Attard Sara, Carney Andrew Simon
College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
ANZ J Surg. 2020 Dec;90(12):2532-2536. doi: 10.1111/ans.16306. Epub 2020 Sep 23.
Subtotal tonsil surgery (tonsillotomy) remains a controversial procedure. We aimed to document bleeding rates and return to normal activity for total versus subtotal tonsil surgery in the paediatric population.
A 10-year cohort of 608 children from a single-surgeon series was analysed. Bleeding events were classified using the Flinders modification of the Stammberger criteria. Return to normal activity was defined as normal diet and return to childcare/school.
A total of 8.3% of tonsil procedures and a subtotal of 1.8% of procedures had some kind of bleeding episode (P < 0.01; odds ratio 3.2; 95% confidence interval (CI) 1.3-7.6). When blood-stained sputum (type A bleed) was excluded, this dropped to 2.5% versus 0.3%, respectively (P < 0.05; odds ratio 8.5; 95% CI 1.2-96.0). Return to normal activities occurred at a mean of 11.1 (95% CI 9.7-12.5) versus 4.6 (95% CI 4.0-5.3) days, respectively (P < 0.0001).
In this 10-year single surgeon series, subtotal tonsillectomy or 'tonsillotomy' was associated with a significant reduction in both prevalence and severity of bleeding, in addition to a more rapid return to normal activities when compared to total tonsillectomy.
扁桃体部分切除术仍存在争议。我们旨在记录儿科患者中扁桃体全切术与部分切除术的出血率及恢复正常活动的情况。
对一位外科医生连续10年治疗的608例儿童患者进行队列分析。出血事件采用施坦伯格标准的弗林德斯修正版进行分类。恢复正常活动定义为恢复正常饮食并返回托儿所/学校。
扁桃体手术中共有8.3%、扁桃体部分切除术中有1.8%出现某种出血情况（P < 0.01；比值比3.2；95%置信区间[CI] 1.3 - 7.6）。排除带血痰液（A型出血）后，分别降至2.5%和0.3%（P < 0.05；比值比8.5；95% CI 1.2 - 96.0）。恢复正常活动的平均时间分别为11.1天（95% CI 9.7 - 12.5）和4.6天（95% CI 4.0 - 5.3）（P < 0.0001）。
在这个10年的单外科医生系列研究中，与扁桃体全切术相比，扁桃体部分切除术或“扁桃体切开术”不仅出血发生率和严重程度显著降低，而且恢复正常活动的速度更快。
