Wilhelm Thomas, Wittlinger Jan, Georgiew Robert, Güldner Christian, Hoch Stephan, Teymoortash Afshin, Günzel Thomas, Stankovic Petar
Department Otolaryngology, Head/Neck & Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany.
Department Otolaryngology, Head and Neck Surgery, Philipps University of Marburg, Marburg, Germany.
Int J Otolaryngol. 2017;2017:8430907. doi: 10.1155/2017/8430907. Epub 2017 Aug 8.
Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TE) could be assumed to decrease PTH compared to traditional tonsillectomy (TE).
In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery [0] or thereafter [1]). The findings at resection site and pain were measured.
869 patients were included (183 TE; 686 TE). PTH requiring RTT was not seen in the TE group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the TE group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for TE were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% ( > 0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH ( = 0.007).
Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TE group. Benefit for TE was observed in high-volume and long experienced surgeons.
扁桃体切除术后出血（PTH）是最令人担忧的并发症。与传统扁桃体切除术（TE）相比，在显微镜下靠近扁桃体被膜进行剥离（TE）可推测能降低PTH。
在本研究中，评估患者是否需要手术控制（R/N：返回/未返回手术室（RTT）：手术当天[0]或之后[1]）。测量切除部位的发现和疼痛情况。
纳入869例患者（183例TE；686例TE）。TE组在手术当天（R0）未出现需要返回手术室的PTH，而随后（R1）有1.1%的病例出现需要返回手术室的PTH。在TE组中，分别有0.6%（N0）和3.4%（N1）观察到无需手术控制的出血。TE组的相应发生率如下：R0，0.3%；R1，1.7%；N0，0.6%；N1，3.6%（P>0.05）。切除部位的术后水肿和局部感染被证明是PTH的预测因素（P=0.007）。
扁桃体切除术中使用显微镜辅助对PTH在统计学上没有影响，尽管TE组的PTH率有降低趋势。在经验丰富的高手术量外科医生中观察到TE的益处。
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