【作者】 潘涛；

【导师】 张庆丰；

【作者基本信息】 大连医科大学 ， 耳鼻咽喉科学， 2010， 硕士

【摘要】 目的：通过对2组腺样体肥大的患儿分别施行低温等离子射频消融术和传统刮除手术,观察患儿术中出血情况,出血部位,分析儿童腺样体切除术术中出血的相关因素及低温等离子射频消融术消融腺样体在减少术中出血方面的优势。方法：分析2007年6月至2009年6月腺样体肥大的患儿100例,其中65例行低温等离子射频消融术,35例行传统的刮除术,计算两种不同术式的术中出血量,观察出血部位,同时对患儿年龄、病程及腺样体大小进行变量转换后用SPSS软件进行多元线性相关分析,计算各项指标对腺样体手术术中出血量的偏相关系数,探讨影响术中出血的因素。结果：1.两种术式术中出血量的测量结果(见附表及附图1)35例传统的刮除手术患儿术中出血量平均为32±5.86ml,65例低温等离子射频消融术的患儿术中出血量平均为4.23±2.5 ml,经配对t检验,P<0.01,差异有统计学意义。2.术中观察出血部位的结果35例传统手术的患儿腺样体刮除后均出现创面的广泛渗血,其中10例术中创面渗血较严重,8例出血量约30ml左右,反复长时间行纱球压迫止血,血止；有2例患儿术中出血较剧烈分别为35.4ml和42.3ml,纱球压迫止血效果不佳,出血点位于鼻中隔后端,行双极电凝止血,血止。低温等离子射频消融术的患儿术中出血较少,平均为5ml,35例术中出血量小于1ml,45例患儿术中腺样体弥漫性渗血,量约3ml左右,30例患儿术中出血集中在与鼻中隔相交界处。考虑此处为腺样体主要供血血管进出腺样体处。术中使用低温等离子射频止血。3.统计学分析术中出血量的相关因素通过SPSS统计统计软件进行腺样体出血的多重线性回归计算偏相关系数患儿年龄、病程及腺样体大小进行变量转换后用SPSS软件进行多元相关分析,所得患儿年龄、病程及腺样体大小对出血量的偏相关系数分别为0.40、0.59、0.25,P<0.05,有显著的统计学意义。提示等离子射低温等离子术术中出血量与患儿年龄、病程及腺样体大小相关。(见附图2,3,4)结论：1.低温等离子射频消融手术大大降低了腺样体切除术中的出血量,同时可充分止血,是一种更加安全,微创,有效的治疗方式。2.通过对影响腺样体手术术中出血量的相关因素分析,可以得出患儿年龄越大、病程越长及腺样体越大,患儿术中越容易出血,其出血量越多。3.低温等离子射频腺样体消融术的手术方式为从中间向周围逐层消融,对于引起阻塞及压迫症状的肥大腺样体组织应予彻底切除,而对于腺样体下缘尤其是靠近口咽部处的腺体组织只需切除50%～80%即可。4.在临床大量手术中,常常见到鼻中隔后端出血较多,是否与腺样体的滋养血管经此进入有关,供应腺样体未见文献报道,需要进一步进行相关基础学研究。更多还原

【Abstract】 Objective:Observe the bleeding volume and spots during adenoidectomy for two group of children with traditional curettage and coblation, analyze the relative factors about hemorrhage and the advantage in reduction bleeding volume with coblationMethod:100 cases of children with adenoid hypertrophy were recruited from June 2007 to June 2009. traditional curettage was carried out for 35 cases of them(group 1)and coblation was carried out for the others(group 2). We calculated the bleeding volumes and spots for two different surgical procedures, respectively. Meanwhile, after making variable convert for age, pathogenesis and adenoid size with SPSS statistical package for Windows, we calculated the partial correlation coefficient about bleeding volume and forementioned indexes to investigate the factors affecting bleeding volume.Result1.Bleeding volumes of two kinds of surgical proceduresThe bleeding volume on average of two groups was 32±5.86ml and 4.23±2.5 ml,respectively.Significant statistical sense was confirmed after making paired t test.2.Results of hemorrhage spots during surgeryExtensive errhysis came up after the excise the adenoid in every case of group 1by traditional curettage.bleeding volume of 8 cases were about 30ml,repetat compress the bleeding volume of 8 cases were about 30ml, repetat compress the bleeding area for a long time to stop bleeding.2 of them bleed severe at posterior extremity of nasal septum during the surgery (35.4ml and 42.3ml),unable to stop bleeding completely by compression and then using bipolar electric coagulation to stop bleeding.Less blood loss happened in group 2 by coblation, about 5 ml.bleeding volumes of 35 cases were less than 1 ml. Diffuse errhysis came up during surgery in 45 cases of children,about 3ml.the bleeding spots of 30cases were concentrated at the juncture of adenoid and nasal septum,which was thought to be the feeding artery of adenoid.We stop bleeding smoothly by using coblation3.Statistical analysis of factors related to bleeding volumesAfter making variable convert for age,pathogeneses and adenoid size,multiple linear regression was performed by using SPSS statistical package for Windows.Partial correlation coefficients on bleeding volumes were 0.40,0.59,0.25,respectively,.which made significant statistical signify-cance and suggested that bleeding volumes by coblation were related to age,pathogenesis and adenoid sizes of children.Conclusion1.Coblation is able to significantly reduce bleeding volume during adenoidectomy and stop bleeding satisfactorily.It is no doubt that coblation is a safe, minimally invasived and stopbleeding satisfactorily.It is no doubt that coblation is a safe,minimally invasived and effective therapeutic method2.According to the result of statistically analysis on factors related tobleeding volumes,bigger age, longer pathogenesis and larger size of adenoids mean more bleeding volume during surgery.3.Coblation surgical procedure mainly ablation the adenoid tissue from middle line to bilateral gradually.Specified adenoid tissue that may canse obstructive or oppressive symptom should be ablated completely.4.Hemorrhage often happened at posterior extremith of nasal septum in clinical adenoidectomy.Further relative fundamental research should be dong in future to figure out whether the feeding artery of adenoid via this area.更多还原