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微型切割器辅助腺样体切除术与低温等离子射频消融腺样体切除术的比较:术中参数及术后恢复情况分析

The Comparison between Microdebrider Assisted Adenoidectomy and Coblation Adenoidectomy: Analyzing the Intraoperative Parameters and Post-operative Recovery.

作者信息

Singh Jaskaran, Bhardwaj Bhanu

机构信息

Sri Guru Ram Das Institute of Health Sciences and Research, Amritsar, India.

Mohali, India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2020 Mar;72(1):59-65. doi: 10.1007/s12070-019-01736-5. Epub 2019 Sep 27.

Abstract

Microdebrider adenoidectomy and Coblation adenoidectomy are the two new techniques available for adenoidectomy these days. The advantages of endoscopic power assisted adenoidectomy over cold steel adenoidectomy has been well established in the literature. As adenoidectomy is one of the most common paediatric surgical procedure there is always a concern to improve the outcomes and make postoperative experience more pleasant for the paediatric population. Cost difference between a coblator wand and microdebrider blade is always a confounding factor in decision making. The present study was conducted to compare both the techniques of adenoidectomy in terms of certain intraoperative and post operative parameters. The present study was a prospective randomized single blind study conducted in a university hospital on 140 subjects. The patients diagnosed with chronic adenoiditis grade 3-4 were randomly allocated in two groups after following the exclusion and inclusion criteria. the adenoidectomy in two groups; Microdebrider group and Coblation group were compared in terms of intraoperative time, post operative pain score; intraoperative bleeding, surgical field and some common complications. The data was analysed for significance by various statistical tests. The average adenoid size operated in both groups was Grade 3. The intraoperative time taken to complete the procedure in group A was 12.78 ± 3.8 min and in group B was 22 ± 3.3 min with value < 0.05. There was statistically significant difference in grade of Intraoperative Bleeding in both groups with mean grade of intraoperative bleeding being 1.4 ± 1.04 in group B and 3.5 ± 0.9 in Group A. The surgical field was poor to average in 33 cases (n = 70) in group A as compared to only 1 case (n = 70) in group B; the difference being statistically significant. The average post-operative pain score was 2.69 ± 0.99 and 1.17 ± 1.1 after post-operatively 24 h and 72 h respectively in group B; 7.14 ± 0.99 and 4.08 ± 1.42 respectively in group A. The value for the same was < 0.05. However there was no statistically significant difference between two groups in terms of any complications or completeness of removal. Though both the techniques are highly efficacious in adenoid removal and low complication rate in our study but still more studies with large sample size are encouraged to validate these results and establish the comparative efficacy of both the techniques in terms of the intraoperative parameters as well as post-operative recovery along with recurrence rates.

摘要

微型切割器腺样体切除术和低温等离子体腺样体切除术是目前可用于腺样体切除术的两种新技术。内镜动力辅助腺样体切除术相对于传统腺样体切除术的优势在文献中已有充分记载。由于腺样体切除术是最常见的儿科外科手术之一,人们一直关注如何改善手术效果,让儿童患者术后体验更舒适。低温等离子体刀头和微型切割器刀片的成本差异始终是决策中的一个混杂因素。本研究旨在比较两种腺样体切除技术在某些术中及术后参数方面的差异。本研究是在一家大学医院对140名受试者进行的一项前瞻性随机单盲研究。在遵循排除和纳入标准后,将诊断为3 - 4级慢性腺样体炎的患者随机分为两组。比较两组腺样体切除术的术中时间、术后疼痛评分、术中出血情况、手术视野及一些常见并发症。通过各种统计检验分析数据的显著性。两组切除的腺样体平均大小均为3级。A组完成手术的术中时间为12.78±3.8分钟,B组为22±3.3分钟,P值<0.05。两组术中出血分级有统计学显著差异,B组术中平均出血分级为1.4±1.04,A组为3.5±0.9。A组70例中有33例手术视野为差至中等,而B组70例中只有1例,差异有统计学显著性。B组术后24小时和72小时的平均疼痛评分分别为2.69±0.99和1.17±1.1;A组分别为7.14±0.99和4.08±1.42。两者的P值<0.05。然而,两组在任何并发症或切除完整性方面均无统计学显著差异。虽然在我们的研究中,两种技术在腺样体切除方面都非常有效且并发症发生率低,但仍鼓励进行更多大样本研究来验证这些结果,并确定两种技术在术中参数、术后恢复以及复发率方面的比较疗效。

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Defining the Surgical Limits of Adenoidectomy so as to Prevent Recurrence of Adenoids.确定腺样体切除术的手术界限以预防腺样体复发。
Indian J Otolaryngol Head Neck Surg. 2016 Jun;68(2):131-4. doi: 10.1007/s12070-016-0971-7. Epub 2016 Mar 12.
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Electrocautery adenoidectomy outcomes: a meta-analysis.
Otolaryngol Head Neck Surg. 2009 Feb;140(2):148-53. doi: 10.1016/j.otohns.2008.11.030.

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