缝合腭弓对扁桃体术后出血影响的临床研究

Effects of palatal arch suturing on postoperative hemorrhage after tonsillectomy

目的客观评价缝合腭弓在减少扁桃体术后出血中的作用。方法回顾性分析2013年1月至2019年10月行成人扁桃体切除术患者234例,所有患者均在全麻下行低温等离子扁桃体切除术,其中125例患者为预防术后出血行双侧腭弓缝合(观察组),另109例患者未行腭弓缝合(对照组),观察与记录术后出血情况。结果观察组和对照组原发性出血发生率分别为0.8%、6.4%,差异有统计学意义(χ^(2)=6.11,P=0.027);观察组和对照组继发性出血率分别为14.4%、9.2%,差异无统计学意义(χ^(2)=1.51,P=0.219);观察组和对照组继发性出血高峰多集中在术后第7~10天,占术后继发性出血的比例分别为77.8%、80%,差异无统计学意义(χ^(2)=0.019,P>0.999);观察组术中缝合时出现腭弓撕裂5例,术后咽腔瘢痕愈合3例。结论腭弓缝合能够减少扁桃体术后原发性出血,并不一定能减少继发性出血的发生,且腭弓缝合会出现腭弓撕裂、瘢痕愈合等并发症,临床要合理掌握和应用这一方法,不可一味放大其减少扁桃体术后出血的作用。

Objective To evaluate the effect of palatal arch suturing on reducing the risk of postoperative hemorrhage after tonsillectomy.Methods We retrospectively analyzed 234 cases of adult tonsillectomy performed by the same chief physician of our department from January 2013 to October 2019.All patients underwent low-temperature plasma tonsillectomy under general anesthesia.Among them,125 patients received bilateral palatal arch suturing to prevent postoperative hemorrhage(observation group),while 109 patients received no palatal arch suturing(control group).The incidences of postoperative hemorrhage in both groups were recorded.Results The incidences of primary hemorrhage in the observation and control groups were 0.8%and 6.4%,respectively,with a statistically significant difference(χ^(2)=6.11,P=0.027,P<0.05);the secondary hemorrhage rates of the observation and control groups were 14.4%and 9.2%,respectively,with no statistically significant difference(χ^(2)=1.51,P=0.219,P>0.05);the secondary hemorrhage peaks in the observation and control groups were mainly on postoperative days 7 to 10,accounting for 77.8%and 80%of the postoperative hemorrhage,respectively,with no statistically significant difference(χ^(2)=0.019,P>0.999,P>0.05);in the observation group,there were five cases of palatal arch tearing during intraoperative suturing and three cases of pharyngeal cavity scar healing.Conclusions Palatal arch suturing could reduce the incidence of primary postoperative hemorrhage but not necessarily that of secondary hemorrhage after tonsillectomy.In addition,palatal arch suturing could cause complications,such as palatal arch tearing and scar healing.Accordingly,we should reasonably grasp and apply this method instead of blindly magnifying its effect of reducing the risk of postoperative hemorrhage after tonsillectomy.