低温等离子切除扁桃体术后出血原因剖析.docVIP

低温等离子切除扁桃体术后出血原因剖析 　　[摘要]目的 分析低温等离子切除扁桃体术后出血的原因，为预防术后出血提供临床依据。方法 回顾性分析2014年1月～2015年6月在我院行低温等离子扁桃体切除手术的227例患者的病历。收集患者一般临床资料，分析术后出血情况（出血部位、出血类型）及术后出血处理等临床资料。结果 227例行低温等离子扁桃体切除术，术后出血11例，其中原发性出血4例，迟发性出血7例；11例术后出血病例中有2例位于扁桃体窝上极，1例位于扁桃体窝内的弥漫性出血，8例位于扁桃体下极，本组低温等离子扁桃体术后出血发生率为4.8%。结论 在扁桃体术后出血部位中扁桃体下极出血比例较高。术中止血不彻底、术后感染、术后饮食不当均为低温等离子扁桃体术后出血的影响因素，可分别对症预防。 　　[关键词]扁桃体切除术；出血原因；低温等离子处理 　　[中图分类号] R766.9 [文献标识码] A [文章编号] 1674-4721（2016）09（b）-0083-03 　　for the prevention of postoperative hemorrhage.Methods A retrospective analysis was performed on 227 patients who underwent low-temperature plasma tonsillectomies in the hospital from January 2014 to June 2015.The clinical data of patients containing general clinical data and postoperative hemorrhage （including the hemorrhage site and type） were collected and recorded.Results Among 227 patients who were involved in this study and underwent low-temperature plasma tonsillectomies，postoperative hemorrhage occurred in 11 cases （accounting for 4.8%），including primary hemorrhage in 4 cases and delayed hemorrhage in 7 cases.Of the 11 cases of postoperative hemorrhage，2 cases were located in the upper pole of amygdaloid fossa；1 case of diffuse hemorrhage was located inside the amygdaloid fossa；8 cases were located in the inferior pole of amygdaloid fossa.Conclusion Postoperative hemorrhage in the upper pole of amygdaloid fossa accounts for a larger proportion.The causes of hemorrhage after low-temperature plasma tonsillectomies include unthorough intraoperative hemostasis，postoperative infections，improper postoperative diets，which can be prevented symptomatically. 　　[Key words]Tonsillectomies；Causes of hemorrhage；Plasma treatment at low temperature 　　慢性扁桃体炎和扁桃体过度肥大是耳鼻咽喉科常见的疾病之一，特别在儿童更为多发。扁桃体切除术是临床治疗的重要手段和有效方式。传统的剥离法切除扁桃体会引起术后出血过多等诸多问题[1-2]。目前扁桃体手术采用了几种不同的技术和仪器，如单纯冷刀切除、单极和双极电凝、双极电剪刀、激光、显微双极电凝和各种射频消融特别是低温消融技术[3-4]。低温射频消融通过40～70℃低温电离能量破坏细胞。在过去的10年中，作为一种成功的、可靠的技术，低温射频消融对扁桃体窝周围组织伤害小，可保护周围黏膜，以避免或减轻术后相关的并发症[5-7]。然而，扁桃体术后出血仍是扁桃体切除术后风险较高的并发症之一。因此