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扁桃体切除术后疼痛与伤口愈合的后柱黏膜悬吊技术:一项前瞻性、随机、对照试验

Posterior pillar mucosal suspension technique for posttonsillectomy pain and wound healing: a prospective, randomized, controlled trial.

作者信息

Akcan Fatih Alper, Dündar Yusuf

机构信息

Department of Otorhinolaryngology, Düzce University School of Medicine, Düzce, Turkey.

Department of Otolaryngology Head and Neck Surgery, Wayne State University, Detroit, MI, USA.

出版信息

Eur Arch Otorhinolaryngol. 2018 Nov;275(11):2879-2887. doi: 10.1007/s00405-018-5148-4. Epub 2018 Sep 26.

Abstract

OBJECTIVES/HYPOTHESIS: To investigate the efficacy of a simple and feasible suturing technique on posttonsillectomy pain control and wound healing.

METHODS

A prospective, randomized, controlled trial was conducted on a sample of 121 children between 3 and 10 years of age. Group A comprised children undergoing surgery with bipolar cautery and the posterior pillar mucosal suspension technique. Bipolar alone (Group B) and cold dissection tonsillectomy (Group C) were used as control groups. Pain was assessed at 1, 3, 5, 7, and 10 days postoperatively via visual analog scale scores. Peritonsillar edema, erythema, and granulation tissue in the tonsillar fossa were evaluated by direct visual examination for wound healing on days 1, 3, 5, 7, and 10.

RESULTS

There were consecutive 121 patients which were included, with mean ages being 6.2 ± 2.5, 6.1 ± 2.4, and 6.1 ± 2.6 in groups A, B, and C, respectively. Postoperative pain scores on days 1 and 3 were significantly lower in Group A than Group B and C (P < .001) and scores were 0.87 ± 1.1, 3.83 ± 2.29, and 4.29 ± 2.48 on day 1 and 0.38 ± 0.88, 2.25 ± 2.13, and 2.76 ± 2.12 on day 3 respectively. The wound-healing scores on postoperative 1st, 3rd, 5th, and 7th days were significantly lower in Group A than control groups (P < .001). The wound-healing score on postoperative day 10 was only different than Group C (P = .020).

CONCLUSIONS

The posterior pillar mucosal suspension technique is an effective and comparable method in terms of wound healing, maintains the preoperative anatomical structures, and enables a better pain control with reduced analgesic/opioid usage.

摘要

目的/假设:探讨一种简单可行的缝合技术对扁桃体切除术后疼痛控制及伤口愈合的疗效。

方法

对121名3至10岁儿童进行了一项前瞻性、随机对照试验。A组儿童采用双极电凝和后柱黏膜悬吊技术进行手术。单独使用双极电凝(B组)和冷剥离扁桃体切除术(C组)作为对照组。术后第1、3、5、7和10天通过视觉模拟量表评分评估疼痛情况。术后第1、3、5、7和10天通过直接视觉检查评估扁桃体窝周围的水肿、红斑和肉芽组织以评估伤口愈合情况。

结果

共纳入121例患者,A、B、C组的平均年龄分别为6.2±2.5岁、6.1±2.4岁和6.1±2.6岁。A组术后第1天和第3天的疼痛评分显著低于B组和C组(P<0.001),第1天的评分分别为0.87±1.1、3.83±2.29和4.29±2.48,第3天的评分分别为0.38±0.88、2.25±2.13和2.76±2.12。A组术后第1、3、5和7天的伤口愈合评分显著低于对照组(P<0.001)。术后第10天的伤口愈合评分仅与C组不同(P=0.020)。

结论

后柱黏膜悬吊技术在伤口愈合方面是一种有效且相当的方法,能保持术前解剖结构,并能通过减少镇痛剂/阿片类药物的使用实现更好的疼痛控制。

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