两种扁桃体切除方法的临床观察

A comparison of radiofrequency ablation with traditional surgical method for the treatment of chronic tonsillitis CHEN Wei, WU Kunming, WANG Tianyou, et al.

摘要:

目的比较两种不同扁桃体切除及止血方法的优缺点。方法将诊治的90例扁桃体切除术患者随机分为等离子手术组（A组）和传统手术组（B组），每组各45例，所有手术均由同一术者完成。等离子手术组用低温等离子法切除扁桃体并止血；传统手术组则采用常规扁桃体剥离并用双极电凝止血。记录切除双侧扁桃体所需时间和出血量；术后第1天起每日记录患者咽部疼痛评分情况，连续10 d；术后第10天观察并记录扁桃体窝内的白膜状况。结果A、B两组手术总时间分别为（18.0±1.6）min、（43.5±3.4）min，术中总出血量分别为（9.3±1.3）ml、（53.8±5.5）ml，两组间差异均具有统计学意义（P<0.05）；两组患者术后1周内疼痛指数差异比较具有统计学意义（P<0.05），1周后疼痛指数比较差异无统计学意义（P>0.05）；A、B两组术后出血发生病例数分别为3例、4例，出血发生率比较差异具有统计学意义(P<0.05)，术后比较，A、B两组白膜与扁桃体窝面积比分别为（43.8±6.6）%、（40.5±5.1）%，两组之间差异无统计学意义，但等离子组白膜较为清洁。结论与传统扁桃体剥离法比较，低温等离子法切除扁桃体具有手术损伤小、术中出血少、术后疼痛轻、恢复好等优点，可作为扁桃体切除手术的首选。

关键词:扁桃体切除术|低温等离子射频|双极电凝|临床观察

Abstract:

Abstract:ObjectiveComparing the advantages and disadvantages between the two different surgical methods for the treatment of chronic tonsillitis.Methods90 patients receiving tonsillectomy in our department were randomly divided into radiofrequency ablation group（RFA）(group A) and regular surgical group(group B), 45 cases in each group. In group A, low temperature RFAassisted tonsillectomy was adopted. In group B, conventional tonsillectomy combing bipolar electrocoagulation was adopted. All the operations were performed by the same surgeon. The operation time and amount of intraoperative bleeding of the two groups were recorded and evaluated. The postoperative pain was daily assessed and recorded via VAS score system. The pseudomembrane in tonsil fossa of all the patients was evaluated at the 10th day postoperatively.ResultsThe average operation time of group A was (18.0±1.6) min while that of group B was (43.5±3.4) min, the difference was statistically significant(P<0.05). The intraoperative bleeding volume of group A and B was (9.3±1.3)ml and (53.8±5.5)ml respectively, and the difference was also statistically significant (P<0.05). As for postoperative pain, the differences of VAS scores within one week postoperatively between the two groups were significant (P<0.05) while those after one week were insignificant (P>0.05). Postoperative hemorrhage occurred in 3 and 4 cases in group A and B respectively, and the hemorrhage rates of the two groups were significantly different (P<0.05). The size ratios of pseudomembrane to tonsil fossa in the two groups were (43.8±6.6)% and (40.5±5.1)% with insignificant difference (P>0.05). ConclusionWith advantages of minimal invasion, little blood loss, light postoperative pain and rapid recovery, low temperature RFAassisted tonsillectomy may be a preferred method for tonsillectomy.

Key words:Tonsillectomy| Low temperature radiofrequency ablation| Bipolar electric coagulation|Clinical observation