JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY) ›› 2016, Vol. 30 ›› Issue (6): 49-52.doi: 10.6040/j.issn.1673-3770.0.2016.401

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Comparison of three surgical methods in adult patients undergoing tonsillectomy.

XU Lei1, ZHU Juanfen1, CHENG Lei2   

  1. 1. Department of Otorhinolaryngology, Affiliated Changzhou No.2 Peoples Hospital, Nanjing Medical University, Changzhou 213003, Jiangsu, China;2. Department of Otorhinolaryngolgy, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu, China
  • Received:2016-09-21 Online:2016-12-16 Published:2016-12-16

Abstract: Objective To compare and analyze the clinical application value of three surgical methods in adult patients undergoing tonsillectomy. Methods Ninety patients who received tonsillectomy were divided into coblation tonsillectomy(coblation group, n=30), electrocautery tonsillectomy(electrocautery group, n=30), and conventional tonsillectomy(conventional group, n=30). The duration of the entire operation, amount of intraoperative and postoperative bleeding, postoperative sore throat assessed using a visual analogue scale(VAS), and hospital costs were all recorded in three groups. Results Significant difference was shown among three groups by comparison to the operation time, amount of blood loss and the VAS scores of postoperative pain 1-4 d after surgery(P<0.001), in which the above indexes of coblation group and electrocautery group were all superior to those of conventional group(P<0.001), but there was no statistical significance between coblation group and electrocautery group(P>0.05). One patient encountered primary hemorrhage after surgery in conventional group, whereas no postoperative hemorrhage in coblation group and electrocautery group. There was no statistical significance among three groups by comparison to the nursing and examination/treatment expenses as well as postoperative charges for medicine(P>0.05). The total hospital cost in electrocautery group and conventional group was obviously lower than that in coblation group(P<0.001), but no significant difference was shown between electrocautery group and conventional group(P>0.05). Conclusion Each of the three surgical methods in adult tonsillectomy has its own advantages and disadvantages. In the clinical practice, the most appropriate surgical method should be selected so as to achieve the optimal therapeutic effect based on the disease characteristics, willingness and economic capability of patients, technical level of surgeons and medical instruments.

Key words: Tonsillectomy, Ablation techniques, Hemorrhage, Postoperative pain, Hospital costs

CLC Number: 

  • R766.9
[1] 郭任重, 苏纪平, 陈平. 扁桃体切除术患者住院费用影响因素分析[J]. 中国卫生质量管理, 2014, 21(6):30-32. GUO Renzhong, SU Jiping, CHEN Ping. Analysis of influencing factors on hospitalization costs of tonsillectomy patients[J]. Chin Health Qual Manag, 2014, 21(6):30-32.
[2] Stucken E Z, Grunstein E, Haddad J Jr, et al. Factors contributing to cost in partial versus total tonsillectomy[J]. Laryngoscope, 2013, 123(11):2868-2872.
[3] Windfuhr J P, Toepfner N, Steffen G. Clinical practice guideline: tonsillitis II. Surgical management[J]. Eur Arch Otorhinolaryngol, 2016, 273(4):989-1009.
[4] 吕晨, 邹建玲, 沈淑华, 等. 视觉模拟量表和语言评价量表用于术后疼痛评估的比较[J]. 全科医学临床与教育, 2004, 2(4):214-215, 219. LÜ Chen, ZOU Jianling, SHEN Shuhua, et al. A comparison of the verbal rating scale and the visual analog scale for pain assessment in postoperative patients[J]. Clin Edu Gen Prac, 2004, 2(4):214-215, 219.
[5] de Tovar C, von Baeyer C L, Wood C, et al. Postoperative self-report of pain in children: interscale agreement, response to analgesic, and preference for a faces scale and a visual analogue scale[J]. Pain Res Manag, 2010, 15(3):163-168.
[6] 庹华为, 黄志纯, 冯旭, 等. 超声刀扁桃体切除术的临床病理研究[J]. 中国耳鼻咽喉头颈外科, 2015, 22(5):261-264. TUO Huawei, HUANG Zhichun, FENG Xu, et al. Clinical research about harmonic scalpel for tonsillectomy[J]. Chin Arch Otolaryngol Head Neck Surg, 2015, 22(5):261-264.
[7] Georgalas C C, Tolley N S, Narula A. Tonsillitis[J]. BMJ Clin Evid, 2009, 2009.pii:0503.
[8] Noordzij J P, Affleck B D. Coblation versus unipolar electrocautery tonsillectomy: a prospective, randomized, single-blind study in adult patients[J]. Laryngoscope, 2006, 116(8):1303-1309.
[9] 项光早, 胡建文, 陈伟军. 低温等离子辅助扁桃体切除术与传统手术疗效的比较[J]. 中国耳鼻咽喉头颈外科, 2013, 20(12):653-654.
[10] 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. ZHANG Liqing, YANG Cuifang, ZHOU Huaqun, et al. Comparison of coblation, ultrasonic knife and conventional approach in tonsillectomy[J]. J Otolaryngol Ophthalmol Shandong Univ, 2016, 30(3):56-60.
[11] Weimert T A, Babyak J W, Richter H J. Electrodissection tonsillectomy[J]. Arch Otolaryngol Head Neck Surg, 1990, 116(2):186-188.
[12] Cardozo A A, Hallikeri C, Lawrence H, et al. Teenage and adult tonsillectomy: dose-response relationship between diathermy energy used and morbidity[J]. Clin Otolaryngol, 2007, 32(5):366-371.
[13] Ozkiri??塂 M, Kapusuz Z, Saydam L. Comparison of three techniques in adult tonsillectomy[J]. Eur Arch Otorhinolaryngol, 2013, 270(3):1143-1147.
[14] Hong S M, Cho J G, Chae S W, et al. Coblation vs. electrocautery tonsillectomy: a prospective randomized study comparing clinical outcomes in adolescents and adults[J]. Clin Exp Otorhinolaryngol, 2013, 6(2):90-93.
[15] Modi V K, Monforte H, Geller K A, et al. Histologic assessment of thermal injury to tonsillectomy specimens: a comparison of electrocautery, coblation, harmonic scalpel, and tonsillotome[J]. Laryngoscope, 2009, 119(11):2248-2251.
[16] García Callejo F J, Rincón Piedrahita I, Monzó Gandía R, et al. Factors related to post-tonsillectomy pain in adults[J]. Acta Otorrinolaringol Esp, 2016, 67(1):23-32.
[17] Ragab S M. Six years of evidence-based adult dissection tonsillectomy with ultrasonic scalpel, bipolar electrocautery, bipolar radiofrequency or ‘cold steel’ dissection[J]. J Laryngol Otol, 2012, 126(10):1056-1062.
[18] Sarny S, Ossimitz G, Habermann W, et al. Hemorrhage following tonsil surgery: a multicenter prospective study[J]. Laryngoscope, 2011, 121(12):2553-2560.
[19] Neumann C, Street I, Lowe D, et al. Harmonic scalpel tonsillectomy: a systematic review of evidence for postoperative hemorrhage[J]. Otolaryngol Head Neck Surg, 2007, 137(3):378-384.
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