Du Jun, Gu Qing-Long, Lu Ying-Xia, Zhang Lei, Zhan Xiao-Jun, Wang Zhan
Department of Otolaryngology, Head and Neck Surgery, Children's Hospital Capital Institute of Pediatrics, Beijing, 100000, People's Republic of China.
Department of Hematopathology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100000, People's Republic of China.
J Inflamm Res. 2024 May 31;17:3515-3525. doi: 10.2147/JIR.S462617. eCollection 2024.
To evaluate the safety and feasibility of tonsillectomy and/or adenoidectomy (T&A) in pediatric patients with prolonged activated partial thromboplastin time (APTT) and coagulation factor deficiency.
A prospective study was admitted to the children undergoing T&A at our institution between October 2019 and January 2020, specifically focusing on preoperative coagulation function. Within this group, we identified 5 patients exhibiting prolonged APTT and coagulation factor deficiencies, constituting the experimental group, and 10 patients matched by gender and age with normal blood coagulation function were selected as the control group. Comparative analyses between the two groups were conducted, focusing on surgical duration, intraoperative bleeding volume, duration of hospital stay, and postoperative complications such as active bleeding across the groups. At the six-month postoperative mark, a reassessment of coagulation functions and factor assays was conducted within the experimental group.
No statistically significant differences were discovered in terms of surgical duration or bleeding volume when comparing the experimental subgroups with their respective control counterparts. Furthermore, there were no incidences of postoperative active bleeding observed in any of the groups. Notably, postoperative APTT values (32.7 ± 1.7s) exhibited a significant disparity compared to preoperative levels (43.7 ± 1.8s, p < 0.01). Coagulation factors demonstrated normalization, evidenced by a significant difference in postoperative Factor XII levels (40.2 ± 5.4%) compared to preoperative levels (63.1 ± 5.9%, p < 0.01).
Prolonged APTT with FXII factor deficiency does not show a significant bleeding tendency and is not a contraindication for T&A surgery. Post T&A surgery, children with abnormal coagulation function and deficient clotting factors show significant improvement compared to pre-surgery. It is important to consider that chronic inflammation in adenoids and tonsils may contribute to the prolongation of APTT and the manifestation of Factor XII deficiency.
评估扁桃体切除术和/或腺样体切除术（T&A）在活化部分凝血活酶时间（APTT）延长和凝血因子缺乏的儿科患者中的安全性和可行性。
一项前瞻性研究纳入了2019年10月至2020年1月在本机构接受T&A手术的儿童，特别关注术前凝血功能。在该组中，我们确定了5例APTT延长和凝血因子缺乏的患者，组成实验组，选择10例性别和年龄匹配、凝血功能正常的患者作为对照组。对两组进行比较分析，重点关注手术时间、术中出血量、住院时间以及术后并发症，如各组间的活动性出血。术后六个月时，对实验组进行凝血功能和因子检测的重新评估。
将实验组亚组与其各自的对照亚组进行比较时，在手术时间或出血量方面未发现统计学上的显著差异。此外，任何一组均未观察到术后活动性出血的情况。值得注意的是，术后APTT值（32.7±1.7秒）与术前水平（43.7±1.8秒，p<0.01）相比存在显著差异。凝血因子显示正常化，术后因子XII水平（40.2±5.4%）与术前水平（63.1±5.9%，p<0.01）相比存在显著差异证明了这一点。
APTT延长伴因子XII缺乏并未显示出显著的出血倾向，不是T&A手术的禁忌症。T&A手术后，凝血功能异常和凝血因子缺乏的儿童与术前相比有显著改善。重要的是要考虑到腺样体和扁桃体的慢性炎症可能导致APTT延长和因子XII缺乏的表现。
