Blanchford Hannah, Lowe David
James Cook University Hospital, Middlesbrough, UK.
ORL J Otorhinolaryngol Relat Spec. 2013;75(3):136-41. doi: 10.1159/000342315. Epub 2013 Aug 22.
An investigation of the risk factors for haemorrhage after tonsillectomy with particular reference to the use of bipolar diathermy for tonsillar dissection and haemostasis, diathermy power settings and coblation tonsillectomy. The findings of the National Prospective Tonsillectomy Audit and subsequent related research are summarised and discussed with reference to the issue of use of hot versus cold tonsillectomy techniques. Additional unpublished data on coblation tonsillectomy is presented. Overall, increased haemorrhage rates were noted for diathermy dissection tonsillectomy (adjusted odds ratio 2.47, p < 0.0001) and coblation tonsillectomy (adjusted odds ratio 3.07, p < 0.0001) compared to the reference category of cold steel tonsillectomy. Use of bipolar diathermy for haemostasis only carried an intermediate risk of haemorrhage (adjusted odds ratio 1.57, p = 0.004). Further investigation of diathermy power settings demonstrated a quantitative relationship between increasing power usage and subsequent haemorrhage. Use of diathermy for haemostasis at the lowest effective setting may carry a comparable risk of haemorrhage to that of cold steel tonsillectomy. Recommendations are given on the optimum tonsillectomy technique for both the older child or adolescent and the particularly young or low weight child.
扁桃体切除术后出血危险因素的调查，特别涉及双极电凝用于扁桃体剥离和止血、电凝功率设置以及低温等离子体扁桃体切除术。总结并讨论了全国扁桃体切除术前瞻性审计的结果以及随后的相关研究，同时参考了热扁桃体切除技术与冷扁桃体切除技术的使用问题。还展示了关于低温等离子体扁桃体切除术的额外未发表数据。总体而言，与冷钢扁桃体切除术这一参考类别相比，电凝剥离扁桃体切除术（调整后的优势比为2.47，p < 0.0001）和低温等离子体扁桃体切除术（调整后的优势比为3.07，p < 0.0001）的出血率有所增加。仅使用双极电凝进行止血的出血风险处于中等水平（调整后的优势比为1.57，p = 0.004）。对电凝功率设置的进一步研究表明，功率使用增加与随后的出血之间存在定量关系。在最低有效设置下使用电凝进行止血可能与冷钢扁桃体切除术具有相当的出血风险。针对大龄儿童或青少年以及特别年幼或低体重儿童，给出了关于最佳扁桃体切除技术的建议。
