MacGregor F B, Albert D M, Bhattacharyya A K
Queen Elizabeth Hospital for Children, London, UK.
Int J Pediatr Otorhinolaryngol. 1995 Jan;31(1):1-6. doi: 10.1016/0165-5876(94)01057-5.
In a prospective study of 76 children aged between 18 months and 13 years, 40 children underwent tonsillectomy using the traditional blunt dissection technique with bipolar diathermy to establish haemostasis while 36 children underwent tonsillectomy where bipolar diathermy alone was used to dissect out the tonsils. Blood loss was significantly reduced in the diathermy dissection group (10.5 ml +/- 2.05, diathermy dissection, 33.56 ml +/- 1.95, blunt dissection, P < 0.05). More analgesia was required in the diathermy dissection group prior to hospital discharge (P = 0.01). The diathermy dissection group took a significantly longer period of time to re-establish a normal diet (7.07 days +/- 0.44, diathermy dissection, 5.15 days +/- 0.36, blunt dissection, P = 0.001). Fifteen percent of children in the blunt dissection group and 31% in the diathermy dissection group were taken to the general practitioner between days 3-10 because of sore throat, poor oral intake or otalgia. Twenty two point four percent of children overall were prescribed antibiotics. This recently described technique of bipolar diathermy dissection could be a useful technique in selected cases such as the very small or those with a bleeding diathesis but is associated with increased postoperative morbidity and requires good postoperative analgesia.
在一项针对76名年龄在18个月至13岁之间儿童的前瞻性研究中，40名儿童采用传统钝性分离技术加双极电凝止血法进行扁桃体切除术，而36名儿童仅使用双极电凝法切除扁桃体。电凝分离组的失血量显著减少（电凝分离组为10.5毫升±2.05，钝性分离组为33.56毫升±1.95，P<0.05）。电凝分离组在出院前需要更多的镇痛治疗（P = 0.01）。电凝分离组恢复正常饮食所需的时间明显更长（电凝分离组为7.07天±0.44，钝性分离组为5.15天±0.36，P = 0.001）。在第3至10天期间，钝性分离组15%的儿童和电凝分离组31%的儿童因喉咙痛、口腔摄入不佳或耳痛而去看全科医生。总体而言，22.4%的儿童使用了抗生素。这种最近描述的双极电凝分离技术在某些特定情况下，如非常小的儿童或有出血倾向的儿童中可能是一种有用的技术，但与术后发病率增加有关，并且需要良好的术后镇痛。
