关键词: 儿童, 腺样体扁桃体切除术, 轻度出血性疾病, 围手术管理, 出血

Abstract: Objective To explore the perioperative management of children with mild bleeding disorders who underwent tonsil and/or adenoid surgery, and to improve the perioperative safety of such cases in the future. Methods We conducted a retrospective analysis of six children with bleeding disorders who underwent tonsil and/or adenoid surgery in our hospital. We collected information on their diagnosis and treatment plans, bleeding risk assessments, surgical plans, and perioperative bleeding control strategies. We also analyzed the key points of diagnosis and treatment of such cases through a literature review. Results The results for the hemagglutination test of the six children were as follows: hemophilia A FVIII: C 4.8%; APTT 57.7 s, hemophilia B FIX: C 4.2%; APTT 59.3 s, hemophilia B FIX: C 5.9%; APTT 57.2 s, FIX: C 64.3%; APTT 52.3 s, FVII: C 73.3%; FX: C 66.2%; FIX: C 58.4%; APTT 44 s, APTT 35s; PLT 102×10⁹/L. The children with hemophilia were treated with factor replacement and antifibrinolytic therapy, while the two children with coagulopathies were treated with fresh frozen plasma. There was no specific treatment for the child with immune-mediated thrombocytopenia. All six children completed tonsil and/or adenoid surgery successfully with the close cooperation of the hematology, anesthesiology, and blood supply departments. The mean operation time and average bleeding volume were 63.3 min and 16.7 mL for the hemophilia cases, 47.5 min and 10 mL for the coagulopathy cases, and 15 min and 5 mL for the child with platelet reduction. During the perioperative period the coagulation function, coagulation factor activity, inhibitor concentration, and platelet function were monitored. Different replacement treatments and anti-fibrinolytic therapies were given for different reasons. Two patients with hemophilia(33.3%)had mild tonsil hemorrhage during the first 4-7 days of their postoperative hospitalization stay. And no bleeding occurred after the transfusion of fresh frozen plasma. However, the remaining children did not show bleeding. The average length of hospitalization for children with hemophilia was 13.3 days, while the other children were hospitalized for 6 days. The patients all healed well and were discharged, and no bleeding was noted during the 1-month follow-up period. Conclusion Children with mild bleeding disorders who need to undergo tonsil and/or adenoid surgery require multi-disciplinary cooperation, and good bleeding control strategies during the perioperative period. The operation is safe and feasible for these cases. However, perioperative antifibrinolytic therapy should be continued for at least 7-14 days. The hospital stay should also be extended to 1 week for children with mild coagulation dysfunction and up to 2 weeks for cases of hemophilia to ensure the wounds are fully healed.

Key words: Children, Adenotonsillectomy, Mild bleeding disorders, Perioperative management, Blood