全麻下使用电刀行扁桃体切除术临床观察.docVIP

全麻下使用电刀行扁桃体切除术临床观察 　 作者：杨勇，谢永汉，何清泉，刘小晶， 蔡吉悟 【摘要】 目的：为扁桃体切除术寻找一种新的手术治疗途径。方法：对84例经临床确诊为慢性扁桃体炎的患者随机分为实验组和对照组两组，每组42例。均在全麻下进行。实验组使用电刀行扁桃体切除术，对照组按常规手术切除扁桃体，对术中出血量、术后组织水肿，扁桃体白膜生长情况，吞咽、讲话与疼痛等方面进行比较。结果：使用电刀在全麻下行扁桃体切除术比常规全麻下行扁桃体切除术出血量减少1/2，术后黏膜无明显水肿，且白膜生长良好，吞咽、讲话与疼痛术后评分与对照组比较差异有统计学意义（Plt;0.001）。结论：使用电刀在全麻下行扁桃体切除术，具有疗效确切、安全、出血少、损伤小、恢复快和无不良反应等优点，值得临床推广使用。 【关键词】 扁桃体；麻醉，全身；扁桃体切除术 ［ABSTRACT］ Objective: To explore a new surgery method of tonsillectomy. Methods: Divided 84 confirmed patients with chronic tonsillitis into two groups: experimental group and control group (42 patients per group). The experimental group was treated by tonsillectomy with electrotome, while the control group was treated with conventional tonsillectomy. Compared blood volume during surgery, tissue edema after surgery, and the conditions of albuginea, swallowing, speaking, and pain between two groups. Results: The blood volume of experimental group was only half of the control group. Besides, the edema in mucous membrane was not obvious after surgery and there was better albuginea. The difference of score about swallowing, speaking and pain between two groups was significant (Plt;0.001). Conclusion: Tonsillectomy with electrotome is effective, safe, with minimal invasion, few bleeding, rapid recovery and little adverse effect. It is valuable in clinic application. ［KEY WORDS］ Tonsil; Anaesthesia, general; Tonsillectomy 治疗慢性反复发作性扁桃体炎，通常以手术切除为主，以往传统常规全麻下手术切除扁桃体创伤大、出血较多、疼痛较重、术后恢复时间长，为了寻找更有效、更安全，损伤小，术后恢复快，减轻术后疼痛等治疗方法很有必要。我科使用电刀对慢性扁桃体炎患者在全麻下行扁桃体摘除术，同时全麻下常规行扁桃体摘除术，从术中出血、术后恢复情况进行分析比较，现报告如下。 1 资料与方法 1．1 临床资料 我科于2004年1月～2007年12月采用法国ERBOTOM 1CC 200型头单极电刀对实验组42例慢性扁桃体炎患者在全麻下行扁桃体切除术；同时对照组42例慢性扁桃体炎患者予全麻下行传统常规切除术。实验组中，男性26例，女性16例，年龄5～50岁，平均年龄27.5岁。病程半年至10年；临床症状为咽痛，有吞咽阻塞感，多痰咳嗽；20%患者存在化脓性扁桃体炎病史，检查双例扁桃体Ⅱ度22例。Ⅲ度20例，均符合慢性扁桃体炎诊断。选择42例为对照阻，两组性别、年龄、病程、临床症状、诊断等一般资料经检验差异无统计学意义（Pgt;0.05）,具有可比性。 1．2 手术方法 插管静脉全麻成功后，患者取仰卧位，软海绵枕垫肩，用全麻扁桃体开口器充分暴露口咽腔及双侧扁桃体，吸干净口咽腔分泌物，先用扁桃体抓钳钳住一侧扁桃体上极并向对侧牵拉确定扁桃体周