Jäckel M C, Petzold S, Dimmer V, Mall G, Reck R
HNO-Klinik des Klinikum Darmstadt, Heidelberger Landstrasse 379, 64297 Darmstadt.
HNO. 2003 Aug;51(8):634-9. doi: 10.1007/s00106-002-0789-3. Epub 2003 Apr 4.
Tonsillectomy by CO(2) laser microsurgery is an almost bloodless procedure that has developed to an alternative to traditional dissection tonsillectomy during recent years. It has been suggested that the laser technique more precise than the conventional one, however, attempts to investigate this morphologically have not yet been undertaken. In addition, there is a need for large clinical studies to compare the postoperative bleeding risk of both procedures.
The charts of 617 patients who underwent routine tonsillectomy between 1995 and 1998 at the ENT department of Darmstadt Hospital, were retrospectively investigated with regard to postoperative bleeding events. A total of 467 patients were treated by the conventional technique and 150 by CO(2) laser microsurgery (continuous mode, 5 W). Moreover, 2 mm serial sections of tonsils of 56 consecutive patients treated in 1999 (31 conventional and 25 laser tonsillectomies) were used to determine peritonsillar (Vp) and tonsillar tissue volumes (Vt).
The postoperative bleeding risk following laser tonsillectomy differed slightly from that following the conventional technique (12.0% vs 14.6%; P=0.499; Fisher's exact test). However, the incidence of severe bleeding events requiring revision in general anesthesia was significantly reduced (0.7% vs 4.9%; P=0.015; Fisher's exact test). Tonsillar specimens that were removed by laser surgery contained significantly less peritonsillar tissue than those from conventional procedures (Vp/Vt 5.1%+/-0.6% vs 10.8%+/-1.1%; P below 0.001; Mann-Whitney U-test).
CO(2) laser microsurgery improves the precision of tonsillectomy and provides a maximum protection for the peritonsillar tissue. The incidence of severe bleeding events is markedly reduced. Laser tonsillectomy is therefore recommended for patients with clotting disorders or those requiring a particularly exact preparation technique.
二氧化碳激光显微手术扁桃体切除术是一种几乎不出血的手术，近年来已发展成为传统剥离扁桃体切除术的替代方法。有人认为激光技术比传统技术更精确，然而，尚未有人尝试从形态学角度对此进行研究。此外，需要进行大规模临床研究来比较两种手术的术后出血风险。
回顾性研究了1995年至1998年在达姆施塔特医院耳鼻喉科接受常规扁桃体切除术的617例患者的病历，以了解术后出血事件。共有467例患者采用传统技术治疗，150例采用二氧化碳激光显微手术（连续模式，5瓦）治疗。此外，对1999年连续治疗的56例患者（31例行传统扁桃体切除术，25例行激光扁桃体切除术）的扁桃体进行2毫米连续切片，以确定扁桃体周围组织体积（Vp）和扁桃体组织体积（Vt）。
激光扁桃体切除术后的术后出血风险与传统技术略有不同（12.0%对14.6%；P = 0.499；Fisher精确检验）。然而，需要在全身麻醉下进行修正的严重出血事件的发生率显著降低（0.7%对4.9%；P = 0.015；Fisher精确检验）。激光手术切除的扁桃体标本所含的扁桃体周围组织明显少于传统手术切除的标本（Vp/Vt为5.1%±0.6%对10.8%±1.1%；P<0.001；Mann-Whitney U检验）。
二氧化碳激光显微手术提高了扁桃体切除术的精确度，并为扁桃体周围组织提供了最大程度的保护。严重出血事件的发生率显著降低。因此，对于有凝血障碍的患者或需要特别精确的手术准备技术的患者，推荐使用激光扁桃体切除术。
