Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, 200062, People's Republic of China.
Eur Arch Otorhinolaryngol. 2022 Dec;279(12):5921-5928. doi: 10.1007/s00405-022-07515-3. Epub 2022 Jul 19.
The influence of tonsil anatomical differences on post-tonsillectomy hemorrhage and pain has not been studied yet. This study aimed to establish a classification and grading scale of palatine tonsil anatomy, not size, for personalized post-tonsillectomy care.
Between August 2020 and August 2021, 337 children who underwent extracapsular tonsillectomy were recruited. The images of tonsil anatomy during the surgery were recorded and then classified and graded. Postoperative hemorrhage was recorded, and the degree of pain was measured using a visual analog scale (VAS). The primary outcomes were the associations between postoperative hemorrhage, pain, and the classification and grade of tonsil anatomy, analyzed by univariable and multivariable analyses.
186 of the 337 patients (55.2%) were male and 151 (44.8%) were female; the mean age was 5.59 years. The overall postoperative hemorrhage rate was 4.1%. The mean postoperative VAS score was 4.96. By univariable analysis with logistic regression model, significant associations were found between postoperative hemorrhage and the grade 2 and grade 3 tonsillar lower pole, and grade 3 tonsillar bed. Multivariable analysis with binary logistic regression model also revealed significant associations between postoperative hemorrhage and the grade 2 and grade 3 lower pole (OR: 8.23, 95% CI 1.01-67.37, P = 0.049; OR: 23.86, 95% CI 2.22-56.47, P = 0.009, respectively) and grade 3 tonsillar bed (OR: 14.25, 95% CI 1.46-18.75, P = 0.022). Linear regression analysis showed the associations between postoperative pain and grade 2 and grade 3 lower pole (β: 0.88, 95% CI 0.31-1.32, P = 0.002; β: 1.56, 95% CI 1.29-3.29, P = 0.001, respectively) and grade 3 anterior surface (β: 0.85, 95% CI 0.30-3.07, P = 0.004). Age and upper pole were not associated with the postoperative hemorrhage and pain neither.
In the present study, we established a novel classification and 3-grade scale of palatine tonsil anatomy, based on upper pole, anterior surface, lower pole, and tonsillar bed. Furthermore, we revealed for the first time that some anatomical characteristics of tonsils were associated with post-tonsillectomy complications.
扁桃体解剖结构的差异对扁桃体切除术后出血和疼痛的影响尚未研究。本研究旨在建立一种基于扁桃体解剖结构而非大小的分类和分级量表，为扁桃体切除术后提供个性化护理。
2020 年 8 月至 2021 年 8 月，招募了 337 例接受囊外扁桃体切除术的儿童。记录扁桃体解剖结构的手术图像，然后进行分类和分级。记录术后出血情况，并使用视觉模拟评分（VAS）测量疼痛程度。主要结局是通过单变量和多变量分析，评估术后出血、疼痛与扁桃体解剖分类和分级之间的关系。
337 例患者中，男性 186 例（55.2%），女性 151 例（44.8%），平均年龄为 5.59 岁。总的术后出血率为 4.1%。术后 VAS 评分平均为 4.96。单变量分析采用逻辑回归模型，发现术后出血与扁桃体下极 2 级和 3 级和扁桃体床 3 级之间存在显著关联。多变量分析采用二元逻辑回归模型也显示，术后出血与扁桃体下极 2 级和 3 级（OR：8.23，95%CI 1.01-67.37，P=0.049；OR：23.86，95%CI 2.22-56.47，P=0.009）和扁桃体床 3 级（OR：14.25，95%CI 1.46-18.75，P=0.022）之间存在显著关联。线性回归分析显示，术后疼痛与扁桃体下极 2 级和 3 级（β：0.88，95%CI 0.31-1.32，P=0.002；β：1.56，95%CI 1.29-3.29，P=0.001）和扁桃体前表面 3 级（β：0.85，95%CI 0.30-3.07，P=0.004）之间存在关联。年龄和上极与术后出血和疼痛均无关联。
在本研究中，我们建立了一种基于上极、前表面、下极和扁桃体床的新的扁桃体解剖分类和 3 级分级量表。此外，我们首次揭示了一些扁桃体的解剖特征与扁桃体切除术后并发症有关。
