Kozcu Sureyya Hikmet, Demirhan Erhan, Çukurova İbrahim
Department of Otorhinolaryngology, Tunceli State Hospital, Tunceli, Turkey.
Department of Otorhinolaryngology Head and Neck Surgery, Tepecik Training and Research Hospital, Izmir, Turkey.
Int J Pediatr Otorhinolaryngol. 2019 Apr;119:63-69. doi: 10.1016/j.ijporl.2019.01.018. Epub 2019 Jan 16.
Adenoidectomy is one of the most frequently performed surgical procedures with different techniques and technologies. Although curettage adenoidectomy (CA) has been practiced conventionally for many years, endoscopic microdebrider adenoidectomy (EMA) has emerged as an innovative surgical method. Comparing physiological effects, efficacy and safety of the endoscopic microdebrider adenoidectomy (EMA) and curettage adenoidectomy (CA) in pediatric population is aimed with this prospective, single-blind, randomized, controlled trial.
Sixty pediatric patients with type-A tympanogram according to Jerger classification in both ears before surgery were randomly assigned to receive the CA (n = 30) and the EMA (n = 30). Tympanometry evaluation for each ear was performed the day before surgery firstly and was repeated on days 1, 7 and 14 after surgery. Intraoperative time, complications during and after the operation were recorded. Postoperative pain was also evaluated for 10 days postoperatively.
Tympanometric evaluation revealed significantly reduced middle ear peak pressure levels with the EMA than with the CA for each ear on day 1 after surgery and for only left ear on day 7 after surgery (P < 0.05). In addition, statistically significant reduced pain scores in postoperative first 3 days were related to the EMA (P < 0.05). There was no significant difference between the methods in terms of duration of surgery and complications.
According to findings from this study, the EMA procedure may be as safe and rapid as the CA. Furthermore, the EMA may be more controlled and less invasive to the surrounding tissues. Further studies are advised to support these data.
腺样体切除术是最常施行的外科手术之一,有不同的技术和方法。尽管传统的刮除腺样体切除术(CA)已应用多年,但内镜下微动力系统腺样体切除术(EMA)已成为一种创新的手术方法。本前瞻性、单盲、随机对照试验旨在比较内镜下微动力系统腺样体切除术(EMA)和刮除腺样体切除术(CA)在儿科患者中的生理效应、疗效及安全性。
60例术前双耳杰格分类为A型鼓室导抗图的儿科患者被随机分为两组,分别接受CA(n = 30)和EMA(n = 30)治疗。术前一天对每只耳朵进行鼓室导抗图评估,并在术后第1、7和14天重复评估。记录手术时间、术中及术后并发症。术后还对疼痛情况进行了10天的评估。
鼓室导抗图评估显示,术后第1天,EMA组每只耳朵的中耳峰压水平均显著低于CA组;术后第7天,仅左耳有此差异(P < 0.05)。此外,术后前3天,EMA组的疼痛评分在统计学上显著降低(P < 0.05)。两种手术方法在手术时间和并发症方面无显著差异。
根据本研究结果,EMA手术可能与CA手术一样安全、快速。此外,EMA手术对周围组织的控制可能更好,侵入性更小。建议进一步研究以支持这些数据。