低温等离子扁桃体切除术后出血的临床讨论
|
摘要
目的对低温等离子扁桃体切除术后出血的原因及处理进行讨论,为临床预防术后出血提供依据。方法回顾性分析2013年7月～2017年11月在西南医科大学附属医院行低温等离子扁桃体切除手术535例患者的病历资料,其中慢性扁桃体炎151例,扁桃体新生物26例,扁桃体肥大337例,阻塞性睡眠呼吸暂停低通气综合征(OSAHS)21例;收集患者一般临床资料,分析术后出血情况(出血部位、出血类型)及术后出血的处理方式。结果 535例患者中发生术后出血15例,其中原发性出血1例,迟发性出血14例,本组低温等离子扁桃体术后出血发生率为2.8%。结论患者自身的身体条件,术者的手术操作水平,术后术区的恢复情况是导致术后出血的重要原因。严格掌握手术适应症、术者丰富的临床经验及精确的手术操作、术前及术后规范的宣教及护理可有效减少低温等离子扁桃体术后出血。
Objective To discuss the causes and treatment of hemorrhage after low temperature plasma tonsillectomy so as to provide clinical basis for prevention of postoperative hemorrhage. Methods A retrospective analysis was carried out among the medical records of 535 patients undergone low temperature plasma tonsillectomy from Jul.2013 to Nov.2017 in the Affiliated Hospital of Southwest Medical University. There were 151 cases of chronic tonsillitis, 26 cases of tonsillar neoplasm, 337 cases of tonsil hypertrophy and 21 cases of obstructive sleep apnea-hypopnea syndrome(OSAHS). The general clinical data of patients were collected,for analyzing the postoperative hemorrhage(including the hemorrhage site and type) and the treatment of postoperative hemorrhage.Results There were 15 cases of postoperative hemorrhage in the 535 cases, including 1 cases of primary hemorrhage and 14 cases of delayed hemorrhage. The incidence of hemorrhage after low temperature plasma tonsillectomy was 2.8% in this study. Conclusion The physical condition of the patient, the skill level of surgeon and the recovery of postoperative area are the important reasons for postoperative hemorrhage. Grasping the indication of operation strictly, having excellent clinical experience and surgical skills,standardized education and nursing in perioperative period can effectively reduce postoperative hemorrhage of low temperature plasma tonsillectomy.
Objective To discuss the causes and treatment of hemorrhage after low temperature plasma tonsillectomy so as to provide clinical basis for prevention of postoperative hemorrhage. Methods A retrospective analysis was carried out among the medical records of 535 patients undergone low temperature plasma tonsillectomy from Jul.2013 to Nov.2017 in the Affiliated Hospital of Southwest Medical University. There were 151 cases of chronic tonsillitis, 26 cases of tonsillar neoplasm, 337 cases of tonsil hypertrophy and 21 cases of obstructive sleep apnea-hypopnea syndrome(OSAHS). The general clinical data of patients were collected,for analyzing the postoperative hemorrhage(including the hemorrhage site and type) and the treatment of postoperative hemorrhage.Results There were 15 cases of postoperative hemorrhage in the 535 cases, including 1 cases of primary hemorrhage and 14 cases of delayed hemorrhage. The incidence of hemorrhage after low temperature plasma tonsillectomy was 2.8% in this study. Conclusion The physical condition of the patient, the skill level of surgeon and the recovery of postoperative area are the important reasons for postoperative hemorrhage. Grasping the indication of operation strictly, having excellent clinical experience and surgical skills,standardized education and nursing in perioperative period can effectively reduce postoperative hemorrhage of low temperature plasma tonsillectomy.
引文
1张慧,诸葛盼,尤慧华.低温等离子切除扁桃体术后出血原因分析及对策[J].浙江实用医学, 2014, 19(4):292-293.
2 臧艳姿,马崧,万保罗,等.低温等离子扁桃体切除术与传统术式的对照研究[J].中国眼耳鼻喉科杂志, 2015,15(1):28-31.
3 王伟,冯耀清,赵英萃.低温等离子射频消融在扁桃体切除术中的应用[J].吉林医学, 2012, 33(25):5424-5425.
4 李燕,李宣.低温等离子刀治疗慢性扁桃体炎疗效观察[J].齐齐哈尔医学院学报, 2011, 32(24):3961-3962.
5 Windfuhr J, Seehafer M.Classification of haemorrhage following tonsillectomy[J]. J Laryngol Otol, 2001, 115(6):457-461.
6 田天捷,周意,刘忠,等.低温等离子术后假膜脱落的临床讨论[J].临床耳鼻喉头颈外科杂志, 2014, 28(13):986
7 Belloso A, Chidambaram A, Morar P, et al. Coblation tonsillectomy versus dissection tonsillectomy:postoperative hemorrhage[J]. Laryngoscope, 2003, 113(11):2010-2013.
8 Tomkinson A, Harrison W, Owens D, et al. Risk factors for postoperative hemorrhage following tonsillectomy[J]. Laryngoscope, 2011, 121(2):279-288.
9 Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15, 218 patients[J].Otolaryngol Head Neck Surg, 2005, 132(2):281-286.
10 Perkins JN, Liang C, Gao D, et al. Risk of post-tonsillectomy hemorrhage by clinical diagnosis[J]. Laryngoscope,2012,122(10):2311-2315.
11 Arnoldner C, Grasl MCh, Thurnher D, et al. Surgical revision of in 8388 patients after cold-steel adenotonsillectomies[J]. Wien Klin Wochenschr, 2008, 120(11-12):336-342.
12 Bhattacharyya N. Evaluation of post-tonsillectomy bleeding in the adult population[J]. Ear Nose Throat J, 2001, 80(8):544-549.
13 Sarny S, Ossimitz G, Habermann W, et al. Hemorrhage following tonsil surgery:amulticenter prospective study[J].Laryngoscope, 2011, 121(12):2553-3560.
14 Sarny S, Habermann W, Ossimitz G, et al. Tonsilar haemorrhage and re-admission:a questionnaire based study[J]. Eur Arch Otorhinolaryngol, 2011, 268(12):1803-1807.
2 臧艳姿,马崧,万保罗,等.低温等离子扁桃体切除术与传统术式的对照研究[J].中国眼耳鼻喉科杂志, 2015,15(1):28-31.
3 王伟,冯耀清,赵英萃.低温等离子射频消融在扁桃体切除术中的应用[J].吉林医学, 2012, 33(25):5424-5425.
4 李燕,李宣.低温等离子刀治疗慢性扁桃体炎疗效观察[J].齐齐哈尔医学院学报, 2011, 32(24):3961-3962.
5 Windfuhr J, Seehafer M.Classification of haemorrhage following tonsillectomy[J]. J Laryngol Otol, 2001, 115(6):457-461.
6 田天捷,周意,刘忠,等.低温等离子术后假膜脱落的临床讨论[J].临床耳鼻喉头颈外科杂志, 2014, 28(13):986
7 Belloso A, Chidambaram A, Morar P, et al. Coblation tonsillectomy versus dissection tonsillectomy:postoperative hemorrhage[J]. Laryngoscope, 2003, 113(11):2010-2013.
8 Tomkinson A, Harrison W, Owens D, et al. Risk factors for postoperative hemorrhage following tonsillectomy[J]. Laryngoscope, 2011, 121(2):279-288.
9 Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15, 218 patients[J].Otolaryngol Head Neck Surg, 2005, 132(2):281-286.
10 Perkins JN, Liang C, Gao D, et al. Risk of post-tonsillectomy hemorrhage by clinical diagnosis[J]. Laryngoscope,2012,122(10):2311-2315.
11 Arnoldner C, Grasl MCh, Thurnher D, et al. Surgical revision of in 8388 patients after cold-steel adenotonsillectomies[J]. Wien Klin Wochenschr, 2008, 120(11-12):336-342.
12 Bhattacharyya N. Evaluation of post-tonsillectomy bleeding in the adult population[J]. Ear Nose Throat J, 2001, 80(8):544-549.
13 Sarny S, Ossimitz G, Habermann W, et al. Hemorrhage following tonsil surgery:amulticenter prospective study[J].Laryngoscope, 2011, 121(12):2553-3560.
14 Sarny S, Habermann W, Ossimitz G, et al. Tonsilar haemorrhage and re-admission:a questionnaire based study[J]. Eur Arch Otorhinolaryngol, 2011, 268(12):1803-1807.