Lehnerdt G, Senska K, Jahnke K, Fischer M
Department of Otorhinolaryngology, University of Duisburg-Essen, Essen, Germany.
Acta Otolaryngol. 2005 Dec;125(12):1312-7. doi: 10.1080/00016480510012336.
There is no increased risk of postoperative haemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies.
There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy à chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy à chaud and tonsillectomy à froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsillectomies.
All patients had been operated on at the Department of Otorhinolaryngology, University of Duisburg-Essen between March 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3-88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2-83 years).
In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1-4.8%) had postoperative haemorrhages which required treatment under general anaesthesia, compared to 17 (5.5%; confidence level 3.2-8.6%) in the age- and gender-matched group of "selected" elective tonsillectomies. The difference between these two rates was not significant (p = 0.056). The fairly high rate of haemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative haemorrhages.
与择期扁桃体切除术相比，扁桃体脓肿切除术术后出血风险并未增加。
关于扁桃体周围脓肿的最佳治疗方法仍存在争议。扁桃体热切除术的反对者认为术后出血风险增加。大多数比较扁桃体热切除术和扁桃体冷切除术术后出血风险的作者没有考虑患者的年龄、性别或外科医生的经验等标准。我们旨在通过进行一项回顾性研究来消除这种偏差，在该研究中，将大量扁桃体脓肿切除术病例与年龄和性别匹配的择期扁桃体切除术组进行比较。
所有患者均于1994年3月至2000年8月在杜伊斯堡 - 埃森大学耳鼻喉科接受手术。扁桃体脓肿切除术组有350例患者（男性61%，女性39%；平均年龄31.8岁；范围3 - 88岁），择期扁桃体切除术对照组有311例患者（男性61%，女性39%；平均年龄30.0岁；范围2 - 83岁）。
在扁桃体脓肿切除术组中，有9例患者（2.6%；置信水平1.1 - 4.8%）术后出血，需要在全身麻醉下进行治疗，而在年龄和性别匹配的“选定”择期扁桃体切除术组中，有17例患者（5.5%；置信水平3.2 - 8.6%）术后出血。这两个比率之间的差异不显著（p = 0.056）。择期扁桃体切除术组中出血率相当高，主要是由于年龄匹配程序的影响，该程序排除了大量通常无问题的针对幼儿扁桃体增生的扁桃体切除术。此外，我们的结果表明，外科医生在进行扁桃体切除术时，在术后出血方面存在学习曲线。
