Johnston Douglas R, Gaslin Michael, Boon Maurits, Pribitkin Edmund, Rosen David
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
Ann Otol Rhinol Laryngol. 2010 Jul;119(7):485-9. doi: 10.1177/000348941011900710.
This study was performed to determine whether teens have different rates of posttonsillectomy hemorrhage, admission for dehydration, or recurrent tonsillitis compared to adults. Specifically, these parameters were compared within two groups: patients who underwent powered intracapsular tonsillectomy (PIT) and those who underwent monopolar electrocautery tonsillectomy (MET).
In a retrospective review of 579 patients at least 12 years of age from January 2000 to July 2006 in a tertiary referral center, outcome measures of reoperation for hemorrhage, readmission or emergency room visit for dehydration, and postoperative tonsillitis were compared for 200 patients 12 to 19 years of age and 379 patients more than 19 years of age. These outcome measures in teens were compared to those in adults who had tonsillectomy by the same technique (101 teens who underwent PIT compared to 117 adults who underwent PIT, and 99 teens who underwent MET compared to 262 adults who underwent MET). Outcome measures were also compared within the PIT and MET groups based on the indication for surgery (chronic tonsillitis, tonsillar hypertrophy, or both).
In comparing teens to adults who underwent the same technique (PIT versus PIT, or MET versus MET), no statistically significant differences existed in the incidence of hemorrhage, dehydration, or postoperative tonsillitis. Greater hemorrhage rates for adults who underwent MET compared to teens, however, almost met statistical significance (p = 0.053). Analyzing complication rates by indication within the PIT and MET groups exclusively revealed higher rates of hemorrhage in adults who underwent the MET technique for the indication of chronic tonsillitis. Within the PIT comparison, no significant differences were found on the basis of indication for surgery.
Teenage patients who undergo tonsillectomy should be considered unique as far as complication rates are concerned. Comparison of technique-specific complication rates between adults and teens showed no significant differences in either the PIT or MET groups, although adults who underwent MET had greater hemorrhage rates that almost met significance (p = 0.053). Adults who were undergoing tonsillectomy for chronic tonsillitis were more likely than teens to encounter postoperative hemorrhage if they underwent the MET technique.
本研究旨在确定青少年与成年人相比，扁桃体切除术后出血、因脱水入院或复发性扁桃体炎的发生率是否存在差异。具体而言，在两组患者中比较这些参数：接受动力囊内扁桃体切除术（PIT）的患者和接受单极电凝扁桃体切除术（MET）的患者。
对一家三级转诊中心2000年1月至2006年7月期间至少12岁的579例患者进行回顾性研究，比较200例12至19岁患者和379例19岁以上患者的出血再次手术、因脱水再次入院或急诊就诊以及术后扁桃体炎的结局指标。将青少年的这些结局指标与采用相同技术进行扁桃体切除术的成年人的结局指标进行比较（101例接受PIT的青少年与117例接受PIT的成年人，99例接受MET的青少年与接受MET的262例成年人）。还根据手术指征（慢性扁桃体炎、扁桃体肥大或两者皆有）在PIT组和MET组内比较结局指标。
在将青少年与采用相同技术的成年人（PIT对PIT，或MET对MET）进行比较时，出血、脱水或术后扁桃体炎的发生率无统计学显著差异。然而，接受MET的成年人的出血率高于青少年，几乎达到统计学显著性（p = 0.053）。仅在PIT组和MET组内按指征分析并发症发生率显示，因慢性扁桃体炎指征接受MET技术的成年人出血率较高。在PIT组的比较中，未发现基于手术指征的显著差异。
就并发症发生率而言，接受扁桃体切除术的青少年患者应被视为独特群体。成人和青少年之间特定技术并发症发生率的比较显示，PIT组或MET组均无显著差异，尽管接受MET的成年人出血率较高，几乎达到显著性（p = 0.053）。如果接受MET技术，因慢性扁桃体炎接受扁桃体切除术的成年人比青少年更易发生术后出血。
