不同手术方式在扁桃体切除术中的应用

Application of Different Surgical Methods in Tonsillectomy

【目的】探讨扁桃体切除术传统剥离法、单极电刀、超声刀和等离子刀四种术式的优缺点,并对其术式特点和应用价值进行评价。【方法】回顾性分析在本院行扁桃体切除术的116例患者,按不同术式分为剥离组、电刀组、超声刀组和等离子组,每组各29例。记录每组手术的手术时间、术中出血量、术后咽部疼痛、白膜脱落时间和术后出血并发症等。【结果】电刀组、超声刀组和等离子组患者手术时间及术中出血量均低于剥离组,而白膜脱落时间高于剥离组,其差异有统计学意义(P<0.05),但前三组之间各指标两两比较差异无统计学意义(P>0.05)。超声刀组、等离子组患者术后1〜3 d的咽部疼痛评分均较剥离组及电刀组低(P<0.05),而术后4〜6 d患者咽部疼痛四组间比较差异无显著性(P>0.05)。四组间术后出血并发症比较,差异无显著性(P>0.05)。【结论】使用单极电刀、超声刀、等离子等热切法切除扁桃体安全、有效,值得临床推广。

【Objective】To evaluate the advantages and disadvantages of conventional approach,monopolar electrocautery,ultrasonic knife,plasma knife in tonsillectomy.【Methods】A total of 116 cases of tonsillectomy were collected and divided into 4 groups:the traditional tonsillectomy group(group A,n=29),monopolar electrocautery group(group B,n=29),ultrasound knife tonsillectomy group(group C,n=29)and coblation tonsillectomy group(group D,n=29)The operation time,intraoperative blood loss,postoperative sore throat situation,white film shedding time,postoperative bleeding and complications were recorded and compared among all groups.【Results】Compared to the group A,the operation time was shorter and the intraoperative blood los.s was less in the group B,C and D.The white film shedding time was longer in group B,C and D than in group A.However,there were no statistically significant differences among group A,B and C(P>0.05).The degree of pharyngeal pain in the first three days after surgery in group C and in group D was significantly lower than that in group A and group B;while there was no difference among the four groups of patients with pharyngeal pain on the 4 to 6 days after operation(P>0.05).There was also no significant differ-ence in postoperative bleeding among group A,B,C and D.【Conclusion】electrocautery Monopolar electrocau-tery,ultrasonic knife and coblation tonsillectomy are the more safe and effective methods,which provides favorable clinical value.