Nguyen Thomas B V, Chin Ronald Y, Paramaesvaran Suchitra, Eslick Guy D
Department of Otolaryngology, Head and Neck Surgery, Nepean Hospital, Derby St, Kingswood, Sydney, NSW, 2750, Australia,
Eur Arch Otorhinolaryngol. 2014 Nov;271(11):3005-10. doi: 10.1007/s00405-014-3075-6. Epub 2014 May 5.
Tonsillectomy is a common otolaryngological procedure and is associated with a small risk of postoperative pharyngeal haemorrhage. This study compares secondary post tonsillectomy haemorrhage rates between two operative techniques: diathermy tonsillectomy and diathermy tonsillectomy with tonsillar bed oversew. A total of 424 patients underwent tonsillectomies with or without other procedures such as adenoidectomy and grommet insertion by two ears, nose and throat surgeons at three hospitals from May 2012 to July 2013. A diathermy tonsillectomy was performed in 266 patients, while a diathermy tonsillectomy with tonsillar bed oversew was performed in 158 patients. All patients were followed up within 2-4 weeks of surgery. Primary haemorrhage did not occur in either surgical technique groups. Secondary haemorrhage occurred in 20 patients (7.52 %) in the diathermy tonsillectomy group and in 9 patients (5.70 %) in the diathermy with tonsillar bed oversew group. This result was not significantly different (OR = 0.74, 95 % CI 0.33-1.67, p = 0.47). Sex, age, indication for surgery and whether or not a tonsillectomy was performed alone or with other procedures were not significant factors for secondary haemorrhage. In summary, routine tonsillar bed oversew after diathermy tonsillectomy does not reduce the risk of secondary tonsillar haemorrhage.
扁桃体切除术是一种常见的耳鼻喉科手术,术后咽部出血风险较小。本研究比较了两种手术技术(电凝扁桃体切除术和电凝扁桃体切除术后扁桃体床缝合术)术后继发性出血的发生率。2012年5月至2013年7月期间,三家医院的两名耳鼻喉科医生共为424例患者实施了扁桃体切除术,部分患者还接受了诸如腺样体切除术和双耳鼓膜置管术等其他手术。266例患者接受了电凝扁桃体切除术,158例患者接受了电凝扁桃体切除术后扁桃体床缝合术。所有患者均在术后2至4周内进行随访。两种手术技术组均未发生原发性出血。电凝扁桃体切除术组有20例患者(7.52%)发生继发性出血,电凝扁桃体切除术后扁桃体床缝合术组有9例患者(5.70%)发生继发性出血。结果无显著差异(OR = 0.74,95%CI 0.33 - 1.67,p = 0.47)。性别、年龄、手术指征以及扁桃体切除术是否单独进行或与其他手术联合进行均不是继发性出血的显著因素。总之,电凝扁桃体切除术后常规缝合扁桃体床并不能降低继发性扁桃体出血的风险。