Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9035, USA.
Eur Arch Otorhinolaryngol. 2012 Apr;269(4):1269-75. doi: 10.1007/s00405-011-1774-9. Epub 2011 Sep 27.
The objective of this paper is to describe an extended microscopic hemostasis technique involving cauterization of exposed blood vessels that were not actively bleeding in tonsillar fossa after bipolar tonsillectomy and to assess the rate of post-tonsillectomy hemorrhage with this technique in children who had bipolar tonsillectomy. The medical records of children who underwent microscopic bipolar tonsillectomy with extended hemostasis between June 2008 and January 2011 were reviewed. Relevant history and physical examination, diagnosis, and characteristics of postoperative hemorrhage were recorded; 994 children (531 males, 463 females), aged between 1 and 18 years (6 ± 3 years), underwent tonsillectomy; of the 994 patients, 11 (1.1%) developed post-tonsillectomy hemorrhage. No primary post-tonsillectomy hemorrhage occurred. The hemorrhage was seen 6-13 days after the surgery. One patient had bleeding after having trauma to the neck on postoperative day 13. Of the 11 patients with post-tonsillectomy bleeding, 3 had blood clot with no active bleeding and 8 exhibited active bleeding after removal of blood clot. Of the 994 patients, 8 (0.8%) needed intervention to control active bleeding. Compared to previous studies of bipolar tonsillectomy, extended microscopic hemostasis achieved by cauterization of tonsil fossa non-bleeding blood vessels appeared to reduce bleeding rate after bipolar cautery tonsillectomy. The present study did not include a control arm; further randomized controlled studies are needed to establish the definite effect of extended microscopic hemostasis technique on the rate of hemorrhage rates after tonsillectomy techniques.
本文旨在描述一种扩展的显微镜下止血技术，即在双极扁桃体切除术后对扁桃体窝内未活动性出血的暴露血管进行烧灼，并评估该技术在接受双极扁桃体切除术的儿童中扁桃体切除术后出血的发生率。回顾了 2008 年 6 月至 2011 年 1 月间接受显微镜下双极扁桃体切除术和扩展止血的儿童的病历。记录了相关的病史和体格检查、诊断以及术后出血的特征；994 例儿童（531 例男性，463 例女性），年龄 1 至 18 岁（6±3 岁），行扁桃体切除术；994 例患者中，11 例（1.1%）发生扁桃体切除术后出血。无原发性扁桃体切除术后出血。出血发生在手术后 6-13 天。1 例患者术后第 13 天颈部外伤后出现出血。11 例扁桃体切除术后出血患者中，3 例有血凝块且无活动性出血，8 例在去除血凝块后出现活动性出血。994 例患者中，8 例（0.8%）需要干预以控制活动性出血。与之前的双极扁桃体切除术研究相比，通过烧灼扁桃体窝无出血血管来实现的扩展显微镜下止血似乎降低了双极电凝扁桃体切除术后的出血率。本研究未包括对照组；需要进一步的随机对照研究来确定扩展显微镜下止血技术对扁桃体切除术后出血率的明确效果。
