单极电刀电凝模式切除儿童扁桃体的临床研究

Clinical research on tonsillectomy with monopolar electrotome electrocoagulation in children

目的通过与传统剥离法扁桃体切除术比较,探讨单极电刀电凝模式(以下称凝切法)切除儿童扁桃体的临床意义。方法对30例需行双侧扁桃体切除术的儿童患者,采用同体异侧对比的方法,按照随机方案一侧扁桃体采用凝切法切除、另一侧采用剥离法切除;分别记录双侧扁桃体的切除时间、止血时间、总手术时间、术中出血量,并观察术中创面损伤、术后白膜生长、咽痛反应等,并对两组数据进行统计分析。结果凝切法与剥离法的切除时间分别为(6.5±2.6)min和(5.6±2.7)min,两种手术方法切除扁桃体的时间差异无统计学意义(P=0.14)。凝切法的止血时间、总手术时间、术中出血量分别为(2.5±2.8)min、(9.0±4.3)min、(6.0±6.8)ml,剥离法的分别为(7.7±3.9)min、(13.2±5.6)min、(18.9±8.8)ml,两种方法在止血时间、总手术时间、术中出血量方面的差异均有统计学意义(P=0.00),凝切法治疗儿童扁桃体肥大疗效明显优于剥离法。凝切法侧的肌纤维损伤积分优于剥离法,其差异具有统计学意义(Z=-4.916,P=0.00)。术后两组白膜生长情况和咽痛比较无明显差异。结论与传统的扁桃体剥离法相比,凝切法的术野清晰、手术时间短、术中出血量少、手术对组织的损伤轻。单极电刀电凝模式儿童扁桃体切除术安全、高效,值得临床推广使用。

Objective To explore the clinical significance of tonsillectomy in children by monopelar electronic knife with electric coagulation. Methods Thirty children with surgical indication of bilateral tonsillectomy were included. Each side of every child received tonsillectomy with one of the methods, electrocoagulation or peeling-off tonsillectomy, and the electrocoagnlation side was decided randomly. The resection time, haemostasis time, operation time, and intraoperative blood loss were recorded. The wound recovering situation and the degree of pain were also observed. Statistic analysis was conducted according to the collected data. Results The difference of resection time between the two groups was statistically insignificant （ P = 0.14 ）. The haemostasis time and operative time in the electrocoagulation group were shorter than that in the peeling-off group. The intraoperative blood loss of electrocoagulation group was less than that of the peeling-off group. The above-mentioned indexes showed statistically significant differences （ P = 0. 00 ）. Compared to peeling-off tonsillectomy, the electrocoagulation tonsillectomy shortened the operation time and reduced the intraoperative blood loss. The difference in fascicle exposure score between the two groups was statistically significant. The electrocoagnlation tonsillectomy showed lower fascicle exposure score. The postoperative pain and recovering situation of tonsillar fossae in the electrocoagulation group were similar tothose in the peeling-off group. Conclusion The clectrocoagulation tonsillectomy is superior to peeling-off tonsillectomy in shortening operation time and reducing intraoperative blood loss. Besides, the electroeoagulation tonsillectomy not only provides a clear surgical view but also minimizes the damage to adjacent tissue. With similar postoperative morbidity to peeling-off tonsillectomy, the application of electroeoagulation tonsillectomy to children is safe, efficient and feasible.