鼻内镜下切除扁桃体及腺样体的临床探索

Clinical exploration of tonsillectomy and adenoidectomy under nasal endoscopy

摘要:

目的 比较鼻内镜下低温等离子切除扁桃体及腺样体与鼻内镜下扁桃体电切术和腺样体吸切术的临床疗效。方法 选取该院因扁桃体及腺样体肥大需要手术的患儿80例。其中，实验组（n = 40）为鼻内镜下低温等离子切除扁桃体及腺样体，对照组（n = 40）为鼻内镜下电切扁桃体与腺样体吸切，比较两组患儿术中和术后相关指标的差异。结果 实验组手术时间（36.80±3.11）min、术中出血量（12.72±3.05）mL、术后6、24、48和72 h疼痛评分分别为（2.05±0.50）、（2.62±0.54）、（2.50±0.55）和（1.90±0.44）分，明显低于对照组，两组比较，差异均有统计学意义（P < 0.01）。对照组扁桃体伪膜脱落时间（9.30±1.29）d明显少于实验组（11.65±1.28）d，两组比较，差异有统计学意义（P < 0.01）。实验组治愈30例，好转9例，无效1例，对照组治愈25例，好转12例，无效3例，两组比较，差异无统计学意义（P > 0.05）。结论 鼻内镜下低温等离子切除扁桃体及腺样体可缩短手术时间，减少术中出血量，减轻术后疼痛，值得在临床上推广。

Abstract:

Objective To compare the clinical effect of low temperature plasma tonsillectomy and adenoidectomy with tonsillectomy by single pole high frequency electrotome and powered microdebrider adenoidectomy under nasal endoscopy.Methods Patients with hypertrophy of tonsil and adenoid were selected. The experimental group was 40 cases with low temperature plasma tonsillectomy and adenoidectomy under nasal endoscopy, and the control group was 40 cases with tonsillectomy by single pole high frequency electrotome and powered microdebrider adenoidectomy under nasal endoscopy.Results The operative time (36.80 ± 3.11) min, intraoperative blood loss (12.72 ± 3.05) mL, the pain scores were (2.05 ± 0.50), (2.62 ± 0.54), (2.50 ± 0.55) and (1.90 ± 0.44) in experimental group at 6, 24, 48 and 72 h after operation, were significantly lower than those in control group, the difference was statistically significant between the two groups (P < 0.01). Tonsil pseudomembrane shedding time in control group (9.30 ± 1.29) d was significantly less than that in experimental group (11.65 ± 1.28) d, the difference was statistically significant between the two groups (P < 0.01). 30 cases were cured, 9 cases were improved and 1 case was invalid in experimental group; 25 cases, improved 12 cases, ineffective 3 cases in control group, there was no statistical difference between the two groups (P > 0.05).Conclusion Low temperature plasma tonsillectomy and adenoidectomy under nasal endoscopy reduce the operation time and intraoperative bleeding and relieve postoperative pain in children. This technique is worth popularizing.