缝合腭弓对扁桃体术后出血影响的临床研究

doi:10.6040/j.issn.1673-3770.0.2020.114

摘要/Abstract

摘要： 目的客观评价缝合腭弓在减少扁桃体术后出血中的作用。方法回顾性分析2013年1月至2019年10月行成人扁桃体切除术患者234例,所有患者均在全麻下行低温等离子扁桃体切除术,其中125例患者为预防术后出血行双侧腭弓缝合(观察组),另109例患者未行腭弓缝合(对照组),观察与记录术后出血情况。结果观察组和对照组原发性出血发生率分别为0.8%、6.4%,差异有统计学意义(χ2=6.11,P=0.027);观察组和对照组继发性出血率分别为14.4%、9.2 %,差异无统计学意义(χ2=1.51,P=0.219);观察组和对照组继发性出血高峰多集中在术后第7~10天,占术后继发性出血的比例分别为77.8%、80%,差异无统计学意义(χ2=0.019,P>0.999);观察组术中缝合时出现腭弓撕裂5例,术后咽腔瘢痕愈合3例。结论腭弓缝合能够减少扁桃体术后原发性出血,并不一定能减少继发性出血的发生,且腭弓缝合会出现腭弓撕裂、瘢痕愈合等并发症,临床要合理掌握和应用这一方法,不可一味放大其减少扁桃体术后出血的作用。

关键词: 扁桃体切除术, 低温等离子消融术, 术后出血, 缝合止血

Abstract: Objective To evaluate the effect of palatal arch suturing on reducing the risk of postoperative hemorrhage after tonsillectomy. Methods We retrospectively analyzed 234 cases of adult tonsillectomy performed by the same chief physician of our department from January 2013 to October 2019. All patients underwent low-temperature plasma tonsillectomy under general anesthesia. Among them, 125 patients received bilateral palatal arch suturing to prevent postoperative hemorrhage(observation group), while 109 patients received no palatal arch suturing(control group). The incidences of postoperative hemorrhage in both groups were recorded. Results The incidences of primary hemorrhage in the observation and control groups were 0.8% and 6.4%, respectively, with a statistically significant difference(χ2=6.11, P=0.027, P<0.05); the secondary hemorrhage rates of the observation and control groups were 14.4% and 9.2%, respectively, with no statistically significant difference(χ2=1.51, P=0.219, P>0.05); the secondary hemorrhage peaks in the observation and control groups were mainly on postoperative days 7 to 10, accounting for 77.8% and 80% of the postoperative hemorrhage, respectively, with no statistically significant difference(χ2=0.019, P>0.999, P>0.05); in the observation group, there were five cases of palatal arch tearing during intraoperative suturing and three cases of pharyngeal cavity scar healing. Conclusions Palatal arch suturing could reduce the incidence of primary postoperative hemorrhage but not necessarily that of secondary hemorrhage after tonsillectomy. In addition, palatal arch suturing could cause complications, such as palatal arch tearing and scar healing. Accordingly, we should reasonably grasp and apply this method instead of blindly magnifying its effect of reducing the risk of postoperative hemorrhage after tonsillectomy.

Key words: Tonsillectomy, Low temperature radiofrequency ablation, Postoperative hemorrhage, Suture hemostasis

中图分类号:

田天捷,张自雄,杨飞,周意. 缝合腭弓对扁桃体术后出血影响的临床研究[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 82-85.

TIAN Tianjie, ZHANG Zixion, YANG Fei, ZHOU Yi. Effects of palatal arch suturing on postoperative hemorrhage after tonsillectomy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(1): 82-85.

参考文献

[1] 张立庆, 杨翠方, 周华群, 等. 低温等离子刀、超声刀及传统方式行扁桃体切除术的比较[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 56-60. doi:10.6040/j.issn.1673-3770.0.2016.123. ZHANG Liqing, YANG Cuifang, ZHOU Huaqun, et al. Comparison of coblation, ultrasonic knife and conventional approach in tonsillectomy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(3): 56-60. doi:10.6040/j.issn.1673-3770.0.2016.123.
[2] 仇书要, 刘大波, 钟建文, 等. 儿童阻塞性睡眠呼吸暂停低通气综合征等离子消融术后并发症分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 34-37. doi:10.6040/j.issn.1673-3770.0.2017.533. QIU Shuyao, LIU Dabo, ZHONG Jianwen, et al. Analysis of coblation complications in children with obstructive sleep apnea-hypopnea syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(2): 34-37. doi:10.6040/j.issn.1673-3770.0.2017.533.
[3] Hsueh WY, Hsu WC, Ko JY, et al. Postoperative hemorrhage following tonsillectomy in adults: Analysis of population-based inpatient cohort in Taiwan[J]. Auris Nasus Larynx, 2019, 46(3): 397-406. doi:10.1016/j.anl.2018.10.008.
[4] Kou YF, Sakai M, Shah GB, et al. Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: a cross-sectional study[J]. Laryngoscope, 2019, 129(4): 995-1000. doi:10.1002/lary.27405.
[5] 覃文格. 术创缝合对防止扁桃体术后出血的意义[J]. 海南医学, 2006, 17(2): 114, 150. doi:10.3969/j.issn.1003-6350.2006.02.082.
[6] 杨正光, 李冠环. 扁桃体切除术中创面缝合处理对创面恢复的影响[J]. 广西医科大学学报, 2007, 24(3): 456-457. doi:10.3969/j.issn.1005-930X.2007.03.059.
[7] Wulu JA, Chua M, Levi JR. Does suturing tonsil Pillars post-tonsillectomy reduce postoperative hemorrhage: a literature review[J]. Int J Pediatr Otorhinolaryngol, 2019, 117: 204-209. doi:10.1016/j.ijporl.2018.12.003.
[8] 黄纪逸, 李柏滋, 吴树浓, 等. 咽腭弓肌黏膜瓣闭合扁桃体等离子术后创面的临床疗效[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 92-95. doi:10.6040/j.issn.1673-3770.0.2018.400. HUANG Jiyi, LI Baizi, WU Shunong, et al. Clinical efficacy of the pharyngopalatine arch muscle mucosal flap for tonsillectomy wound closure after plasma surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 92-95. doi:10.6040/j.issn.1673-3770.0.2018.400.
[9] 刘倩, 吕颜露. 术腔缝合止血对TLTPRA术后迟发出血及凝血的影响[J]. 武汉大学学报(医学版), 2019, 40(5): 815-818. doi:10.14188/j.1671-8852.2018.1154. LIU Qian, LYU Yanlu. Clinical effect of suture of the operating cavity on delayed bemorrhage of tonsil after low temperature plasma radiofrequency ablation and the changes of coagulation factors[J]. Medical Journal of Wuhan University, 2019,40(5): 815-818. doi:10.14188/j.1671-8852.2018.1154.
[10] Fornazieri MA, Miyazato ES, Yamamoto HM, et al. Reducing the exposure of the tonsillar Fossa does not impact postoperative pain levels in children undergoing tonsillectomy: a double-blind randomized controlled trial[J]. Int J Pediatr Otorhinolaryngol, 2018, 111: 63-68. doi:10.1016/j.ijporl.2018.05.029.
[11] Windfuhr JP, Chen YS. Do changing trends in tonsil surgery affect hemorrhage rates? A longitudinal study covering 1, 452, 637 procedures[J]. Eur Arch Otorhinolaryngol, 2019, 276(9): 2585-2593. doi:10.1007/s00405-019-05532-3.
[12] 赖若沙, 李葳, 曾俊杰, 等. 肥胖对14岁以上扁桃体切除术患者术后出血的影响[J]. 中国现代医学杂志, 2019, 29(8): 62-65. doi:10.3969/j.issn.1005-8982.2019.08.013. LAI Ruosha, LI Wei, ZENG Junjie, et al. Effect of obesity on post-tonsillectomy hemorrhage of patients over 14 years old[J]. China Journal of Modern Medicine, 2019, 29(8): 62-65. doi:10.3969/j.issn.1005-8982.2019.08.013.
[13] Hoshino T, Tanigawa T, Yanohara G, et al. Effect of body mass index on posttonsillectomy hemorrhage[J]. Biomed Res Int, 2017, 2017: 1-4. doi:10.1155/2017/9610267.
[14] Matt BH, Krol BJ, Ding Y, et al. Effect of tonsillar Fossa closure on postoperative pain and bleeding risk after tonsillectomy[J]. Int J Pediatr Otorhinolaryngol, 2012, 76(12): 1799-1805. doi:10.1016/j.ijporl.2012.09.004.
[15] El-Taher M, Aref Z. Coblation versus conventional tonsillectomy: a double blind randomized controlled trial[J]. Indian J Otolaryngol Head Neck Surg, 2019, 71(suppl 1): 172-175. doi:10.1007/s12070-017-1189-z.
[16] Senska G, Schröder H, Pütter C, et al. Significantly reducing post-tonsillectomy haemorrhage requiring surgery by suturing the faucial Pillars: a retrospective analysis[J]. PLoS One, 2012, 7(10): e47874. doi:10.1371/journal.pone.0047874.
[17] 张良, 王亚娜, 翟钊, 等. 扁桃体切除术后出血风险的多因素分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2015,23(4): 270-273. doi:10.16542/j.cnki.issn.1007-4856.2015.04.009. ZHANG Liang, WANG Yana, ZHAI Zhao, et al. Risk factors for post-tonsillectomy hemorrhage based on logistic regression analysis[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2015, 23(4): 270-273. doi:10.16542/j.cnki.issn.1007-4856.2015.04.009.
[18] 余爵波, 程泽星, 练状, 等. 扁桃体切除术后出血118例危险因素分析[J]. 中国基层医药, 2019, 26(6): 732-737. doi:10.3760/cma.j.issn.1008-6706.2019.06.028. YU Juebo, CHENG Zexing, LIAN Zhuang, et al. Risk factors analysis of 118 cases with post-tonsillectomy hemorrhag[J]. Chinese Journal of Primary Medicine and Pharmacy, 2019, 26(6): 732-737. doi:10.3760/cma.j.issn.1008-6706.2019.06.028.
[19] 王媛媛, 赵飞鹏, 罗剑, 等. 低温等离子扁桃体切除术后出血的临床讨论[J]. 中国中西医结合耳鼻咽喉科杂志, 2019, 27(1): 49-51, 10. doi:10.16542/j.cnki.issn.1007-4856.2019.01.010. WANG Yuanyuan, ZHAO Feipeng, LUO Jian, et al. Clinical analysis of hemorrhage after low temperature plasma tonsillectomy[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2019, 27(1): 49-51, 10. doi:10.16542/j.cnki.issn.1007-4856.2019.01.010.
[20] Elinder K, Söderman ACH, Stalfors J, et al. Factors influencing morbidity after paediatric tonsillectomy: a study of 18, 712 patients in the National Tonsil Surgery Register in Sweden[J]. Eur Arch Oto-Rhino-Laryngol, 2016, 273(8): 2249-2256. doi:10.1007/s00405-016-4001-x.
[21] McKeon M, Kirsh E, Kawai K, et al. Risk factors for multiple hemorrhages following tonsil surgery in children[J]. Laryngoscope, 2019, 129(12): 2765-2770. doi:10.1002/lary.27719.
[22] Albright JT, Duncan NO, Smerica AM, et al. Intra-capsular complete tonsillectomy, a modification of surgical technique to eliminate delayed post-operative bleeding[J]. Int J Pediatr Otorhinolaryngol, 2020, 128: 109703. doi:10.1016/j.ijporl.2019.109703.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed