and recorded albuginea in tonsillar fossa. [Results] The operation time in coblation group was shorter than that in control group. The total intraoperation bleeding volume was lower than 10ml, while the average bleeding volume was （105 ±37）ml. The recovery of normal diet in coblation group was faster than that in control group. There was no significant difference in the recovery time of normal activity between two groups. The exfoliation of albug- inea in coblation group was slower than that in control group. One ease in coblation group had postoperation bleeding and needed surgical hemostasis. Two cases had active bleeding at 7 days and 10 clays after operation and the bleeding was stopped by compression. [Conclusion]Coblation tonsillectomy has less intraoperative bleeding and shorter operation time than blunt dissection. However, coblation tonsillectomy had longer healing time of tonsillar fossa and the trend of postop- eration bleeding.