鼻内镜辅助等离子射频治疗舌扁桃体肥大的初步研究

Preliminary study on treatment of lingual tonsil hypertrophy by endoscopic assisted coblation

目的:探讨鼻内镜辅助等离子射频舌扁桃体切除术的可行性和安全性。方法:回顾分析27例舌扁桃体肥大患者临床资料,术前均行纤维喉镜及舌根部CT和(或)MRI检查,经鼻气管内插管全麻后,70°鼻内镜辅助下以等离子射频切除舌扁桃体。术后观察舌根创面愈合及术后出血情况,分析鼻内镜辅助下等离子射频舌扁桃体切除术的优点,总结其可行性与安全性。结果:术中舌根及会厌谷在同一术野中得到满意的暴露,术中未发生并发症,术后均安全拔管;术后无原发出血发生,继发出血4例,占14.81%(4/27),分别发生在术后第6、7、10、12天,出血量30～70 ml,经保守治疗或再次应用等离子射频止血均获成功;27例术后均无味觉障碍发生,术后随访6～30个月无复发。结论:鼻内镜辅助等离子射频切除舌扁桃体手术暴露充分,切除彻底,复发率低,但术中要特别注意彻底止血,以预防术后出血发生。

Objective：To investigate the feasibility and safety of lingual tonsil excision by endoscopic assisted coblation.Method：Twenty seven cases with lingual tonsil hypertrophy were recruited in this study.Preoperative fibrolaryngoscope and CT and（or） MRI examination of the base of the tongue,lingual tonsil was removed by 70 °nasal endoscopy-assisted plasma radiofrequency after nasotracheal intubation.The tongue wound healing and postoperative bleeding were observed after operation,the advantages of the endoscopic-assisted plasma radiofrequency on lingual tonsil removal were analyzed,and its feasibility and safety were summarized.Result：During the surgery the base of the tongue and epiglottis had satisfaction exposure in the same operative field.No complications happened in the surgery and endotracheal tube was plucked safely after operation.There was no primary bleeding,and the number of secondary bleeding were 4 cases,accounting for 14.81%（4/27）,respectively occurred on the sixth,seventh,tenth and twelfth day with the amount of bleeding of 30-70 ml.The bleeding were cured after conservative treatment or re-application applicating of radiofrequency;27 patients had no taste disturbance,and they were followed up for 6-30 months without recurrence.Conclusion：Lingual tonsil excision by nasal endoscopic-assisted coblation has enough exposure,complete resection and low recurrence rate.Stopping bleeding should be attentioned to prevent postoperative bleeding.