腺样体切除术出血原因及预防方法

腺样体切除术患者绝大多是儿童,术中或术后出血对儿童和家长心理影响较大,也是手术医师应尽量避免的并发症之一。本文就术中及术后出血原因及预防方法加以分析,以供读者借鉴。1资料与方法1.1临床资料。2006年1月～2010年1月我科共行腺样体切除术312例,     

低温等离子刀扁桃体腺样体切除术后出血原因及预防的探讨

目的探讨应用低温等离子刀行儿童扁桃体及腺样体切除术后出血的原因及预防。方法回顾分析2010年11月～2013年2月188例患儿应用低温等离子刀行扁桃体及腺样体切除术,年龄19个月～12岁,平均（5.3±3.1）岁,其中单纯行扁桃体切除60例,同时行扁桃体及腺样体切除69例,单纯行腺样体切除59例。结果 4例发生术后出血,其中3例为术后7～10 d,1例为术后24 h内,均为扁桃体切除术后出血,无腺样体切除术后出血病例。结论患儿自身因素及术者的操作水平是导致术后出血的重要原因,术前及术后宣教及护理、术中充分止血及较高的手术技巧是减少术后出血的关键。     

腺样体切除术治疗儿童鼻窦炎20例

儿童鼻窦炎较为常见，近年来发病率日趋升高，颇受社会重视。其中有相当一部分与腺样体肥大同时存在，其病因与腺样体有很大关系。我科近2年来以切除腺样体作为治疗儿童鼻窦炎的一种方式，取得了良好疗效，现报告如下。     

等离子辅助下扁桃体及腺样体切除术治疗儿童鼾症术后出血的危险因素分析

目的 探讨等离子辅助下扁桃体及腺样体切除术治疗儿童鼾症术后出血的危险因素,为降低术后出血提供理论参考依据。方法　选取信阳市中心医院2017年1月~2019年12月等离子辅助下扁桃体及腺样体切除术治疗的740例鼾症患儿作为研究对象,观察术后是否出血分为出血组（32例）和未出血组（708例）,对比两组临床资料,同时采用多因素Logistic回归分析确定患儿等离子辅助下扁桃体及腺样体切除术后出血的危险因素。结果　740例患儿术后出血32例,出血率为4.32%。出血组与未出血组单因素分析,年龄、身体 质量指数Z分数（body mass index Z score,BMIZ）、红细胞计数、白细胞计数、中性粒细胞计数、鼾症家族史、扁桃体嵌入程度、术前诊断情况、平均手术时间、抗生素使用、手术医师对等离子熟练程度以及饮食配合度差异均有统计学意义（P 均<0.05）;多变量Logistic 回归分析表明患儿年龄≥6岁、术前诊断情况、扁桃体嵌入程度、饮食配合度以及抗生素使用是治疗儿童鼾症术后出血的危险因素（P 均<0.05）。结论　等离子辅助下扁桃体及腺样体切除术治疗儿童鼾症疗效较好,但术后出血危险因素诸多且复杂,年 龄、术前诊断情况、扁桃体嵌入程度、饮食配合度及抗生素使用情况均会影响术后出血,可重点关注以降低术后出血风险,促进术后康复。     

儿童扁桃体、腺样体低温等离子切除术后出血的临床研究

目的 探讨应用低温等离子手术或者传统手术方式行儿童扁桃体、腺样体切除术在术后出血方面存在的差异。方法 回顾性分析1597例接受手术治疗的儿童慢性扁桃体炎、腺样体肥大的患者资料,行等离子射频辅助的扁桃体和(或)腺样体切除术者793例(等离子组),行传统扁桃体切除和(或)腺样体者804例(传统组)。比较两组原发性及继发性出血的发生率、出血程度和出血部位的差异。结果 等离子组发生术后出血25例(3.2％),传统组出血19例(2.4％),两组间差异无统计学意义(χ2=3．34,P>0．05);其中等离子组原发性出血9例(1.1％),继发性出血16例(2.0％);传统组原发性出血11例(1.4％),继发性出血8例(1．0％),两者比较差异有统计学意义(χ2=9．45,P<0．01)。两组术后的出血部位经卡方检验,出血程度经Wilcoxon秩和检验,P值均>0．05,差异均无统计学意义。结论 低温等离子辅助行儿童扁桃体、腺样体切除术,在术后出血的发生率、程度、部位三个方面相对于传统的手术方法治疗,二者差异无统计学意义。     

儿童腺样体等离子切除术

腺样体肥大是儿童常见病多发病,可引起鼻-鼻窦炎、分泌性中耳炎等,更是儿童阻塞性睡眠呼吸暂停低通气综合征的最常见病因,常需手术治疗。腺样体切除术目前国内常用的是传统刮除法和鼻内镜下吸切割器切除法。随着等离子低温射频系统在耳鼻咽喉科的广泛应用,我科2008年5月-2009年8月对63例儿童腺样体肥大行等离子切除,取得良好手术效果,现报道如下。     

儿童扁桃体腺样体低温等离子手术迟发性出血的初步研究

目的 比较低温等离子手术与常规手术方式在儿童扁桃体、腺样体手术后迟发性出血(手术24 h后)率及出血时间点的情况,初步探讨导致低温等离子手术迟发性出血的可能原因.方法 回顾性分析的方法研究采用传统手术和低温等离子手术行扁桃体切除和(或)腺样体刮除术1～14岁患儿术后迟发性出血率及出血时间点的差异.传统组为2005年4月至2006年7月行传统冷法手术(即传统手术刀切除,对周围组织没有热损伤的方法)的患儿,等离子组为2008年4月至2009年9月行低温等离子扁桃体切除和(或)腺样体消融术的患儿.结果 传统组患儿484例,术后迟发性出血2例,迟发性出血率为0.4%,出血时间点1例为术后2 d,另1例为术后3 d.等离子组患儿502例,术后迟发性出血11例,迟发性出血率为2.2%,出血时间点2～12 d,中位数为6.0 d.其中等离子刀初学者主刀手术的迟发性出血率为2.6%(10/385),技术操作熟练者手术的迟发性出血率为0.9%(1/117).等离子组迟发性出血率高于传统组(χ2=5.987,P=0.014),两组出血时间点差异无统计学意义(Mann-Whitney检验U=2.500,P=0.103).13例出血患儿中创面局部或上呼吸道感染者6例,术后进食不当的3例.结论 低温等离子技术应用于儿童扁桃体腺样体手术后迟发性出血的原因可能与手术技能经验不足、止血稳定性欠佳等有关,术后感染和进食不当也会造成迟发性出血,应引起临床重视.     

儿童扁桃体腺样体日间手术术后出血的防范措施

目的:探讨儿童扁桃体腺样体日间手术的防范措施在减少术后出血中的效果,明确其安全性和可行性.方法:回顾性分析2021年2月至4月上海市儿童医院收治的649例因扁桃体腺样体肥大引起阻塞性睡眠呼吸暂停(OSA)行日间手术的患儿资料.根据是否采取防范措施分为观察组和对照组,比较2组患儿的术后出血率、出血时间和出血因素.结果:观...     

经鼻和口进路腺样体切除术出血分析

腺样体肥大除了传统的刮除术外，鼻内镜下用动力切吸腺样体也是广泛采用的一种有效方法。后者的优点是整个手术过程可以在监视器下进行，术野暴露清楚，术中切除腺样体干净，还可防止损失周围解剖组织。尽管存在上述优点，但随着该手术方法的推广，术中和术后仍可能出现相关的并发症，特别是出血。通过国内文献检索，较少有针对腺样体出血的报道。我科2007—2008年行扁桃体切除术和（或）腺样体切除术272例，其中6例术中和术后发生腺样体出血，本文分析可能导致出血的原因，为避免此类并发症的发生提供借鉴作用。     

Analysis of the causes of immediate unanticipated bleeding after pediatric adenotonsillectomy

OBJECTIVES: To assess the incidence of unexpected postoperative bleeding in children undergoing adenoidectomy and/or tonsillectomy (T&A), and to investigate its possible undetected haematological causes. METHODS: We prospectively collected all patients under 14 years of age with a normal preoperative haematologic work-up (activated partial thromboplastic time, prothrombin time, fibrinogen, and platelet count), who underwent surgery of adenoids and/or tonsils at our institution between January 1997 and November 2000. RESULTS: There were 1516 cases that accomplished the inclusion criteria in the period of survey. Thirteen patients bled after surgery. This represents an incidence of 0.8% of immediate postoperative haemorrhage among the 1516 procedures analyzed. No statistical differences were found between bleeding and non-bleeding patients according to age, sex, and type of procedure (P>0.05). In 6 of the 13 bleeding patients (46.1%) an alteration of the coagulation system was subsequently found: 5 von Willebrand's disease, and 1 releasing thrombopathy. CONCLUSIONS: The incidence of bleeding after adeno and/or tonsillectomy at our institution is comparable with series previously reported in the current medical literature. In nearly one half of the cases, undetected coagulation diseases (mainly von Willebrand's disease) are diagnosed after surgery in the haematological study.     

Nasalance scores in pediatric patients after adenoidectomy

Objective

Adenoidectomy is one of the most frequently performed operations in childhood. Nasal obstruction and chronic infection are the basic indications for surgery. Nasometer measures both oral and nasal air pressure during loud speech, and calculates their ratio. The aim of this study was to compare the mean nasal values in patients who had adenoidectomy at different ages against a control group.

Methods

Eighty children between the ages of three and sixteen that had adenoidectomy in our clinic between 2006 and 2010 were compared against eighty age-matched controls who had not had nasal obstruction in their lifetime and were proven to have open nasal airways on physical examination.

Results

Statistical analysis of the data showed that mean nasalance scores were significantly lower in patients who had adenoidectomy before 6 years of age when compared to the ones who had the operation after the age of six. In addition, when we compared the children who had adenoidectomy before 5 years of age and between 5and 6 years of age, we found that their nasalance scores were significantly lower when compared to those who had adenoidectomy after the age of six (p = 0.017 and p = 0.019, respectively).

Conclusion

This study has shown that, even when adenoidectomy is performed, hyponasality may continue in clinically symptomatic patients under the age of six, and that there are no determined risk factors other than the early age.     

儿童腺样体切除术对相关疾病转归的影响

目的探讨腺样体切除术在治疗儿童分泌性中耳炎、鼻窦炎及鼾症的临床作用。方法对住院行腺样体切除术的68例分泌性中耳炎、鼻窦炎及鼾症患儿的临床表现、治疗方法和预后进行回顾性分析。结果68例患儿经切除肥大的腺样体,辅以相应的药物治疗,临床症状均明显好转。结论腺样体肥大较易成为儿童分泌性中耳炎、鼻窦炎及鼾症发病的基础因素。切除肥大的腺样体是治疗儿童分泌性中耳炎、鼻窦炎及鼾症有效、安全的方法。     

儿童扁桃体腺样体低温等离子射频消融术后出血特点分析及应对策略

目的　探讨低温等离子射频消融和传统手术行儿童扁桃体腺样体切除术在术后出血方面存在的差异特点,并提出应对策略。方法　选取2014年于我科行扁桃体腺样体射频消融术999例为等离子组,2010年于我科行扁桃体腺样体切除术1275例为传统组。比较两组总出血率、原发性及继发性出血的发生率、出血部位、出血程度和治疗方法的差异。结果　等离子组术后总出血率、出血部位分布、出血程度和治疗方法分布上与传统组相比差异无统计学意义。等离子组术后原发性出血少于传统组,而继发性出血多于传统组,差异有统计学意义。结论　等离子手术与传统手术相比并不增加术后出血几率,在出血部位分布、治疗方法分布上亦无明显差别;但术后原发性出血减少,而继发性出血升高,分析等离子手术后出血的常见原因,并针对性提出应对策略     

An extremely rare complication of adenoidectomy; massive bleeding 7 days after the operation

Hemorrhagic complications after adenoidectomy are quite rare, and nearly all of these take place in a few hours after the operation and result from the remnants of the adenoid tissue. We report here in an eight-year-old girl with a massive life-threatening bleeding episode, which developed seven days after the operation. In this case, endoscopic bipolar cauterization, and posterior nasal pack, completely filling the nasopharynx was enough to control bleeding.     

扁桃体腺样体切除治疗儿童鼻-鼻窦炎

目的 观察切除肥大或有炎症的扁桃体、腺样体对儿童鼻-鼻窦炎的治疗作用。方法 对63例儿童鼻-鼻窦炎行扁桃体、腺样体切除后消炎治疗3d,纳米银水凝胶抗菌鼻喷剂喷鼻,1日3次,阿奇霉素颗粒口服,1日1次,治疗10d。结果 1个月后61例鼻塞、脓涕、头晕、头痛、睡眠打鼾等症状消失,2例伴有鼻中隔偏曲者仍有轻微鼻塞感,无明显脓性鼻涕、头晕、头痛症状,睡眠时打鼾明显减轻。结论 行肥大或有炎症的扁桃体、腺样体切除对单纯药物治疗效果不好的儿童鼻-鼻窦炎治疗效果好,同时又可治疗儿童鼾症。