Hals-, Nasen-, Ohren-Heilkunde, Plastische Operationen, Marienhospital Gelsenkirchen GmbH, Gelsenkirchen, Germany.
PLoS One. 2012;7(10):e47874. doi: 10.1371/journal.pone.0047874. Epub 2012 Oct 31.
The tonsillectomy is one of the most frequently performed surgical procedures. Given the comparatively frequent postsurgical bleeding associated with this procedure, particular attention has been paid to reduction of the postoperative bleeding rate. In 2006, we introduced routine suturing of the faucial pillars at our clinic to reduce postoperative haemorrhage.
Two groups from the years 2003-2005 (n = 1000) and 2007-2009 (n = 1000) have been compared. We included all patients who had an elective tonsillectomy due to a benign, non-acute inflammatory tonsil illness. In the years 2007-2009, we additionally sutured the faucial pillars after completing haemostasis. For primary haemostasis we used suture ligation and bipolar diathermy.
The rate of bleeding requiring second surgery for haemostasis was 3.6% in 2003-2005 but only 2.0% in 2007-2009 (absolute risk reduction 1.6% (95% CI 0.22%-2.45%, p = 0.04)). The median surgery time-including adenoidectomy and paracentesis surgery-increased from 25 to 31 minutes (p<0.01).
We have been able to substantiate that suturing of the faucial pillars nearly halves the rate of postoperative haemorrhage. Surgery takes 8 minutes longer on average. Bleeding occurs later, mostly after 24 h. The limitations of this study relate to its retrospective character and all the potential biases related to observational studies.
扁桃体切除术是最常进行的手术之一。鉴于该手术术后出血较为频繁，因此特别关注降低术后出血率。2006 年，我们在诊所常规缝合咽柱以减少术后出血。
对 2003-2005 年（n=1000）和 2007-2009 年（n=1000）的两组患者进行比较。我们纳入了所有因良性、非急性炎症性扁桃体疾病而接受择期扁桃体切除术的患者。在 2007-2009 年，我们在完成止血后还额外缝合了咽柱。主要止血方法为缝合结扎和双极电凝。
2003-2005 年需要再次手术止血的出血率为 3.6%，而 2007-2009 年仅为 2.0%（绝对风险降低 1.6%（95%CI 0.22%-2.45%，p=0.04））。包括腺样体切除术和切开术在内的手术时间中位数从 25 分钟增加到 31 分钟（p<0.01）。
我们已经证实，缝合咽柱几乎可以将术后出血率减半。手术平均延长 8 分钟。出血发生较晚，大多在 24 小时后。这项研究的局限性在于其回顾性特征和与观察性研究相关的所有潜在偏倚。
