等离子射频消融术在儿童阻塞性睡眠呼吸暂停中的应用和进展

doi:10.6040/j.issn.1673-3770.1.2020.105

摘要/Abstract

摘要： 精准微创的科学理念推动耳鼻咽喉头颈外科手术方式不断进步,等离子射频消融术的应用与发展为典型代表。分析等离子射频消融术在儿童阻塞性睡眠呼吸暂停手术(扁桃体腺样体切除术)中的使用特点,包括操作简便,手术时间短;术野清晰,出血量少;温度较低,避免热灼伤且创面光滑平整,术后疼痛轻,恢复正常饮食较早;术后白膜形成早,但在炎性细胞和纤维组织基础上增加了变性的胶原薄层,故白膜较厚,脱落时间延后,有延迟出血可能。建议对儿童扁桃体切除术实行个体化治疗,提倡扁桃体囊内(部分)切除术,保留患儿免疫力。等离子射频消融技术优势明显,但仍需在临床实践中不断深入探索,使其应用前景愈来愈广阔。

关键词: 睡眠呼吸暂停,阻塞性, 儿童, 等离子射频消融术, 腺样体扁桃体切除术, 扁桃体囊外(全部)切除术, 扁桃体囊内(部分)切除术

Abstract: The scientific concept of precise and minimally invasive surgery promotes the continuous progress of otolaryngology head and neck surgery. A typical example is the application and development of coblation. This article describes the advantages and disadvantages of coblation in children with obstructive sleep apnea surgery(tonsillectomy and adenoidectomy). Its operation is simple, and the operation time is short. Regarding coblation, the surgical field is clear, and the amount of bleeding is low. Moreover, the temperature is low to avoid thermal burns. The wound surface is smooth and flat, the postoperative pain is mild, and the restoration to normal diet occurs early; the albuginea is formed early after the operation, but a thin layer of denatured collagen is added on the basis of inflammatory cells and fibrous tissue; therefore, the albuginea is thicker, and delayed shedding time may delay bleeding. This article highlights the individualized treatment of tonsillectomy in children and advocates for intracapsular(partial)tonsillectomy in order to preserve the immunity of children. Coblation technology has obvious advantages, but it still needs to be continuously explored in clinical practice to widen its application prospects.

Key words: Sleep apnea, obstructive, Children, Coblation, Tonsillectomy, adenoidectomy, Extracapsular tonsillectomy, Intracapsular tonsillectomy

中图分类号:

R766.7

冯晨,郭瑞祥,王岩. 等离子射频消融术在儿童阻塞性睡眠呼吸暂停中的应用和进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 16-21.

FENG Chen, GUO Ruixiang, WANG Yan. Application and progress of coblation in children with obstructive sleep apnea[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 16-21.

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