CAJ | 학술논문

目的比较低温等离子手术与常规手术方式在儿童扁桃体、腺样体手术后迟发性出血(手术24 h后)率及出血时间点的情况,初步探讨导致低温等离子手术迟发性出血的可能原因.方法回顾性分析的方法研究采用传统手术和低温等离子手术行扁桃体切除和(或)腺样体刮除术1～14岁患儿术后迟发性出血率及出血时间点的差异.传统组为2005年4月至2006年7月行传统冷法手术(即传统手术刀切除,对周围组织没有热损伤的方法)的患儿,等离子组为2008年4月至2009年9月行低温等离子扁桃体切除和(或)腺样体消融术的患儿.结果传统组患儿484例,术后迟发性出血2例,迟发性出血率为0.4%,出血时间点1例为术后2 d,另1例为术后3 d.等离子组患儿502例,术后迟发性出血11例,迟发性出血率为2.2%,出血时间点2～12 d,中位数为6.0 d.其中等离子刀初学者主刀手术的迟发性出血率为2.6%(10/385),技术操作熟练者手术的迟发性出血率为0.9%(1/117).等离子组迟发性出血率高于传统组(χ2=5.987,P=0.014),两组出血时间点差异无统计学意义(Mann-Whitney检验U=2.500,P=0.103).13例出血患儿中创面局部或上呼吸道感染者6例,术后进食不当的3例.结论低温等离子技术应用于儿童扁桃体腺样体手术后迟发性出血的原因可能与手术技能经验不足、止血稳定性欠佳等有关,术后感染和进食不当也会造成迟发性出血,应引起临床重视.
목적 비교저온등리자수술여상규수술방식재인동편도체、선양체수술후지발성출혈(수술24 h후)솔급출혈시간점적정황,초보탐토도치저온등리자수술지발성출혈적가능원인.방법 회고성분석적방법연구채용전통수술화저온등리자수술행편도체절제화(혹)선양체괄제술1～14세환인술후지발성출혈솔급출혈시간점적차이.전통조위2005년4월지2006년7월행전통랭법수술(즉전통수술도절제,대주위조직몰유열손상적방법)적환인,등리자조위2008년4월지2009년9월행저온등리자편도체절제화(혹)선양체소융술적환인.결과 전통조환인484례,술후지발성출혈2례,지발성출혈솔위0.4%,출혈시간점1례위술후2 d,령1례위술후3 d.등리자조환인502례,술후지발성출혈11례,지발성출혈솔위2.2%,출혈시간점2～12 d,중위수위6.0 d.기중등리자도초학자주도수술적지발성출혈솔위2.6%(10/385),기술조작숙련자수술적지발성출혈솔위0.9%(1/117).등리자조지발성출혈솔고우전통조(χ2=5.987,P=0.014),량조출혈시간점차이무통계학의의(Mann-Whitney검험U=2.500,P=0.103).13례출혈환인중창면국부혹상호흡도감염자6례,술후진식불당적3례.결론 저온등리자기술응용우인동편도체선양체수술후지발성출혈적원인가능여수술기능경험불족、지혈은정성흠가등유관,술후감염화진식불당야회조성지발성출혈,응인기림상중시.
Objective To compare secondary postoperative haemorrhage rate of coblation with the conventional pediatric adenotonsillectomy. And to analyze possible reasons which cause the secondary bleeding after coblation adenotonsillectomy. Methods A retrospective study was applied to compare the secondary postoperative haemorrhage rate and the bleeding moment between two groups in which 1-14 years old children from April 2005 to September 2009 in Guangzhou Children's Hospital were included. Group A was pediatric patients who had conventional adenoidectomy and/or tonsillectomy ( dissection, without heat damage to the tissue) from April 2005 to July 2006 in Department of Otorhinolaryngology. Group B was pediatric patients who had eoblation adenoidectomy and/or tonsillectomy from April 2008 to September 2009 in Department of Otorhinolaryngology. Results Two of 484 cases in group A had secondary postoperative bleeding, the rate was 0. 4%. One happened 2 days after operation, another after 3 days. Eleven of 502 cases in group B had secondary postoperative bleeding, the rate was 2. 2%. Secondary bleeding happened 2 to 12 days after surgery, median 6.0 days. The secondary postoperative haemorrhage rate of operating by the freshman was 2.6% (10/385), and it was 0.9% (1/117) by the senior. The rate of secondary bleeding was higher in group B than group A (χ2 = 5. 987, P < 0. 05). There was no significant difference of secondary bleeding time in both groups (Mann-Whitney U score was 2.500, P>0.05). Six of 13 cases who had secondary bleeding suffered wound or upper respiratory tract infection. Three of 13 ate inappropriately after the operation. Conclusions Pediatric eoblation adenotonsillectomy is a new method. The most possible reasons of secondary bleeding are poor surgery skills and ill experience. And, infection,inappropriate eating after the operation may be the other reasons of secondary bleeding.