背景:在保持中医烙法优点的基础上,改革传统的中医火烙法,自行设计了手枪式具有烙铁加热和喷射油剂性能的电烙器,已取得国家专利,专利证书号:17634,医用电烙器专利号:872106187.目的:观察电烙法治疗慢性扁桃体炎的疗效,并与火烙法相比较.设计:随机抽样法,病例对照观察.单位:辽宁中医学院附属医院耳鼻咽喉科,辽宁省肿瘤医院外科.对象:于1989年在辽宁中医耳鼻咽喉科门诊共烙治扁桃体肥大患者80例,纳入标准:扁桃体均为Ⅱ度和Ⅲ度肥大,均无其他重大心脑血管疾病,均签署知情同意书.排除标准:试验烙治、辍治和病志记载不全者,已出现并发症者.符合标准者40例,男22例,女18例,年龄5～40岁.方法:采用自制电烙器烙治扁桃体肥大,电烙法仍保持传统的中医火烙法的特征,即烙铁不插入扁桃体隐窝和组织内,只烧烙扁桃体表面.根据扁桃体有否慢性充血情况,采取轻烙法和重烙法.扁桃体Ⅲ度肥大,无明显充血者宜用大号烙铁,热度可用700℃、800℃,采用重烙法;慢性充血者宜用大号或中号烙铁,热度可用500、600℃,采用轻烙法.扁桃体Ⅱ度肥大,无明显充血者宜用中号烙铁,热度可用700℃、800℃,采用重烙法;慢性充血者宜用中号或小号烙铁,热度可用500℃、600℃,采用轻烙法.扁桃体Ⅰ度大,慢性充血者宜用小号烙铁,热度可用500℃,采用轻烙法.不论扁桃体几度肥大,有无充血,扁桃体表面经多次烙治后在两咽弓内略呈平面时,如在烧烙时向耳部放散疼痛,均采用轻烙法,并热度需低些.电烙法的每次烙治间隔时间,须间隔两三天烙治1次.主要观察指标:观察电烙法对扁桃体Ⅱ度和Ⅲ度肥大患者施烙后扁桃体大小及局部组织改变.结果:参与中医电烙法治疗的扁桃体肥大患者40例全部进入结果分析,无脱落.①电烙法每次烧烙的组织明显增厚,其中38例的烙治次数仅为4～10次,烙治7次和8次的病例将近半数(9/22.5%,9/22.5%).②中医电烙法的疗程与中医火烙法相比,缩短疗程约3/4,扁桃体肥大程度与烙治次数不完全成正比,Ⅱ度肥大的22例,烙治4～10次,Ⅲ度肥大的18例,除其中2例烙治13次外,其他均烙治7～10次.③每次实施电烙法烙治后扁桃体表面形成一片黑褐色的烧烙焦痂.表层呈蜂窝网状,网眼大小不等,或呈素网状,伊红染色深层见有很多的不着色的索束状坏死组织,为暗灰色,斜行或交错,在索束状变化的间隙中可见到残存的淋巴细胞,有些为核浓缩或碎裂,有些为红染核消失,均为坏死改变.坏死表层上的炭化改变与火烙法相比,明显增厚且极易脱落.④实施电烙法烙治24 h后,坏死组织移行至正常淋巴组织的区域层,有的可见到血管扩张,淋巴细胞间隙增宽(水肿)和中性白细胞浸润等炎性反应改变,其程度与火烙法相比无大差异,此炎性反应改变在四五天后即告消失.结论:中医电烙法由于热度高,烙治次数少,缩短了疗程,对扁桃体Ⅱ度和Ⅲ度肥大治疗效果明显;但因扁桃体质地软硬、充血与否和年龄以及合作等情况不同,烙治次数有差异.
揹景:在保持中醫烙法優點的基礎上,改革傳統的中醫火烙法,自行設計瞭手鎗式具有烙鐵加熱和噴射油劑性能的電烙器,已取得國傢專利,專利證書號:17634,醫用電烙器專利號:872106187.目的:觀察電烙法治療慢性扁桃體炎的療效,併與火烙法相比較.設計:隨機抽樣法,病例對照觀察.單位:遼寧中醫學院附屬醫院耳鼻嚥喉科,遼寧省腫瘤醫院外科.對象:于1989年在遼寧中醫耳鼻嚥喉科門診共烙治扁桃體肥大患者80例,納入標準:扁桃體均為Ⅱ度和Ⅲ度肥大,均無其他重大心腦血管疾病,均籤署知情同意書.排除標準:試驗烙治、輟治和病誌記載不全者,已齣現併髮癥者.符閤標準者40例,男22例,女18例,年齡5～40歲.方法:採用自製電烙器烙治扁桃體肥大,電烙法仍保持傳統的中醫火烙法的特徵,即烙鐵不插入扁桃體隱窩和組織內,隻燒烙扁桃體錶麵.根據扁桃體有否慢性充血情況,採取輕烙法和重烙法.扁桃體Ⅲ度肥大,無明顯充血者宜用大號烙鐵,熱度可用700℃、800℃,採用重烙法;慢性充血者宜用大號或中號烙鐵,熱度可用500、600℃,採用輕烙法.扁桃體Ⅱ度肥大,無明顯充血者宜用中號烙鐵,熱度可用700℃、800℃,採用重烙法;慢性充血者宜用中號或小號烙鐵,熱度可用500℃、600℃,採用輕烙法.扁桃體Ⅰ度大,慢性充血者宜用小號烙鐵,熱度可用500℃,採用輕烙法.不論扁桃體幾度肥大,有無充血,扁桃體錶麵經多次烙治後在兩嚥弓內略呈平麵時,如在燒烙時嚮耳部放散疼痛,均採用輕烙法,併熱度需低些.電烙法的每次烙治間隔時間,鬚間隔兩三天烙治1次.主要觀察指標:觀察電烙法對扁桃體Ⅱ度和Ⅲ度肥大患者施烙後扁桃體大小及跼部組織改變.結果:參與中醫電烙法治療的扁桃體肥大患者40例全部進入結果分析,無脫落.①電烙法每次燒烙的組織明顯增厚,其中38例的烙治次數僅為4～10次,烙治7次和8次的病例將近半數(9/22.5%,9/22.5%).②中醫電烙法的療程與中醫火烙法相比,縮短療程約3/4,扁桃體肥大程度與烙治次數不完全成正比,Ⅱ度肥大的22例,烙治4～10次,Ⅲ度肥大的18例,除其中2例烙治13次外,其他均烙治7～10次.③每次實施電烙法烙治後扁桃體錶麵形成一片黑褐色的燒烙焦痂.錶層呈蜂窩網狀,網眼大小不等,或呈素網狀,伊紅染色深層見有很多的不著色的索束狀壞死組織,為暗灰色,斜行或交錯,在索束狀變化的間隙中可見到殘存的淋巴細胞,有些為覈濃縮或碎裂,有些為紅染覈消失,均為壞死改變.壞死錶層上的炭化改變與火烙法相比,明顯增厚且極易脫落.④實施電烙法烙治24 h後,壞死組織移行至正常淋巴組織的區域層,有的可見到血管擴張,淋巴細胞間隙增寬(水腫)和中性白細胞浸潤等炎性反應改變,其程度與火烙法相比無大差異,此炎性反應改變在四五天後即告消失.結論:中醫電烙法由于熱度高,烙治次數少,縮短瞭療程,對扁桃體Ⅱ度和Ⅲ度肥大治療效果明顯;但因扁桃體質地軟硬、充血與否和年齡以及閤作等情況不同,烙治次數有差異.
배경:재보지중의락법우점적기출상,개혁전통적중의화락법,자행설계료수창식구유락철가열화분사유제성능적전락기,이취득국가전리,전리증서호:17634,의용전락기전리호:872106187.목적:관찰전락법치료만성편도체염적료효,병여화락법상비교.설계:수궤추양법,병례대조관찰.단위:료녕중의학원부속의원이비인후과,요녕성종류의원외과.대상:우1989년재료녕중의이비인후과문진공락치편도체비대환자80례,납입표준:편도체균위Ⅱ도화Ⅲ도비대,균무기타중대심뇌혈관질병,균첨서지정동의서.배제표준:시험락치、철치화병지기재불전자,이출현병발증자.부합표준자40례,남22례,녀18례,년령5～40세.방법:채용자제전락기락치편도체비대,전락법잉보지전통적중의화락법적특정,즉락철불삽입편도체은와화조직내,지소락편도체표면.근거편도체유부만성충혈정황,채취경락법화중락법.편도체Ⅲ도비대,무명현충혈자의용대호락철,열도가용700℃、800℃,채용중락법;만성충혈자의용대호혹중호락철,열도가용500、600℃,채용경락법.편도체Ⅱ도비대,무명현충혈자의용중호락철,열도가용700℃、800℃,채용중락법;만성충혈자의용중호혹소호락철,열도가용500℃、600℃,채용경락법.편도체Ⅰ도대,만성충혈자의용소호락철,열도가용500℃,채용경락법.불론편도체궤도비대,유무충혈,편도체표면경다차락치후재량인궁내략정평면시,여재소락시향이부방산동통,균채용경락법,병열도수저사.전락법적매차락치간격시간,수간격량삼천락치1차.주요관찰지표:관찰전락법대편도체Ⅱ도화Ⅲ도비대환자시락후편도체대소급국부조직개변.결과:삼여중의전락법치료적편도체비대환자40례전부진입결과분석,무탈락.①전락법매차소락적조직명현증후,기중38례적락치차수부위4～10차,락치7차화8차적병례장근반수(9/22.5%,9/22.5%).②중의전락법적료정여중의화락법상비,축단료정약3/4,편도체비대정도여락치차수불완전성정비,Ⅱ도비대적22례,락치4～10차,Ⅲ도비대적18례,제기중2례락치13차외,기타균락치7～10차.③매차실시전락법락치후편도체표면형성일편흑갈색적소락초가.표층정봉와망상,망안대소불등,혹정소망상,이홍염색심층견유흔다적불착색적색속상배사조직,위암회색,사행혹교착,재색속상변화적간극중가견도잔존적림파세포,유사위핵농축혹쇄렬,유사위홍염핵소실,균위배사개변.배사표층상적탄화개변여화락법상비,명현증후차겁역탈락.④실시전락법락치24 h후,배사조직이행지정상림파조직적구역층,유적가견도혈관확장,림파세포간극증관(수종)화중성백세포침윤등염성반응개변,기정도여화락법상비무대차이,차염성반응개변재사오천후즉고소실.결론:중의전락법유우열도고,락치차수소,축단료료정,대편도체Ⅱ도화Ⅲ도비대치료효과명현;단인편도체질지연경、충혈여부화년령이급합작등정황불동,락치차수유차이.
BACKGROUND: For the purpose of keeping the merits of traditional actual cautery, we improved traditional actual cautery and developed a pistollike electrocautery which has the function of heating and spraying oil preparation (it has been issued national patent, patent number: 17634; patent number of medical electrocautery: 872106187). OBJECTIVE: To observe the effect of unique electrocautery of traditional Chinese medicine (TCM) on treating chronic tonsillitis as compared with cautery.DESIGN: Random sampling and case-controlled study.SETTING: Department of Otolaryngology, Affiliated Hospital of Liaoning College of Traditional Chinese Medicine; Surgical Department of Liaoning Oncology Hospital.PARTICIPANTS: Totally 80 patients with hypertrophy of tonsil were selected from the Department of Otolaryngology of the Affiliated Hospital of Liaoning College of Traditional Chinese Medicine in 1989. Inclusion criteria: degrees Ⅱ and Ⅲ of tonsil hypertrophy, without other serious cardiovascular and cerebral diseases, and consent. Exclusion criteria: attempted cauterization, cease of treatment, incomplete case history having complication, and not acceptance. Totally 40 patients were coincidence with the criteria including 22 males and 18 females aged from 5 to 40 years.METHODS: Mild and potent cauterization was adopted according to whether there was chronic congestion in tonsil. For patients with degree Ⅲ of tonsil hypertrophy without obvious congestion, potent cauterization with large size cautery was adopted at 700-800 ℃, if with chronic congestion,potent cauterization with large or middle size cautery at 500-600 ℃ and mild cauterization was adopted; For patients with degree Ⅱ of hypertrophy of tonsil without obvious congestion, potent cauterization with middle size cautery was adopted at 700-800 ℃, if with chronic congestion, mild cauterization with middle or small size cautery was adopted at 500-600 ℃; for patient with first degree of hypertrophy of tonsil without obvious congestion, potent cauterization with small size cautery was adopted at 600-700 ℃, if with chronic congestion, mild cauterization with small size cautery was used at 500 ℃. Cauterization of TCM was not of rather good therapeutic effect on degree Ⅰ of tonsil hypertrophy than on degrees Ⅱ and Ⅲ of hypertrophy of tonsil. Regardless of which degree of hypertrophy of tonsil and congestion, mild cauterization should be adopted at low degree of heat if there was pain radiating to the ear region or pharyngopalatine arch becoming surface-like structure. The average interval between each cauterization was 2-3 days.MAIN OUTCOME MEASURES: Size of tonsil and histological changes of patients with degrees of Ⅱ and Ⅲll tonsil hypertrophy after cauterization.RESULTS: Totally 40 patients with degrees Ⅱ and Ⅲ of tonsil hypertrophy were treated with cautery without any loss. ① Tissues were thickened after each cautery, 38 cases received only 4-10 times of cauterization, and half of the total number of the patients received 7-8 times of cauterization (9/22.5%, 9/22.5%). ② Electrocautery could reduce course of treatment to 1/4 of that of actual cautery. Degree of hypertrophy of tonsil was of no direct ratio to cauterizing times in that 22 patients with degree Ⅱ of hypertrophy of tonsil received 4-10 times of cauterization; while 18 cases of patients with degree Ⅲ of hypertrophy, 2 patients received 13 times of cauterization, the other received 7-10 times of cauterization. ③ A patch of black and brown cauterized scab was formed after each electrocautery on the surface of tonsil; superfical layer was of faveolate structure with different sized eosin dyed mesh; the deep layer was of dull grey oblique and interdigitating cord like structure with necrotic tissues without being dyed and survival lymphocyte in the space between cord, the lymphocyte had the changes of karyo pyknosis and nuclear fragmentation or disappearing of red dyed nuclear. Compared with actual cautery, cauterization of necrotic layer was obviously thickening and easy to exfoliate in electrocautery of TCM. ④ After 24 hours of cauterization, necrotic tissues migrated to normal lymphatic area presented with such inflammatory changes as vascular dilation, widening of lymphocyte space and infiltration of neutrophil. The degrees of above mentioned changes between electrocautery of TCM and actual cautery achieve no significant difference and the inflammatory changes disappeared in 4-5 days.CONCLUSION: Because of high temperature, few cauterized times and short course, electrocautery of TCM has a remarkable effect on degrees Ⅱ and Ⅲ of tonsil hypertrophy; however, various textures, degrees of hyperemia, ages and co-operations can cause different cauterized times.
