Thomaser E G, Tschopp K
Klinik für Hals-, Nasen- und Ohrenkrankheiten, Hals- und Gesichtschirurgie des Kantonspitals Liestal.
Laryngorhinootologie. 2004 Aug;83(8):501-6. doi: 10.1055/s-2004-814467.
Postoperative pain after tonsillectomy is greater using diathermy compared to the use of ligatures for hemostasis. In the present paper, the influence of coagulation current on the postoperative course is assessed quantitatively. The applied coagulation current was registered in Watt per second (Ws) in 63 patients. Intraoperative blood loss, operation time, experience of the surgeon, postoperative pain and the consumption of analgesics were registered.
The mean intraoperative blood loss was correlated to the amount of applied coagulation current. Operation time was reduced with increased coagulation current. The energy of the applied coagulation current correlated significantly with pain in the late postoperative period. There was no influence in the amount of coagulation current on the consumption of analgesics or postoperative hemorrhage. Blood loss was less and operation time was shorter with more experienced surgeons. Six secondary postoperative hemorrhages were observed. Hemorrhage occurred more often with inexperienced surgeons. The applied coagulation current was, however, not dependent on the surgeon's experience but on his individual technique for intraoperative control of hemostasis.
Pain following tonsillectomy is related to the amount of intraoperatively applied coagulation current, especially in the late postoperative course (days 10 - 14). This may be explained by tissue damage and increased eschar due to coagulation. Careful and reserved use of intraoperative coagulation will reduce postoperative pain.
与使用结扎法止血相比，扁桃体切除术后使用透热法产生的术后疼痛更剧烈。在本文中，对凝血电流对术后病程的影响进行了定量评估。记录了63例患者以瓦每秒（Ws）为单位的凝血电流量。记录术中失血量、手术时间、外科医生的经验、术后疼痛和镇痛药的消耗量。
术中平均失血量与凝血电流量相关。随着凝血电流增加，手术时间缩短。凝血电流能量与术后晚期疼痛显著相关。凝血电流量对镇痛药消耗量或术后出血无影响。经验更丰富的外科医生手术时失血量更少，手术时间更短。观察到6例继发性术后出血。经验不足的外科医生术后出血更常见。然而，凝血电流量不取决于外科医生的经验，而是取决于其术中控制止血的个人技术。
扁桃体切除术后疼痛与术中凝血电流量有关，尤其是在术后晚期（第10 - 14天）。这可能是由于凝血导致组织损伤和焦痂增加所致。谨慎且适度使用术中凝血可减轻术后疼痛。
