儿童及成人行扁桃体切除术后出血5例临床分析

Clinical analysis of 5 cases of bleeding after tonsillectomy in children and adults

目的探讨扁桃体切除术后出血的止血及预防方法,为减少扁桃体术后出血提供参考依据。方法收集我院2018年6～9月术前诊断为慢性扁桃体炎的患者123例,分别应用3种不同的手术方法(低温等离子刀、单极电凝切除及冷兵器切除)行扁桃体切除术,统计术后出血发生概率。结果 123例行扁桃体切除术的患者,5例发生术后出血,其中2例应用肾上腺素棉球压迫止血,3例二期全麻手术缝合止血,所有患者行二次手术后均未发生出血,均为扁桃体术后出血,无腺样体出血的病例。结论⑴右侧扁桃体上极出血发生概率较高,可能是由于术者不习惯左手操作、右侧扁桃体上极视野受限,从而造成右侧扁桃体上极止血不充分。⑵加强术前宣教、合理选用手术器械、术中彻底止血、提高术者操作技巧及术后补液量充足是降低扁桃体术后出血的关键。

Objective To investigate the hemostasis and prevention of postoperative hemorrhage after tonsillectomy,and to provide reference for reducing postoperative hemorrhage after tonsillectomy.Methods From June to September,2018,123patients with chronic tonsillitis were treated by tonsillectomy with three different surgical methods (hypothermic plasma,unipolar coagulation and cold weapon resection).The incidence of postoperative bleeding was calculated.Results Among 123patients who underwent tonsillectomy,5had postoperative hemorrhage.Among them,2received epinephrine cotton ball compression for hemostasis,3received second-stage general-anesthesia for hemostasis.No hemorrhage occurred after the second operation in all patients.All patients had postoperative hemorrhage after tonsillectomy and no adenoid hemorrhage.Conclusion (1)The right upper extremity tonsils have a higher probability of episodes of hemorrhage,which may be due to the fact that the surgeon is not accustomed to left-handed operation and the right side of the right tonsils is limited,resulting in insufficient hemostasis on the right tonsils.(2)Strengthening preoperative education,rational use of surgical instruments,complete hemostasis during surgery,improving the operator's operation skills and adequate postoperative fluid replacement are the key to reducing postoperative tonsil bleeding.