不同手术方式治疗儿童腺样体肥大的临床试验研究

发布时间：2018-02-26 00:12

  本文关键词： 腺样体肥大 鼻内镜 低温等离子 射频消融 电动切割　出处：《吉林大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的:本研究通过比较鼻内镜辅助经口低温等离子腺样体射频消融术、鼻内镜辅助经口腺样体电动切割术及传统经口腺样体刮除术三种术式的优缺点,以求寻找出最佳治疗效果的手术方式。 方法:采集吉林大学中日联谊医院耳鼻咽喉头颈外科联合黑龙江省大庆油田总医院耳鼻咽喉科2008年2月至2009年8月收治的临床诊断明确的腺样体肥大的患儿90例,年龄在6～12岁,随机分为3组,采用不同手术方式进行腺样体切除手术,A组:等离子射频消融组32例,B组:电动切割组34例,C组:传统腺样体刮除组24例。对三种手术方式的手术情况进行分析:(1)腺样体切除时间(即手术器械开始切除腺样体组织到腺样体完全切除为止的时间);(2)手术时间(即为麻醉满意后口腔上开口器开始计算直至腺样体切除完成彻底止血后撤离器械为止,伴有扁桃体切除等其他术式的不将其时间计算在内);(3)手术中出血量;(4)术后并发症情况(包括腺样体残留、继发出血及复发);(5)术后症状恢复情况(包括听力、睡眠打鼾、鼻塞、鼻漏)等指标进行统计学分析比较。 结果:采用鼻内镜/纤维鼻咽镜检查及问卷调查形式进行术后随访,随访时间为3～12个月。三种手术方式的手术情况统计学分析比较:(1)三种术式腺样体切除时间两两比较均有显著的统计学差异(P0.01),其中A组腺样体切除时间最长,其次是B组,C组腺样体切除时间最短。(2)三种术式手术时间两两比较,A组与B组无统计学差异(P0.05),而A组和B组手术时间均长于C组,有显著统计学差异(P0.01)。(3)三种术式手术中出血量比较,A组要显著少于B组及C组(P0.01),而B组与C组比较术中出血量无统计学差异(P0.05)。(4)三种手术方式术后并发症的对比研究发现,A组32例患儿均无腺样体残留,无咽鼓管损伤及术后出血、复发等并发症,明显优于其他两组。C组有22例患儿存在不同程度腺样体残留,残留率91.67%,有2例咽鼓管圆枕损伤,1例术后继发出血;B组中有2例少量残留,残留率5.88%,无咽鼓管损伤,1例术后继发出血;C组残留率高于B组,统计学有显著差异(P0.01)。(5)术后症状恢复情况比较,听力:X2=1.53,P0.05;打鼾:X2=0.66,P0.05;鼻塞:X2=1.48,P0.05;鼻漏:X2=0.57,P0.05。三种术式之间手术有效率无统计学差异,P均0.05。 结论:三种腺样体切除手术术式中的最佳手术方法为鼻内镜辅助经口低温等离子腺样体射频消融术。在鼻内镜辅助下经口低温等离子腺样体射频消融手术,视野清楚,能达到完全轮廓化,边消融边止血,避免盲视下切除腺样体而致的腺样体残留,术中出血少、损伤小、腺样体无残留、无术后并发症发生,因此效果满意。
[Abstract]:Objective: To compare the advantages and disadvantages of three operative methods, such as endoscope assisted low-frequency plasma radiofrequency ablation, nasal endoscope assisted transoral adenoelectric electrotomy and traditional oral adenotyping, in order to find out the best surgical treatment.
Methods: collected in General Hospital of Daqing Oil Field of Jilin University of Otolaryngology Head and neck surgery, China Japan Union Hospital in Heilongjiang Province Department of Otolaryngology from February 2008 to August 2009 were clinical diagnosis of adenoid hypertrophy in 90 cases, at the age of 6~12, were randomly divided into 3 groups by adenoidectomy, using different surgical methods for the A group group: 32 cases, radiofrequency ablation group B: electric cutting group 34 cases, group C: traditional adenoidectomy group 24 cases. Analyze the operation situation of three operation methods: (1) adenoidectomy time (i.e. surgical resection of adenoid tissue began to adenoid completely for time); (2) the operation time (which is satisfied with the anesthesia oral on the gag start until adenoidectomy to complete hemostasis after the withdrawal of instruments, accompanied by tonsillectomy and other operation is not the time to count); (3) hand The amount of bleeding; (4) postoperative complications (including residual adenoids, hemorrhage and recurrence); (5) the recovery of postoperative symptoms (including listening, snoring, nasal congestion, rhinorrhea) and other indicators were statistically analyzed and compared.
缁撴灉:閲囩敤榧诲唴闀，

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