【作者】 李重；

【导师】 周永；

【作者基本信息】 广西医科大学 ， 耳鼻咽喉头颈外科学， 2012， 硕士

【摘要】 目的：通过对单极电刀电凝模式与单极电刀切割模式切除儿童扁桃体的比较，探讨单极电刀两种不同模式切除儿童扁桃体的优缺点与合理性。方法：对20例需行双侧扁桃体切除术的患儿，以随机方法对其中一侧扁桃体采用单极电刀电切割法切除，另一侧采用单极电刀电凝切法切除。记录两种方法的出血量、手术时间、扁桃体窝创面肌纤维暴露率和损伤程度、术后咽痛程度、白膜生长情况及并发症等指标，并对以上指标进行比较分析。结果：20侧电凝切法全部顺利完成，20侧电切割法仅3侧（15%）能顺利完成；另17侧用电切割法开始后，在手术进程中由于频繁出血，无法继续，用电凝切法完成（下称混合法）。电凝切法的切除时间、止血时间、手术总时间、术中出血量分别为5.02±1.79min、1.30±1.23min、6.32±2.43min、2.63±2.59ml；电切割法的分别为11.17±3.26min、4.30±1.21min、15.47±4.10min、11.67±5.20ml；混合法的分别为9.18±2.51min、4.38±3.76min、13.37±4.39min、12.13±6.04ml。电凝切法与电切割法相比，以上对应指标的P值分别为0.00、0.01、0.00、0.01，两方法在上述所有指标的差异均有统计学意义，电凝切法优于电切割法；电凝切法与混合法相比，以上指标的P值均为0.00，电凝切法优于混合法；电切割法与混合法相比，以上指标的P值分别为0.50、0.31、0.54、0.60，两方法在上述所有指标的差异均无统计学意义。三法术中肌纤维暴露率之间没有差别；混合法的肌纤维损伤程度较电凝切法重，P=0.02。三法术后白膜生长情况相当，咽痛混合法明显。结论：由于手术过程中出血，运用单极电刀电切模式很难完成儿童扁桃体切除术。单极电刀电切模式法或混合法切除儿童扁桃体，两者的各项观察指标相当；与单极电刀电凝模式法相比，前两者在手术中的出血量、手术中各环节的耗时均多于电凝模式法，手术损伤等不良反应相当。在运用单极电刀进行儿童扁桃体切除术中，低功率电凝模式是安全和高效的，是更为合理的模式。更多还原

【Abstract】 OBJECTIVE:By comparing children’s tonsillectomy with monopole electrocautery electro section mode(electrosection) with monopole electrocautery coagulation mode(coagulation),to investigate the advantages and disadvantages and rationality of different modes.METHOD:Twenty children patients treated with tonsillectomy of both sides were decided randomly to use electrosection for one side of the tonsils,coagulation for the other side.The blood loss during operation,the operation time, the exposure of tonsillar fossa wounds,the degree of pain, albuginea growth and complications ect were recorded.And then analyse these above indexes.RESULT:Twenty sides of the coagulation were all completed successfully.Only3sides (15%) were completed successfully for twenty sides of the electrosection,other seventeen sides of the electrosection were unable to continue due to frequent bleeding,they had to be completed by coagulation in the later stages(referred to as mixed).The removaling time,the hemostaticing time,the total time and the blood loss during operation of coagulation were5.02±1.79min、1.30±1.23min、6.32±2.43min、2.63±2.59ml.The removaling time,the hemostaticing time,the total time and the blood loss during operation of electrosection were11.17±3.26min、4.30±1.21min、15.47±4.10min、11.67±5.20ml.The removaling time,the hemostaticing time,the total time and the blood loss during operation of mixed were9.18±2.51min、4.38±3.76min13.37±4.39min、12.13±6.04ml.Coagulation compared to electrosection,the corresponding P were0.00、0.01、0.00、0.01,all of the above indicators of differences were statistically significant.Coagulation is superior to electrosection.Coagulation compared to mixed,the corresponding P were all0.00.Coagulation is superior to mixed.Electrosection compared to mixed,thecorresponding P were0.50、0.31、0.54、0.60.The two methods showed no significant difference in all of these indicators.Nodifference between the rate of the exposure of muscle fibers in three methods.Muscle fiber damage of mixed was more serious than coagulation,P=0.02. Albuginea growth is quite of three methods. Sore throat were Obvious in mixed.CONCLUSION:The amount of bleeding of electrosection was large,operation efficiency was low,it is difficult to separately complete tonsillectomy in children,mixed can be done in tonsillectomy,but the weak point was similar to electrosection. Coagulation have a smaller amount of bleeding and shorter operative time of advantages,did not increase post-operative adverse events. Monopolar electrocautery coagulation is safe and efficient for tonsillectomy in children, low-power coagulation mode is a more reasonable model.更多还原