Stavroulaki Pelagia, Skoulakis Charalampos, Theos Evangelos, Kokalis Nikolaos, Valagianis Dimitrios
Department of Otorhinolaryngology, General Hospital of Volos, Volos, Greece.
Ann Otol Rhinol Laryngol. 2007 Aug;116(8):565-70. doi: 10.1177/000348940711600802.
We performed a single-blind, prospective, randomized, controlled clinical study to compare the rates of postoperative morbidity in adults undergoing thermal welding tonsillectomy versus cold dissection tonsillectomy.
Thirty-two adults with recurrent tonsillitis who were scheduled for elective tonsillectomy were randomized to either thermal welding or cold dissection tonsillectomy groups. The main outcome measures included intraoperative blood loss, intensity of postoperative pain expressed on a 10-cm visual analog scale (with 0 representing no pain and 10 representing the worst possible pain), day of cessation of significant pain (ie, a pain score of at least 7), and presence of postoperative hemorrhage estimated on a 3-point scale (with 0 representing no bleeding, 1 representing minor bleeding, and 2 representing major bleeding). Additional outcome measures included total analgesic requirements, last day of receipt of analgesics, presence of nausea and/or vomiting, and wound healing after 10 days of surgery.
The rate of intraoperative blood loss was significantly lower in the thermal welding group (p < .0001). Patients who had thermal welding tonsillectomy also showed a general trend toward lower pain scores, and this difference was statistically significant from the first to the fourth postoperative days (p < .05). Cessation of significant pain also occurred 3 days earlier in this group (p < .05). No significant difference was observed regarding pain medication, nausea and/or vomiting, postoperative hemorrhage, or wound healing.
Thermal welding tonsillectomy is a relatively safe and reliable method with significantly less postoperative morbidity than cold dissection tonsillectomy.
我们进行了一项单盲、前瞻性、随机对照临床研究，以比较接受热凝扁桃体切除术与冷剥离扁桃体切除术的成人患者术后发病率。
32例计划择期行扁桃体切除术的复发性扁桃体炎成人患者被随机分为热凝组或冷剥离组。主要观察指标包括术中出血量、术后疼痛强度（采用10厘米视觉模拟评分法，0表示无疼痛，10表示可能的最严重疼痛）、显著疼痛停止日（即疼痛评分至少为7）以及术后出血情况（采用3分制评估，0表示无出血，1表示少量出血，2表示大量出血）。其他观察指标包括总镇痛需求、镇痛药使用的最后一天、恶心和/或呕吐的发生情况以及术后10天的伤口愈合情况。
热凝组术中出血量显著更低（p < .0001）。接受热凝扁桃体切除术的患者术后疼痛评分总体也呈较低趋势，且从术后第1天至第4天，这种差异具有统计学意义（p < .05）。该组显著疼痛停止时间也提前3天（p < .05）。在止痛药物、恶心和/或呕吐、术后出血或伤口愈合方面未观察到显著差异。
热凝扁桃体切除术是一种相对安全可靠的方法，与冷剥离扁桃体切除术相比，术后发病率显著更低。
