等离子扁桃体切除与扁桃体常规剥离法切除对患者围术期指标、术后疼痛及并发症的影响
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摘要
目的探究等离子扁桃体切除与扁桃体常规剥离法切除对患者围术期指标、术后疼痛及并发症的影响。方法回顾性分析我院行等离子扁桃体切除治疗(观察组)及行扁桃体常规剥离法治疗(对照组)患者各32例临床资料。记录两组围术期相关指标(手术时间、术中出血量、恢复正常饮食时间、白膜形成时间、白膜完全消退时间)、术后2周并发症发生情况和术后1、3、5 d时疼痛程度[视觉模拟评分(visual analogue scale,VAS)],并比较两组术前及术后1d创伤应激指标[皮质醇(cortisol,Cor)、降钙素原(procalcition,PCT)]差异。结果两组白膜形成时间及术后2周内并发症发生情况比较,差异无统计学意义(P>0. 05);观察组手术时间、术中出血量、恢复正常饮食时间均低于对照组(P <0.05),而白膜完全消退时间高于对照组(P <0.05)。两组术后疼痛程度(VAS评分)比较,变化趋势均为术后1d>术后3d>术后5d(P <0.05),且观察组各时间点VAS评分均低于对照组(P <0. 05)。术后1d时,两组创伤应激指标(Cor、PCT)均较术前升高(P<0.05),且对照组高于观察组(P<0.05)。结论等离子扁桃体切除与扁桃体常规剥离法切除均具有较高的安全性,但等离子扁桃体切除术具有创伤小、手术时间短、术中出血量少等优点,临床应用价值较高,不过需重视白膜消退时间延迟现象,以避免术后继发性出血等并发症。
Objective To investigate the effects of plasma tonsillectomy and conventional dissection tonsillectomy on perioperative indexes,postoperative pain and complications. Methods The clinical data of 32 patients with plasma tonsillectomy(the observation group) and 32 patients with conventional dissection tonsillectomy(the control group) were retrospectively analyzed. Perioperative indexes( operative time,intraoperative blood loss,time of diet normal recovery,albuginea formation time,complete remission time of albuginea),occurrence of complications at 2 w after the operation and pain degrees at 1 d,3 d and 5 d after the operation [Visual Analogue Scale(VAS) ] were recorded in both groups,and the traumatic stress indicators[cortisol(Cor),procalcitonin(PCT) ] were compared between the two groups before the operation and at 1 d after the operation. Results There were no significant differences in the formation time of albuginea and the occurrence of complications within 2 w after the operation between the two groups(P >0.05). The operative time, intraoperative blood loss and time of diet normal recovery in the observation group were lower than those in the control group(P <0.05),and the complete regression time of albuginea was higher than that in the control group(P<0. 05). The changing trend of the postoperative pain degree(VAS score) in the two groups showed the ranking as following : 1 d after the operation greater than 3 d after the operation greater than 5 d after the operation(P <0. 05),and the VAS score in the observation group at each time point was lower than that in the control group(P < 0. 05). At 1 d after the operation, the traumatic stress indicators(Cor,PCT) were increased compared with those before the operation(P <0. 05),and the indicators in the control group were higher than those in the observation group(P < 0. 05). Conclusion Plasma tonsillectomy and conventional dissection tonsillectomy both have high clinical safeties. However,plasma tonsillectomy has the advantages of small trauma,short operative time and little intraoperative blood loss,suggesting a high clinical application value. But physicians need to pay attention to the delay of albuginea regression time to avoid complications of postoperative secondary bleeding.
Objective To investigate the effects of plasma tonsillectomy and conventional dissection tonsillectomy on perioperative indexes,postoperative pain and complications. Methods The clinical data of 32 patients with plasma tonsillectomy(the observation group) and 32 patients with conventional dissection tonsillectomy(the control group) were retrospectively analyzed. Perioperative indexes( operative time,intraoperative blood loss,time of diet normal recovery,albuginea formation time,complete remission time of albuginea),occurrence of complications at 2 w after the operation and pain degrees at 1 d,3 d and 5 d after the operation [Visual Analogue Scale(VAS) ] were recorded in both groups,and the traumatic stress indicators[cortisol(Cor),procalcitonin(PCT) ] were compared between the two groups before the operation and at 1 d after the operation. Results There were no significant differences in the formation time of albuginea and the occurrence of complications within 2 w after the operation between the two groups(P >0.05). The operative time, intraoperative blood loss and time of diet normal recovery in the observation group were lower than those in the control group(P <0.05),and the complete regression time of albuginea was higher than that in the control group(P<0. 05). The changing trend of the postoperative pain degree(VAS score) in the two groups showed the ranking as following : 1 d after the operation greater than 3 d after the operation greater than 5 d after the operation(P <0. 05),and the VAS score in the observation group at each time point was lower than that in the control group(P < 0. 05). At 1 d after the operation, the traumatic stress indicators(Cor,PCT) were increased compared with those before the operation(P <0. 05),and the indicators in the control group were higher than those in the observation group(P < 0. 05). Conclusion Plasma tonsillectomy and conventional dissection tonsillectomy both have high clinical safeties. However,plasma tonsillectomy has the advantages of small trauma,short operative time and little intraoperative blood loss,suggesting a high clinical application value. But physicians need to pay attention to the delay of albuginea regression time to avoid complications of postoperative secondary bleeding.
引文
[1]张琳琳,周永.扁桃体切除术对患者主要生化指标的远期影响[J].临床耳鼻咽喉头颈外科杂志,2017,31(9):682-686.
[2]磨宾宇,李纪辉,冯海燕,等.高频电刀扁桃体部分切除术与完全切除术治疗儿童OSHAS的中远期疗效对比[J].实用医学杂志,2017,33(21):3577-3581.
[3]张剑伟,徐金,张其昌,等.单极电刀凝切术与传统剥离切除术在儿童扁桃体手术中的比较[J].中国微创外科杂志,2016,16(2):158-160.
[4]谢芳,陈惟虎,胡春玖,等.低温等离子射频消融术行成人扁桃体切除的疗效观察[J].中国中西医结合耳鼻咽喉科杂志,2017,25(2):115-117.
[5]刘淑香,李国芳,苏江涛,等.三种不同镇痛方案对剖宫产产妇炎症因子影响的研究[J].标记免疫分析与临床,2016,23(6):627-629.
[6]雷亨发,夏中元.盐酸右美托咪定在扁桃体切除术中的麻醉效果及对术后认知功能的影响研究[J].河北医学,2017,23(5):732-735.
[7]张立庆,宋圣花,王愿,等.低温等离子刀、超声刀及传统方式行扁桃体切除术的术后两年随访比较[J].山东大学耳鼻喉眼学报,2017,31(5):67-71.
[8]周成勇,孙宝春,王丰,等.低温等离子辅助下儿童腺样体和扁桃体手术临床疗效观察[J].临床耳鼻咽喉头颈外科杂志,2016,30(11):863-866.
[9]林荣志,洪育明,梁振源,等.手术结束前升高血压对减少低温等离子扁桃体切除术后出血的疗效观察[J].中国耳鼻咽喉头颈外科,2017,24(1):39-40.
[10]朱增辉,赵怀志,孙珂,等.低温等离子联合血管缝扎在扁桃体切除中的临床应用[J].中国耳鼻咽喉头颈外科,2016,23(11):675-676.
[11]吴昊,刘磊,王东海.低温等离子腺样体联合双侧扁桃体切除对小儿鼾症患者最低动脉血氧饱和度和睡眠质量的影响[J].解放军预防医学杂志,2017,35(6):629-631.
[12]陈洽鑫,张涛.扁桃体手术对人体免疫功能的影响[J].国际耳鼻咽喉头颈外科杂志,2017,41(5):249-253.
[13]刘学军,黄赛瑜,高金建,等.鼻内镜下低温等离子射频消融术治疗儿童鼾症的疗效及术后反应观察[J].中国内镜杂志,2016,22(6):5-8.
[14] PANG Y,GONG J,HUANG J,et al. Coblation tonsillectomy under surgical microscopy:A retrospective study[J]. J Int Med Res,2016,44(4):923-930.
[15] FANG V S,TRICOU B J,ROBERTSON A,et al. Plasma ACTH and cortisol levels in depressed patients:relation to dexamethasone suppression test[J]. Life Sc,1981,29(9):931-938.
[16] GAO Y,YU K J,KANG K,et al. Procalcitionin as a diagnostic marker to distinguish upper and lower gastrointestinal perforation[J]. World J Gastroenterol,2017,23(24):4422-4427.
[2]磨宾宇,李纪辉,冯海燕,等.高频电刀扁桃体部分切除术与完全切除术治疗儿童OSHAS的中远期疗效对比[J].实用医学杂志,2017,33(21):3577-3581.
[3]张剑伟,徐金,张其昌,等.单极电刀凝切术与传统剥离切除术在儿童扁桃体手术中的比较[J].中国微创外科杂志,2016,16(2):158-160.
[4]谢芳,陈惟虎,胡春玖,等.低温等离子射频消融术行成人扁桃体切除的疗效观察[J].中国中西医结合耳鼻咽喉科杂志,2017,25(2):115-117.
[5]刘淑香,李国芳,苏江涛,等.三种不同镇痛方案对剖宫产产妇炎症因子影响的研究[J].标记免疫分析与临床,2016,23(6):627-629.
[6]雷亨发,夏中元.盐酸右美托咪定在扁桃体切除术中的麻醉效果及对术后认知功能的影响研究[J].河北医学,2017,23(5):732-735.
[7]张立庆,宋圣花,王愿,等.低温等离子刀、超声刀及传统方式行扁桃体切除术的术后两年随访比较[J].山东大学耳鼻喉眼学报,2017,31(5):67-71.
[8]周成勇,孙宝春,王丰,等.低温等离子辅助下儿童腺样体和扁桃体手术临床疗效观察[J].临床耳鼻咽喉头颈外科杂志,2016,30(11):863-866.
[9]林荣志,洪育明,梁振源,等.手术结束前升高血压对减少低温等离子扁桃体切除术后出血的疗效观察[J].中国耳鼻咽喉头颈外科,2017,24(1):39-40.
[10]朱增辉,赵怀志,孙珂,等.低温等离子联合血管缝扎在扁桃体切除中的临床应用[J].中国耳鼻咽喉头颈外科,2016,23(11):675-676.
[11]吴昊,刘磊,王东海.低温等离子腺样体联合双侧扁桃体切除对小儿鼾症患者最低动脉血氧饱和度和睡眠质量的影响[J].解放军预防医学杂志,2017,35(6):629-631.
[12]陈洽鑫,张涛.扁桃体手术对人体免疫功能的影响[J].国际耳鼻咽喉头颈外科杂志,2017,41(5):249-253.
[13]刘学军,黄赛瑜,高金建,等.鼻内镜下低温等离子射频消融术治疗儿童鼾症的疗效及术后反应观察[J].中国内镜杂志,2016,22(6):5-8.
[14] PANG Y,GONG J,HUANG J,et al. Coblation tonsillectomy under surgical microscopy:A retrospective study[J]. J Int Med Res,2016,44(4):923-930.
[15] FANG V S,TRICOU B J,ROBERTSON A,et al. Plasma ACTH and cortisol levels in depressed patients:relation to dexamethasone suppression test[J]. Life Sc,1981,29(9):931-938.
[16] GAO Y,YU K J,KANG K,et al. Procalcitionin as a diagnostic marker to distinguish upper and lower gastrointestinal perforation[J]. World J Gastroenterol,2017,23(24):4422-4427.