Stoeckli S J, Moe K S, Huber A, Schmid S
Clinic of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Switzerland.
Laryngoscope. 1999 Apr;109(4):652-5. doi: 10.1097/00005537-199904000-00025.
The notable morbidity of tonsillectomy includes considerable postoperative pain and a rate of postoperative bleeding that have remained largely uninfluenced by modern surgical techniques or medication. Fibrin glue is known to have a hemostatic effect in some settings, and there is research suggesting it may also reduce postoperative pain. The objectives of this study were to evaluate the effect of fibrin glue on pain and bleeding after tonsillectomy.
A prospective randomized double-blind study was performed on 50 consecutive adult patients undergoing tonsillectomy for chronic tonsillitis.
After removal of both tonsils the tonsillar fossa randomly assigned to the treatment protocol was coated with fibrin glue. The other side was left unaltered. The patient was then monitored for postoperative bleeding and wound healing, and a patient-based pain assessment instrument was used to evaluate symptoms every 8 hours for 10 days after surgery.
Detailed evaluation of the pain scores allowed the authors to create a pain profile for what the typical patient experiences over the first 10 postoperative days, as well as during the course of a single day. The pain remains relatively constant for the first 7 days and begins to decrease only on the eighth postoperative day. During a single day there is increased pain in the morning compared with noon and evening. However, no statistically significant difference was detected in postoperative pain, bleeding, or healing between the wounds treated with fibrin glue and controls.
The patient-based pain evaluation data should aid the physician in preoperative outcome counselling and targeted prescription of pain medication. However, contrary to previous indications, the authors cannot substantiate a significant beneficial effect of fibrin glue in postoperative pain control. Furthermore, we did not find its action as a hemostatic agent clinically applicable in this setting, and thus find no indication for the routine use of fibrin glue in tonsillectomy.
扁桃体切除术的显著发病率包括术后疼痛严重以及术后出血率较高，而现代手术技术或药物对此影响不大。已知纤维蛋白胶在某些情况下具有止血作用，并且有研究表明它可能还能减轻术后疼痛。本研究的目的是评估纤维蛋白胶对扁桃体切除术后疼痛和出血的影响。
对50例因慢性扁桃体炎接受扁桃体切除术的成年患者进行了一项前瞻性随机双盲研究。
切除双侧扁桃体后，将随机分配至治疗方案组的扁桃体窝用纤维蛋白胶覆盖。另一侧保持不变。然后对患者进行术后出血和伤口愈合监测，并在术后10天内每8小时使用一种基于患者的疼痛评估工具来评估症状。
对疼痛评分的详细评估使作者能够描绘出典型患者在术后头10天以及一天当中的疼痛情况。疼痛在头7天相对稳定，仅在术后第8天开始减轻。在一天当中，早晨的疼痛比中午和晚上更严重。然而，在使用纤维蛋白胶治疗的伤口与对照组之间，术后疼痛、出血或愈合情况未检测到统计学上的显著差异。
基于患者的疼痛评估数据应有助于医生在术前进行预后咨询以及有针对性地开具止痛药。然而，与之前的研究结果相反，作者无法证实纤维蛋白胶在控制术后疼痛方面有显著的有益效果。此外，我们未发现其作为止血剂在这种情况下具有临床适用性，因此找不到在扁桃体切除术中常规使用纤维蛋白胶的依据。
