低温等离子刀、超声刀及传统方式行扁桃体切除术的术后两年随访比较

Comparison of the efficacy of coblation,ultrasonic knife operation,and conventional tonsillectomy in a 2-year postoperative follow-up

目的通过对低温等离子刀、超声刀及传统方式行扁桃体切除术的患者进行2年随访,探讨三种手术方式的术后疗效差异。方法对行上述三种手术方式的86例患者在扁桃体切除术后6个月、1年及2年进行随访,观察术后扁桃体残体大小及黏膜炎症情况,并使用自制问卷调查咽部症状及满意度等信息。结果术后1年及2年随访时,低温等离子刀组和传统组的扁桃体上极残体评分较超声刀组要低,而低温等离子刀组和超声刀组的扁桃体下极残体评分则较传统组要低;术后6个月随访时低温等离子刀组和超声刀组的咽干症状均较传统组明显;术后2年随访时低温等离子刀组和超声刀组的患者满意度较传统组更高,而且传统组患者的咽部异物感更为明显;以上差异均有统计学意义(P<0.05)。另外术后1年及2年随访时,三组患者的咽干症状、扁桃体窝黏膜慢性炎症程度、咽痛频率及术后下呼吸道感染发生次数均无统计学差异(P>0.05)。结论相较于传统方式而言,使用低温等离子刀切除扁桃体的患者术后扁桃体残体发生率低,除短期术后易发生咽干外,中长期咽部不适症状较轻,患者满意度较高。超声刀方式优点与低温等离子刀相近,但在术中要注意对扁桃体上极的处理,防止其残留。

Objective To study the efficacy of coblation,ultrasonic knife operation,and conventional tonsillectomy in patients in a 2-year postoperative follow-up. Methods With respect to the above-mentioned three types of operation methods,86 patients were followed up for 6 months,1 year,and 2 years after tonsillectomy,respectively. The postoperative tonsil residue size and mucosal inflammation,pharyngeal symptoms by assessing self-made questionnaire responses,and satisfaction information were evaluated. Result Upon 1-and 2-year postoperative follow-ups,the ＂superior pole of the tonsil residue＂scores in the coblation and conventional groups were significantly lower than those in the ultrasonic knife operation group; and ＂pole of the tonsil residue＂scores in the coblation and ultrasonic knife operation groups were also significantly lower than those in the conventional group. Upon 6-month postoperative follow-up,the scores of ＂dry pharynx＂in the coblation and ultrasonic knife operation groups were more statistically significant than those in the conventional group. Upon 2-year postoperative follow-up,＂satisfaction of information＂scores in the coblation and ultrasonic knife groups were significantly higher than those in the conventional group,and＂paresthesia pharynges＂scores in the conventional group were more significant than those in the other groups. In addition,there were no significant differences among the three groups in the incidence rates of dry pharynx,mucosal inflammation,pharyngeal symptoms,sore throat,and lower respiratory tract infections upon 1-and 2-year postoperative follow-ups（ P〉0. 05）.Conclusion Compared with traditional methods,coblation has advantages related to a lowincidence of postoperative tonsillar residue. By using coblation,postoperative dry pharynx symptoms are more likely to occur in a short time,throat discomfort symptoms are mild in the mid-to long-term,and the degree of patient satisfaction is high. Ultrasonic knife operations have similar advantages as coblation,but surgeons should pay more attention to the superior poles of the tonsils during operation and prevent tonsil residues.