Ota Haruka, Yoshida Takuya, Suzuki Keita, Yagi Kazutake, Higashi Kenjiro, Ohkoshi Akira, Katori Yukio
Department of Otolaryngology, Iwate Prefectural Iwai Hospital, Ichinoseki, JPN.
Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, JPN.
Cureus. 2025 May 27;17(5):e84933. doi: 10.7759/cureus.84933. eCollection 2025 May.
Introduction Tonsillectomy is a common surgical procedure in otolaryngology; however, postoperative hemorrhage remains a serious complication. Although novel hemostatic devices have been introduced, no definitive preventive strategy has been established. This study evaluated a standardized surgical approach combining preemptive hemostasis, reduced energy device output, and endoscopic assistance to minimize postoperative complications. Methods This single-center, non-randomized, observational cohort study included 137 patients aged 15 years or older who underwent extracapsular tonsillectomy between April 2018 and March 2025. Patients were grouped based on the time period of treatment: those who underwent conventional tonsillectomy between 2018 and 2021 comprised the Conventional Group (n = 85), and those who underwent a standardized procedure incorporating preemptive hemostasis and low-output energy devices between 2022 and 2025 comprised the Standardized Group (n = 52). Perioperative outcomes, postoperative hemorrhage rates, pain control, and hospital stay length were compared between groups using the Mann-Whitney U test and Fisher's exact test (p < 0.05 was considered significant). Results The Standardized Group showed a significantly lower postoperative hemorrhage rate (0% vs. 9.5%, p = 0.0236) and less intraoperative blood loss (0.42 ± 1.01 mL vs. 8.31 ± 26.7 mL, p = 0.0031) compared to the Conventional Group. Although operative time was longer (83.5 ± 33.3 min vs. 56.5 ± 23.8 min, p < 0.001), the Standardized Group had a shorter hospital stay (8.86 ± 1.24 days vs. 10.1 ± 1.15 days, p < 0.001) and required fewer rescue analgesic interventions (p = 0.0178). Conclusion The combination of preemptive hemostasis, reduced energy output, and endoscopic supervision significantly improved surgical outcomes, reduced complications, and enhanced the educational experience for junior surgeons. This protocol represents a standardized, cost-effective technique that enhances safety and surgical training.
引言
扁桃体切除术是耳鼻喉科常见的外科手术；然而，术后出血仍是一种严重的并发症。尽管已引入新型止血设备，但尚未确立明确的预防策略。本研究评估了一种标准化手术方法，该方法结合了预防性止血、降低能量设备输出以及内镜辅助，以尽量减少术后并发症。
方法
这项单中心、非随机、观察性队列研究纳入了137例15岁及以上在2018年4月至2025年3月期间接受扁桃体包膜外切除术的患者。根据治疗时间段对患者进行分组：2018年至2021年期间接受传统扁桃体切除术的患者组成传统组（n = 85），2022年至2025年期间接受包含预防性止血和低输出能量设备的标准化手术的患者组成标准化组（n = 52）。使用曼-惠特尼U检验和费舍尔精确检验比较两组的围手术期结局、术后出血率、疼痛控制和住院时间（p < 0.05被认为具有统计学意义）。
结果
与传统组相比，标准化组术后出血率显著更低（0% 对 9.5%，p = 0.0236），术中失血量更少（0.42 ± 1.01 mL对8.31 ± 26.7 mL，p = 0.0031）。尽管手术时间更长（83.5 ± 33.3分钟对56.5 ± 23.8分钟，p < 0.001），但标准化组住院时间更短（8.86 ± 1.24天对10.1 ± 1.15天，p < 0.001），且所需的急救镇痛干预更少（p = 0.0178）。
结论
预防性止血、降低能量输出和内镜监测相结合显著改善了手术结局，减少了并发症，并提升了初级外科医生的学习体验。该方案代表了一种标准化、具有成本效益的技术，可提高安全性并加强外科培训。
