鼻内镜下等离子止血在腺样体手术中的应用(1)
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[摘要] 目的 探讨经鼻内镜电动吸割器切除腺样体，术中使用低温等离子止血方法的优势。 方法 将我院60例行腺样体切除的患儿随机分成两组，30例腺样体肥大患儿采用经鼻内镜电动吸割器联合低温等离子止血行腺样体切除(低温等离子组)，与同期30例经鼻内镜电动吸割器切除腺样体，用双极电凝止血相比(双极电凝组)。对两组术后出血、发热、鼻腔恢复正常通气时间、并发症等临床症状进行分析比较。 结果 两组在术后出血、发热、恢复正常通气时间、并发症等方面比较，差异均有统计学意义(均P﹤0.05)。术后平均随访6个月～1 年，患者症状明显好转，无鼻腔粘连、腺样体肿大等发生。 结论 鼻内镜下切除腺样体，术中使用低温等离子止血，具有微创、痛苦小、出血少、疗效满意等特点，值得在临床推广。
[关键词] 腺样体肥大；鼻内镜；低温等离子；止血
[中图分类号] R765.9 [文献标识码] B [文章编号] 1673-7210(2012)02(b)-0144-02
Application of low-temperature plasma haemostasis under the nasal endoscopy in adenoid surgery
CHEN Enkuan SONG Wenguang
Department of Otolaryngology, Guangzhou Red Cross Hospital the Fourth Affiliated Hospital of Ji'nan University, Guangdong Province, Guangzhou 510220, China
[Abstract] Objective To investigate the effect of low-temperature plasma in endoscopic adenoidectomy. Methods A total of 60 patients receiving adenoid surgery were randomly divided into low-temperature plasma group and double-pole coagulation group. 30 children with hyperplasia of adenoids were treated by low-temperature plasma in endoscopic adenoidectomy, compared with the 30 cases hyperplasia of adenoids by bipolar coagulation. The different clinical indexes of two groups were analyzed. Results There were significant differences between the two groups in operating bleeding, complications, postoperative fever and the nasal natural venting (all P < 0.05). During 6 months to 1 year follow-up, there were significant improvements in all the symptoms and no nasal adhesion and recurrence happened. Conclusion The low-temperature plasma excision in endoscopic is mini-trauma, light painful, fastly convalescence. This operative method is especially suitable for children patients.
[Key words] Hyperplasia of adenoids; Nasal endoscopy; Low-temperature plasma; Haemostasis
腺样体肥大是儿童期最常见的上呼吸道疾病之一，尤其在学龄与学龄前期儿童(3～13岁)发病率最高，在儿童中的发病率为9.9%～29.2%[1]，腺样体肥大易导致严重鼻阻塞症状、反复分泌性中耳炎、鼻咽部炎症、气管炎或支气管炎，甚至伴不明原因发热和阻塞性睡眠呼吸暂停低通气综合征(OSAHS)等，腺样体成为致病灶或影响吞咽及呼吸功能，因此，一经确诊应尽早施行腺样体切除术[2]。腺样体术中常常会遇到局部渗血多或一些搏动性出血，用传统的止血方法效果差。2009年8月～2011年8月我科在鼻内镜下电动吸割器联合等离子止血行腺样体切除术30例，与同期经鼻内镜电动吸割器联合双极电凝行腺样体切除术30例进行比较，效果显著，现报道如下：
1 资料与方法
1.1 一般资料
选取我院60例行腺样体切除术患儿，将其随机分成低温等离子组和双极电凝组，每组各30例；年龄4～13岁，平均6.4岁，病史3个月～7年。60例患者均有不同程度的睡眠打鼾、张口呼吸或听力下降。术前常规行咽部检查、鼻咽部X线侧位片。所有患儿选择标准：均经鼻内镜或纤维鼻咽镜检查，测量用力吸气时腺样体占后鼻孔范围比值(adenoid-choanae area ratio)大小 ......
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