ENT Department, Royal Blackburn Hospital, Haslingden Road, Blackburn, Lancashire, BB2 3HH, UK.
Eur Arch Otorhinolaryngol. 2012 Feb;269(2):667-71. doi: 10.1007/s00405-011-1678-8. Epub 2011 Jun 26.
The aim of this study is to examine the incidence of return to theatre (RTT) for post-operative haemorrhage following coblation and dissection tonsillectomy and to investigate those that required RTT more than 10 days post-surgery. Retrospective review of post-tonsillectomy haemorrhages requiring RTT from April 2005 to March 2009 was conducted. Of 2,541 tonsillectomies performed, 81% were by coblation and 19% by dissection methods. The overall RTT rate was 1.7%. No difference was found in the overall RTT rates for primary and secondary haemorrhage between the two techniques. However, the overall RTT rates for primary and secondary haemorrhage were higher in adults than children (P = 0.0456 and P = 0.0215, respectively). RTT for secondary haemorrhage during the first ten post-operative days occurred in both coblation and dissection tonsillectomy with no significant difference. After the first post-operative week, late secondary bleeding requiring RTT occurred only in the coblation group (P = 0.0676). Four patients required blood transfusion; all were in the coblation group, three of which were required during RTT in the late secondary haemorrhage (after 10 days). The post-operative RTT rates for coblation tonsillectomy did not reveal a change of trend over the 4-year study period. Our RTT rate for secondary haemorrhage is higher than earlier published results. A learning curve could not be identified in RTT for coblation tonsillectomy haemorrhage. Late secondary haemorrhages requiring surgical intervention have only been identified in cases performed by coblation and could potentially be life threatening as 33% (3/9) required blood transfusion. This phenomenon may be explained by a particular physiological healing process associated with coblation.
本研究旨在探讨使用低温等离子射频消融术和传统剥离术切除扁桃体后发生术后出血需再次手术（RTT）的发生率，并研究那些术后 10 天以上发生 RTT 的病例。对 2005 年 4 月至 2009 年 3 月期间因扁桃体切除术后出血需行 RTT 的病例进行了回顾性分析。在 2541 例扁桃体切除术患者中，81%采用低温等离子射频消融术，19%采用传统剥离术。总体 RTT 发生率为 1.7%。两种技术的原发性和继发性出血的总体 RTT 发生率无差异。然而，成人的原发性和继发性出血的总体 RTT 发生率高于儿童（P = 0.0456 和 P = 0.0215）。在术后的头 10 天内，无论是采用低温等离子射频消融术还是传统剥离术，均会发生继发性出血，无明显差异。在术后第一周后，仅在低温等离子射频消融术组发生需要 RTT 的迟发性继发性出血（P = 0.0676）。有 4 例患者需要输血；均在低温等离子射频消融术组，其中 3 例在迟发性继发性出血（术后 10 天）期间进行 RTT 时需要输血。在 4 年的研究期间，低温等离子射频消融术的术后 RTT 发生率没有呈现出趋势变化。我们的继发性出血 RTT 发生率高于早期发表的结果。在低温等离子射频消融术治疗扁桃体出血的 RTT 中，没有发现学习曲线。仅在采用低温等离子射频消融术的病例中发现需要手术干预的迟发性继发性出血，这可能会危及生命，因为有 33%（3/9）的患者需要输血。这种现象可能与低温等离子射频消融术相关的特定生理愈合过程有关。
