儿童腺样体低温等离子射频消融术术中出血情况的研究

发布时间：2018-02-27 13:36

本文关键词： 低温等离子射频儿童腺样体肥大手术出血　出处：《大连医科大学》2010年硕士论文　论文类型：学位论文

【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,P0.01,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,P0.05,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。
[Abstract]:Objective:. Two groups of children with adenoid hypertrophy were treated with low temperature plasma radiofrequency ablation and traditional curettage respectively. To analyze the factors related to bleeding during adenoidectomy in children and the advantages of radiofrequency ablation of low temperature plasma in reducing intraoperative bleeding. Methods:. From June 2007 to June 2009, 100 cases of adenoid hypertrophy were analyzed. 65 cases were treated with low temperature plasma radiofrequency ablation (RFA) and 35 cases were treated with traditional curettage. The amount of intraoperative bleeding was calculated and the location of bleeding was observed. At the same time, the age, course of disease and the size of adenoid were analyzed by multivariate linear correlation analysis with SPSS software. The partial correlation coefficient of blood loss during adenoidectomy was calculated, and the factors influencing the bleeding were discussed. Results:. 1. Measurement of intraoperative bleeding in two types of operations (see attached table and figure 1). The average blood loss in 35 cases of traditional curettage operation was 32 卤5.86 ml and 65 cases of low temperature plasma radiofrequency ablation was 4.23 卤2.5 ml, the difference was statistically significant. 2. Intraoperative observation of bleeding site. 35 cases of children with traditional operation had extensive bleeding after adenoid curettage, of which 10 cases had severe bleeding and 8 cases had about 30ml blood loss. The bleeding was stopped by gauze ball compression for a long time. There were 2 cases with severe intraoperative bleeding of 35.4ml and 42.3ml respectively. The bleeding point was located at the posterior end of nasal septum and the bleeding point was at the back of nasal septum. The bleeding was stopped by bipolar electrocoagulation. The intraoperative bleeding was less in children with low temperature plasma radiofrequency ablation, and the average intraoperative bleeding was 5 ml or less in 45 cases with less than 1 ml of intraoperative bleeding, and there was diffuse blood leakage from adenoids in 45 cases. The volume of intraoperative bleeding was about 3 ml in 30 children. The bleeding was concentrated at the junction with nasal septum, which was considered to be the place where the main blood supply vessels of adenoids came into and out of adenoids. Low temperature plasma radio frequency hemostasis was used during the operation. 3.The factors related to intraoperative bleeding were analyzed statistically. SPSS statistical software was used to calculate the age of children with partial correlation coefficient by multiple linear regression of adenoid hemorrhage, the course of disease and the size of adenoid were converted into variables, and then multivariate correlation analysis was carried out with SPSS software. The partial correlation coefficients of course of disease and size of adenoid to bleeding volume were 0.400.59 ~ 0.25g / p 0.05, respectively, with significant statistical significance. It is suggested that the amount of blood loss in plasma plasma hypothermia plasma surgery is related to the age, course of disease and size of adenoid (see figure 2 / 3 ~ (4)). Conclusion:. 1. Low temperature plasma radiofrequency ablation is a safe, minimally invasive and effective method for the treatment of adenoidectomy. 2. Through the analysis of the factors affecting the amount of blood loss during adenoidectomy, it can be concluded that the older the age, the longer the course of disease and the larger the adenoid, the easier the bleeding is, and the more the amount of bleeding is. 3. The procedure of radiofrequency radiofrequency adenoidectomy is from the middle to the periphery, and the hypertrophic adenoid tissue that causes obstruction and compression should be removed completely. For adenoid inferior margin, especially near oropharynx, only 50% of adenoid tissue should be excised. 4. In a large number of clinical operations, it is often found that there is more bleeding at the posterior end of nasal septum, whether it is related to the entry of the nutrient vessels of adenoids, and the supply of adenoids has not been reported in literature, so it is necessary to carry out further basic research.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R766

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