经口鼻内窥镜下小儿腺样体刮除术临床研究.docVIP

经口鼻内窥镜下小儿腺样体刮除术临床研究 　　【摘要】 目的 探讨经口鼻内窥镜辅助行小儿腺样体刮除术与传统的腺样体刮匙切除术两种术式的疗效,术后残留或复发率高低及其优劣。方法 64例患儿随机分为观察组(33例)和对照组(31例),观察组采用经口鼻内窥镜辅助行小儿腺样体刮除术。对照组用传统的腺样体刮匙切除术切除腺样体,随访3个月~1年,比较两组治疗总有效率及术后残留或复发率高低。结果 观察组与对照组治疗总有效率分别为96．9%和90．3%,两组比较,差异无显著意义(x=2．25P0．05)。观察组与对照组术后残留或复发率分别为9．1%和41．9%,两组比较,差异有显著意义(x=9．2P 　　【关键词】内窥镜；腺样体；手术；外科 　　 　　The clinical research about transoral endoscopic-assisted adenoidectomy for children 　　 　　ZHONG Quan，TANG Rui.Department of Otorhinolaryngology,People’s Hospital of Guangxi,541002 China 　　 　　【Abstract】 Objective To discuss the effects of transoral endoscopic-assisted adenoidectomy for children and traditional adenoidectomy.the remains or the rafe of recurrence and the good and the bad about it after the operation.Methods Sixty-four sick children were divided into an experimentral group(n=33)and a control group(n=31),the experimentral group were performed the trasoral endoscopic-assisted adenoidectomy for children,the control group were performed the traditional adenoidectomy,all cases were following up 3 months to one year,comparethe totel therapeutic effective rates and the remains or the height of recurrence after the operation.Results Total effective rates of the two groups were 96．9% and 90．3%,respectively,with no significant difference found between the two groups(x=2．25 P0．05),the remains or the rate of recurrence between the experimentrol group and the control group were 9% and 41．9%,respectively,with a significant difference found between the two groups(x=9．2 P0．05)。 　　1．2 方法 　　1．2．1 手术方法 64例患儿均在全麻气管插管下进行手术，患儿取仰卧位，垫肩，用Davis开口器撑开并暴露口腔，对同时伴有扁桃体肥大者常规行扁桃体剥离术。观察组双侧鼻腔用1%麻黄素液收缩，以小号导尿管自双侧前鼻孔插入，经鼻咽从口腔引出，用血管钳将导尿管轻提并固定，以达上提软腭的目的。用直径4 mm德国产鲁道夫70°或30°鼻内窥镜经口腔插入，看清腺样体的形态和咽鼓管咽口及圆枕。一手持镜，一手持腺样体刮匙，在电视监视器直视下，将腺样体刮匙置于肥大的腺样体表面，自上而下切入刮除。然后用直角钳夹纱球放入鼻咽部压迫止血。取出纱球再次插入鼻内窥镜，看清手术创面及周边情况，如周边仍有残留腺样体组织，可再次在内窥镜直视下刮除之，直至手术满意并压迫血止为止。对照组术者先用手指从口腔伸入鼻咽触摸腺样体的大小及部位,再将腺样体刮匙从口腔伸入鼻咽,自上而下切入刮出腺样体,反复几次,直至满意为止。然后用直角钳夹纱球放入鼻咽部压迫止血,取出纱球,若仍有血从鼻咽流下,则再置纱球压迫,直至无血从鼻咽流下为止。 　　1．2．2 评价方法 ①疗