囊內扁桃腺切除術可能比電子切除扁桃腺切除術效果更佳


  September 17, 2007 — 根據9月份的耳鼻喉科學文獻:頭和頸外科學期刊中發表的一篇大型回溯病例評估,相較於傳統的電子切除扁桃腺切除術,囊內扁桃腺切除術(intracapsular tonsillectomy,IT)術後出血的發生率比較低,疼痛導致的住院也比較少。
  
  Alfred I. duPont兒童醫院的Richard Schmidt醫師和同事指出,為了緩和不必要的後遺症,過去幾年來對於扁桃腺切除術一直有各種不同版本,在我們的機構中,傳統扁桃腺切除術 (traditional tonsillectomies,TT)主要對扁桃腺進行單極電子切除,扁桃腺移除後,以抽吸電燒進行止血。
  我們發表了接受 IT 之病患的延遲出血發生率,以及因為術後疼痛或者脫水而住院或者急診的比率,並且將這些結果和那些由同一手術團隊在同一時期進行TT之病患的結果進行比較。
  
  研究者回顧了2002年1月1日到5月31日間,於三級小兒轉診中心接受扁桃腺切除術合併或未合併腺樣體切除術之2,944位病患的醫療紀錄,初級終點是延遲術後出血比率 ,疼痛或脫水而導致回診或急診,以及需要校正手術。
  
  這2,944位病患中,1,731位病患接受囊內扁桃腺切除術,1,212位接受傳統電子切除扁桃腺切除術;前者,延遲出血發生率是 1.1%,後者則是 3.4% (P < .001);囊內扁桃腺切除術組因為延遲出血導致必須回手術室控制出血的比率是0.5%,傳統電子切除扁桃腺切除術組是 2.1% (P < .001)。
  
  囊內扁桃腺切除術組,11位病患 (0.64%) 需要校正扁桃腺切除術,3.0%需要急診或住院治療疼痛或脫水,傳統電子切除扁桃腺切除術組是5.4%(P = .002)。
  
  研究限制包括這是回溯設計、缺少隨機設計、兩組的平均追蹤期間不同、兩組的病患數不同,以及樣本數相對較少。
  
  作者表示,與傳統電子切除扁桃腺切除術相比,囊內扁桃腺切除術降低了術後出血發生率 ,也降低了因疼痛導致的住院,不過仍有少數病患 (我們研究中為0.6% )需要校正手術。
  
  作者報告沒有相關財金關係。

Intracapsular Tonsillectomy Ma

By Laurie Barclay, MD
Medscape Medical News

September 17, 2007 — Compared with traditional electrodissection tonsillectomy, intracapsular tonsillectomy (IT) had a lower incidence of postoperative hemorrhage and pain leading to hospital-based evaluation, according to the results of a large, retrospective chart review reported in the September issue of the Archives of Otolaryngology–Head and Neck Surgery.

"In an attempt to mitigate...unwanted consequences, various modifications of standard tonsillectomy have been promoted over the years," write Richard Schmidt, MD, from the Alfred I. duPont Hospital for Children in Wilmington, Delaware, and colleagues. "The vast majority of traditional tonsillectomies (TT) at our institution is performed with monopolar electrodissection of the tonsil, with suction cautery used for additional hemostasis after the tonsil is removed. We present the incidences of delayed hemorrhage and evaluation in the hospital or emergency department for postoperative pain or dehydration in a consecutive sample of patients who underwent IT, and compare these results with those of patients who underwent TT performed by the same group of surgeons during the same period."

The investigators reviewed the medical records of 2944 patients undergoing tonsillectomy with or without adenoidectomy at a tertiary care pediatric referral center between January 1, 2002, and May 31, 2005. The primary endpoints were rates of delayed postoperative hemorrhage, pain or dehydration resulting in return to the hospital or ED, and the need for revision surgery.

Of the 2944 patients, 1731 patients underwent intracapsular tonsillectomy, and 1212 underwent traditional electrodissection tonsillectomy. In the former group, the incidence of delayed hemorrhage was 1.1%, compared with 3.4% in those undergoing traditional electrodissection tonsillectomy (P < .001). Delayed hemorrhage necessitating return to the operating room for control occurred in 0.5% of the intracapsular tonsillectomy group and in 2.1% of the traditional electrodissection tonsillectomy group (P < .001).

In the intracapsular tonsillectomy group, 11 patients (0.64%) required revision tonsillectomy, and 3.0% required treatment in the emergency department or hospital for pain or dehydration, compared with 5.4% of the traditional electrodissection tonsillectomy group (P = .002).

Study limitations include retrospective design, lack of randomization, mean length of follow-up being different between the groups, unequal proportion of patients in each group undergoing surgery for a given indication, and relatively small sample size.

"Intracapsular tonsillectomy has a lower incidence of postoperative hemorrhage and pain leading to hospital-based evaluation compared with traditional electrodissection tonsillectomy...although a few patients (0.6% in our study) may need revision surgery," the authors write.

The authors report no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. 2007;133(9):925–928.

    
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