Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2021, Vol. 35 ›› Issue (1): 82-85.doi: 10.6040/j.issn.1673-3770.0.2020.114

Previous Articles     Next Articles

Effects of palatal arch suturing on postoperative hemorrhage after tonsillectomy

TIAN Tianjie, ZHANG Zixion, YANG Fei, ZHOU Yi   

  1. Department of Otolaryngology & Head and Neck Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei, China
  • Published:2021-02-01

PDF (PC)

122

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

CLC Number: 

  • R66
[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.
[1] ZHANG Fengzhen, WANG Guixiang, WEI Yunyun, ZHANG Yamei, ZHAO Jing, WANG Hua, LI Hongbin, LI Xiaodan, ZHANG Jie. Perioperative management of children with mild bleeding disorders undergoing adenotonsillectomy procedures [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 66-72.
[2] SHI Xiaoli, MU Hong. Multidisciplinary diagnosis and treatment of a child with severe obstructive sleep apnea syndrome complicated by pulmonary hypertension [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 116-119.
[3] SHEN Nimei, QIAN Maohua, JIN Jiaxin, QIN Yang, WANG Jun, WU Ying, GAO Gang. Application of the ultrasonic scalpel in tonsillectomy for biopsy of patients with suspected tonsillar tumor [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(5): 62-66.
[4] WANG Xuechang, WANG Tao, REN Xin, ZHAO Mingjun. Analysis of the clinical efficacy of endoscopy-assisted intraoral removal of an elongated styloid process without tonsillectomy [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 17-21.
[5] 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.
[6] SHEN Yao, ZHOU Chengyong. Comparison of coblation assisted tonsillectomy and tonsillotomy in children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 22-27.
[7] LIU Shaofeng, HUANG Guiliang, HUANG Zhenyun, SUN Changzhi, LUO Renzhong. Partial tonsillectomy for 86 cases of obstructive sleep apnea syndrome in children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 50-54.
[8] Zhaokun WU,Xinhua ZHU. Can adenotonsillectomy adequately cure children with obstructive sleep apnea syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 148-152.
[9] HUANG Jiyi, LI Baizi, WU Shunong, LÜ Zhenghua. 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.
[10] LI Yanzhong, ZHANG Tai. Problems we face in children with obstructive sleep apnea hypopnea syndrome [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2018, 32(2): 1-5.
[11] XU Zhifei, NI Xin. Post-surgery management in children with obstructive sleep apnea syndrome [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2018, 32(2): 9-13.
[12] ZHANG Liqing, SONG Shenghua, WANG Yuan, LIU Xiaojing, DONG Weida, ZHOU Han. Comparison of the efficacy of coblation, ultrasonic knife operation, and conventional tonsillectomy in a 2-year postoperative follow-up. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(5): 67-71.
[13] ZHANG Jie, CHEN Xuemei, XU Anting. A comparative analysis of harmonic scalpel tonsillectomy and coblation tonsillectomy. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(5): 95-100.
[14] XU Lei, ZHU Juanfen, CHENG Lei. Comparison of three surgical methods in adult patients undergoing tonsillectomy. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(6): 49-52.
[15] WANG Lei, LOU Feng, ZHANG Yuan, ZHAO Xin. Effect of different doses of dexmedetomidine preoperative intranasal medication on the safety in children tonsillectomy. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(5): 115-119.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 84 -87 .
[2] NIU Shanli,CHAI Maowen,LI Zhenxiu . Endoscopic rhinoplasty of inferior turbinate in 60 patients with chronic hypertrophic rhinitis[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 16 -18 .
[3] MENG Qing-guo,LU Yong-tian,FAN Xian-liang .

Association of killer cell immunoglobulin-like receptor gene polymorphisms with nasopharyngeal carcinoma

[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 196 -199 .
[4] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 199 -199 .
[5] WAN Li-jia,LU Hai-tao,JIANG Yi-dao,LIU Hui,LI Qin,SHE La-zhi . Effect of H-uvulopalatopharyngoplasty on obstructive sleep apnea
hypopnea syndrome[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 204 -205 .
[6] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 222 -224 .
[7] JI Xiao-bin,DENG Jia-de,ZANG Lin-quan,WANG Lei,XIE Jun . Blood histamine in guinea pigs with allergic rhinitis[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 228 -230 .
[8] XIANG Deng,LU Yong-tian,SUN Huan-ji . Endoscopic repair for cerebrospinal fluid rhinorrhea in 19 cases and a literature review [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 234 -236 .
[9] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 253 -257 .
[10]
YIN Guo-hua,ZHONG Xiao . Long-term effect of laser reduction on lingua adenoids
[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 280 -282 .
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd