Aytac Ismail, Güzel Berkay, Tunc Orhan, Baysal Elif, Bescocuklu Fatih Ubeydullah
Department of Otorhinolaryngology, School of Medicine, Gaziantep University, 27310 Gaziantep, Turkey.
Department of Otorhinolaryngology, Basaksehir Cam and Sakura City Hospital, 34480 Istanbul, Turkey.
J Clin Med. 2025 Sep 15;14(18):6491. doi: 10.3390/jcm14186491.
Tonsillectomy is among the most frequently performed pediatric ENT procedures. Post-tonsillectomy pain and hemorrhage remain key determinants of postoperative morbidity and may differ by surgical technique. This work's objective is to compare postoperative pain, bleeding, and operative duration across three pediatric tonsillectomy techniques: cold dissection with suturing, cold dissection with ligation, and hot dissection with bipolar cautery. In this single-center, prospective study, 150 children ( = 50 per group) undergoing tonsillectomy (with adenoidectomy) between October 2022 and October 2024 were assigned preoperatively to the following groups: Group 1-cold dissection + suturing; Group 2-cold dissection + ligation; Group 3-hot dissection (bipolar cautery). Pain was assessed with the Wong-Baker FACES scale at 1, 6, and 24 h, days 3 and 7, and with the Parents' Postoperative Pain Measure (PPPM) at 1, 6, and 24 h. Primary bleeding was defined within 24 h; secondary bleeding was within 2 weeks. Operative time was recorded from first incision to hemostasis. Non-parametric tests and chi-square analyses were used with < 0.05 considered significant. Of 150 patients, 58% were male. No primary hemorrhage occurred. Secondary hemorrhage occurred in 4/150 (2.7%): 1/50 (2%) in Group 1, 0/50 (0%) in Group 2, and 3/50 (6%) in Group 3 (overall > 0.05). Readmission for oral-intake difficulty occurred in 4/150 (2.7%): 1/50 (2%) in Group 1 and 3/50 (6%) in Group 3 ( > 0.05). Operative time differed significantly across groups (Kruskal-Wallis < 0.05), being longest in Group 1 and shortest in Group 3 (17.53 ± 1.26 min); Group 2 averaged 18.60 ± 0.94 min and Group 1 21.89 ± 1.64 min. Pain decreased over time in all groups (Friedman < 0.001). Across virtually all time points, Group 2 (ligation) had significantly lower Wong-Baker and PPPM scores than Groups 1 and 3 (Dunn post-hoc, adjusted < 0.05), while Groups 1 and 3 did not differ consistently. : Cold dissection with ligation yielded the most favorable pain profile while maintaining low bleeding rates; hot dissection minimized operative time but tended toward higher secondary bleeding and postoperative intake difficulties. Technique selection should prioritize postoperative comfort and morbidity reduction-particularly in pediatric populations-favoring cold dissection, with ligation offering a consistent analgesic advantage.
扁桃体切除术是儿科耳鼻喉科最常开展的手术之一。扁桃体切除术后的疼痛和出血仍是术后发病的关键决定因素，且可能因手术技术而异。本研究的目的是比较三种儿科扁桃体切除技术的术后疼痛、出血情况及手术时长：缝合冷剥离术、结扎冷剥离术和双极电凝热剥离术。在这项单中心前瞻性研究中，2022年10月至2024年10月期间接受扁桃体切除术（伴腺样体切除术）的150名儿童（每组50名）术前被分为以下几组：第1组——缝合冷剥离术；第2组——结扎冷剥离术；第3组——热剥离术（双极电凝）。分别在术后1小时、6小时、24小时、第3天和第7天，采用面部表情疼痛量表（Wong-Baker FACES scale）评估疼痛情况，并在术后1小时、6小时和24小时采用家长术后疼痛评估量表（Parents' Postoperative Pain Measure, PPPM）进行评估。原发性出血定义为术后24小时内发生的出血；继发性出血定义为术后2周内发生的出血。记录从首次切口到止血的手术时间。采用非参数检验和卡方分析，P<0.05认为具有统计学意义。150例患者中，58%为男性。未发生原发性出血。150例中有4例（2.7%）发生继发性出血：第1组1/50例（2%），第2组0/50例（0%），第3组3/50例（6%）（总体P>0.05）。因经口进食困难再次入院的有4/150例（2.7%）：第1组1/50例（2%），第3组3/50例（6%）（P>0.05）。各组手术时间差异有统计学意义（Kruskal-Wallis检验，P<0.05），第1组最长，第3组最短（17.53±1.26分钟）；第2组平均为18.60±0.94分钟，第1组为21.89±1.64分钟。所有组的疼痛均随时间减轻（Friedman检验，P<0.001）。几乎在所有时间点，第2组（结扎术）的面部表情疼痛量表和家长术后疼痛评估量表得分均显著低于第1组和第3组（Dunn事后检验，校正P<0.05），而第1组和第3组之间差异不具有一致性。结论：结扎冷剥离术在保持低出血率的同时，产生的疼痛情况最为良好；热剥离术使手术时间最短，但继发性出血和术后进食困难的发生率有升高趋势。技术选择应优先考虑术后舒适度和降低发病率——尤其是在儿科患者中——冷剥离术更为可取，结扎术具有持续的镇痛优势。
