腭扁桃体切除术后出血部位与程度的关系探讨

Discussion on the relationship between the position and degree of hemorrhage after palatal tonsillectomy

目的探讨腭扁桃体切除术后术腔不同部位出血概率及出血程度的关系,为临床合理干预提供决策依据。方法回顾分析2015年1月~2019年12月行腭扁桃体切除术共567例患者的病历资料,统计术后出现术腔出血的患者例数共59例(10.4%),将其出血部位分为扁桃体上窝、扁桃体下窝及其它部位,出血程度则采用Windfuhr分度法分为5度,分别统计各部位出血概率及出血程度,分析二者之间的关系。结果 扁桃体术腔术后出血部位分别为扁桃体上窝35例(59.32%)、扁桃体下窝12例(20.34%)、其它部位12例(20.34%),在出血程度上则为扁桃体下窝出现严重出血7/12,较扁桃体上窝1/35及其它部位0/12更常见,差异具有统计学意义(将前者分别与后两者进行x^2检验,x^2=19.472、9.882,P均<0.05)。结论 腭扁桃体切除术后术腔上段较其他部位更易出血,且多为轻度、少量的出血,大多数能自止。而术腔下段一旦出血,则有较大可能为严重出血,应尽快妥善处理,避免出现严重后果。

Objective To explore the relationship between the hemorrhage probability and the degree of bleeding in different parts of the surgical cavity after palatal tonsillectomy to provide a basis for decision-making for clinical rational handling.Methods The medical records of 567 patients undergoing palatal tonsillectomy from January 2015 to December 2019 were retrospectively analyzed.A total of 59 patients(10.4%)with surgical cavity bleeding were counted.The sites are divided into upper tonsil fossa,lower tonsil fossa and other parts.The degree of bleeding is divided into 5 degrees by Windfuhr index method.The bleeding probability and degree of bleeding of each part are counted,for analyzing the relationship between the two.Results The bleeding position after tonsillectomy were 35 cases of upper tonsil fossa(59.32%),12 cases of lower tonsil fossa(20.34%),and 12 cases of other parts(20.34%).The serious hemorrhage of lower tonsil fossa was 7/12,which was more common than 1/35 of the upper tonsil fossa and 0/12 in other parts,and the difference was statistically significant(the three proportion were pairwise compared by Chi-square test,x2=19.472,9.882,P<0.05.Conclusions The upper position of the surgical cavity after palatal tonsillectomy is easier to bleed than other parts,and it is mostly mild and small amount of hemorrhage,most of which can be self-stop.Once the lower part of the cavity is bleeding,it is more likely to be serious hemorrhage,which should be properly handled as soon as possible to avoid serious consequences.