Bitar Mohamad, Dunya Gabriel, Khalifee Elie, Muwakkit Samar, Barazi Randa
Department of Otolaryngology Head and Neck Surgery, Al Jalila Children's Hospital, Dubai, United Arab Emirates.
Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Int J Pediatr Otorhinolaryngol. 2019 Jan;116:62-64. doi: 10.1016/j.ijporl.2018.10.024. Epub 2018 Oct 19.
Tonsillectomy and adenoidectomy (T& A) are the most common pediatric surgical procedures performed world-wide. Bleeding remains the most common complication of these procedures with 1-5.7% prevalence.
We recruited 1269 patients who were scheduled for either tonsillectomy, adenoidectomy or both. All patients had preoperative CBC, PT, and aPTT ordered. According to the results, patients were labelled as either "abnormal group" or "normal group".
35 patients had abnormal lab results 18 of these patients were diagnosed with coagulation disorders on further laboratory testing.9 of these patients had no pertinent history of bleeding. Even though an association is noted between abnormal lab tests and preoperative history of risk of bleeding, the correlation did not have high sensitivity (28.6%).
This study provides evidence that preoperative history can give some information on patients with abnormal coagulation profile but may underestimate the prevalence of such diseases. In addition, patients with abnormal coagulation profile have more risk of postoperative bleeding even after adequate medical treatment perioperative. Thus, identifying these patients will help the clinician in providing the best surgical management with the least morbidity and mortality.
扁桃体切除术和腺样体切除术(T&A)是全球范围内最常见的儿科外科手术。出血仍然是这些手术最常见的并发症,发生率为1%至5.7%。
我们招募了1269例计划进行扁桃体切除术、腺样体切除术或两者皆有的患者。所有患者术前均进行了血常规、凝血酶原时间(PT)和活化部分凝血活酶时间(aPTT)检查。根据检查结果,将患者分为“异常组”或“正常组”。
35例患者实验室检查结果异常,其中18例患者经进一步实验室检查被诊断为凝血障碍。这些患者中有9例没有相关的出血病史。尽管实验室检查异常与术前出血风险史之间存在关联,但这种相关性的敏感性不高(28.6%)。
本研究提供的证据表明,术前病史可以为凝血功能异常的患者提供一些信息,但可能低估此类疾病的患病率。此外,即使围手术期进行了充分的药物治疗,凝血功能异常的患者术后出血风险更高。因此,识别这些患者将有助于临床医生以最低的发病率和死亡率提供最佳的手术管理。