Pruegsanusak Kowit, Wongsuwan Kotchporn, Wongkittithawon Junya
Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
J Med Assoc Thai. 2010 May;93(5):558-65.
Tonsillectomy is a common procedure in children. It could produce moderate to severe post operative pain and morbidity. Preserving tonsillar capsule attached to pharyngeal constrictor muscle by microdebrider technique may reduce pain when compared to conventional cold dissection technique.
To compare the postoperative pain, perioperative, and postoperative morbidity between the microdebrider-assisted intracapsular tonsillectomy (MT) and cold instrument dissection tonsillectomy (CT).
Forty children with ages between 3-14 years old in Songklanagarind Hospital with tonsillar hypertrophy were randomly assigned to have MT and CT in each group. Data of perioperative morbidity, time to start taking food, LOS, treatment satisfaction, post operative pain, and amount of analgesia were recorded for 7 days. Post operative complication was also followed-up.
There were no statistical significantly differences between groups in operation time, time to start taking food, LOS, and amount of postoperative analgesia and treatment satisfaction score. The MT had significantly more blood loss during operation (54.3 +/- 35.45 mL) than the CT (14.78 +/- 18.71 mL) (p < 0.001). The MT had significantly less post operative pain score on postoperative day 2 (2.50 +/- 1.15 and 1.05 +/- 0.83) and 3 (1.70 +/- 0.80 and 1.05 +/- 0.76) (p < 0.05) but no difference on day 0, 1, 4, 5, 6. Pain score after analgesia was significantly better in the MT on day 0 (2.45 +/- 0.94 and 3.40 +/- 1.47) (p = 0.024) but no difference on day 1-6. There were no significant differences in fentanyl use for break through pain, immediate and delayed complications between the groups.
MT is an effective alternative procedure for children with tonsillar hypertrophy and results in improved postoperative pain but have more intraoperative blood loss.
扁桃体切除术是儿童常见的手术。它可能会导致中度至重度术后疼痛和并发症。与传统的冷剥离技术相比，通过微型切割器技术保留附着于咽缩肌的扁桃体包膜可能会减轻疼痛。
比较微型切割器辅助囊内扁桃体切除术（MT）和冷器械剥离扁桃体切除术（CT）的术后疼痛、围手术期和术后并发症情况。
宋卡纳卡林医院40名年龄在3至14岁之间患有扁桃体肥大的儿童被随机分为MT组和CT组。记录围手术期并发症、开始进食时间、住院时间、治疗满意度、术后疼痛和镇痛量等数据，为期7天。同时对术后并发症进行随访。
两组在手术时间、开始进食时间、住院时间、术后镇痛量和治疗满意度评分方面无统计学显著差异。MT组术中出血量（54.3±35.45 mL）明显多于CT组（14.78±18.71 mL）（p<0.001）。MT组在术后第2天（2.50±1.15和1.05±0.83）和第3天（1.70±0.80和1.05±0.76）的术后疼痛评分明显更低（p<0.05），但在第0、1、4、5、6天无差异。镇痛后第0天MT组的疼痛评分明显更好（2.45±0.94和3.40±1.47）（p = 0.024），但在第1至6天无差异。两组在用于突破性疼痛的芬太尼使用、即时和延迟并发症方面无显著差异。
MT是治疗扁桃体肥大儿童的一种有效替代手术方法，可改善术后疼痛，但术中出血量更多。
