本文關(guān)鍵詞： 腺樣體肥大 鼻內(nèi)鏡 低溫等離子 射頻消融 電動(dòng)切割　出處：《吉林大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的:本研究通過比較鼻內(nèi)鏡輔助經(jīng)口低溫等離子腺樣體射頻消融術(shù)、鼻內(nèi)鏡輔助經(jīng)口腺樣體電動(dòng)切割術(shù)及傳統(tǒng)經(jīng)口腺樣體刮除術(shù)三種術(shù)式的優(yōu)缺點(diǎn),以求尋找出最佳治療效果的手術(shù)方式。 方法:采集吉林大學(xué)中日聯(lián)誼醫(yī)院耳鼻咽喉頭頸外科聯(lián)合黑龍江省大慶油田總醫(yī)院耳鼻咽喉科2008年2月至2009年8月收治的臨床診斷明確的腺樣體肥大的患兒90例,年齡在6～12歲,隨機(jī)分為3組,采用不同手術(shù)方式進(jìn)行腺樣體切除手術(shù),A組:等離子射頻消融組32例,B組:電動(dòng)切割組34例,C組:傳統(tǒng)腺樣體刮除組24例。對三種手術(shù)方式的手術(shù)情況進(jìn)行分析:(1)腺樣體切除時(shí)間(即手術(shù)器械開始切除腺樣體組織到腺樣體完全切除為止的時(shí)間);(2)手術(shù)時(shí)間(即為麻醉滿意后口腔上開口器開始計(jì)算直至腺樣體切除完成徹底止血后撤離器械為止,伴有扁桃體切除等其他術(shù)式的不將其時(shí)間計(jì)算在內(nèi));(3)手術(shù)中出血量;(4)術(shù)后并發(fā)癥情況(包括腺樣體殘留、繼發(fā)出血及復(fù)發(fā));(5)術(shù)后癥狀恢復(fù)情況(包括聽力、睡眠打鼾、鼻塞、鼻漏)等指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析比較。 結(jié)果:采用鼻內(nèi)鏡/纖維鼻咽鏡檢查及問卷調(diào)查形式進(jìn)行術(shù)后隨訪,隨訪時(shí)間為3～12個(gè)月。三種手術(shù)方式的手術(shù)情況統(tǒng)計(jì)學(xué)分析比較:(1)三種術(shù)式腺樣體切除時(shí)間兩兩比較均有顯著的統(tǒng)計(jì)學(xué)差異(P0.01),其中A組腺樣體切除時(shí)間最長,其次是B組,C組腺樣體切除時(shí)間最短。(2)三種術(shù)式手術(shù)時(shí)間兩兩比較,A組與B組無統(tǒng)計(jì)學(xué)差異(P0.05),而A組和B組手術(shù)時(shí)間均長于C組,有顯著統(tǒng)計(jì)學(xué)差異(P0.01)。(3)三種術(shù)式手術(shù)中出血量比較,A組要顯著少于B組及C組(P0.01),而B組與C組比較術(shù)中出血量無統(tǒng)計(jì)學(xué)差異(P0.05)。(4)三種手術(shù)方式術(shù)后并發(fā)癥的對比研究發(fā)現(xiàn),A組32例患兒均無腺樣體殘留,無咽鼓管損傷及術(shù)后出血、復(fù)發(fā)等并發(fā)癥,明顯優(yōu)于其他兩組。C組有22例患兒存在不同程度腺樣體殘留,殘留率91.67%,有2例咽鼓管圓枕損傷,1例術(shù)后繼發(fā)出血;B組中有2例少量殘留,殘留率5.88%,無咽鼓管損傷,1例術(shù)后繼發(fā)出血;C組殘留率高于B組,統(tǒng)計(jì)學(xué)有顯著差異(P0.01)。(5)術(shù)后癥狀恢復(fù)情況比較,聽力:X2=1.53,P0.05;打鼾:X2=0.66,P0.05;鼻塞:X2=1.48,P0.05;鼻漏:X2=0.57,P0.05。三種術(shù)式之間手術(shù)有效率無統(tǒng)計(jì)學(xué)差異,P均0.05。 結(jié)論:三種腺樣體切除手術(shù)術(shù)式中的最佳手術(shù)方法為鼻內(nèi)鏡輔助經(jīng)口低溫等離子腺樣體射頻消融術(shù)。在鼻內(nèi)鏡輔助下經(jīng)口低溫等離子腺樣體射頻消融手術(shù),視野清楚,能達(dá)到完全輪廓化,邊消融邊止血,避免盲視下切除腺樣體而致的腺樣體殘留,術(shù)中出血少、損傷小、腺樣體無殘留、無術(shù)后并發(fā)癥發(fā)生,因此效果滿意。
[Abstract]:Objective: To compare the advantages and disadvantages of three operative methods, such as endoscope assisted low-frequency plasma radiofrequency ablation, nasal endoscope assisted transoral adenoelectric electrotomy and traditional oral adenotyping, in order to find out the best surgical treatment.
Methods: collected in General Hospital of Daqing Oil Field of Jilin University of Otolaryngology Head and neck surgery, China Japan Union Hospital in Heilongjiang Province Department of Otolaryngology from February 2008 to August 2009 were clinical diagnosis of adenoid hypertrophy in 90 cases, at the age of 6~12, were randomly divided into 3 groups by adenoidectomy, using different surgical methods for the A group group: 32 cases, radiofrequency ablation group B: electric cutting group 34 cases, group C: traditional adenoidectomy group 24 cases. Analyze the operation situation of three operation methods: (1) adenoidectomy time (i.e. surgical resection of adenoid tissue began to adenoid completely for time); (2) the operation time (which is satisfied with the anesthesia oral on the gag start until adenoidectomy to complete hemostasis after the withdrawal of instruments, accompanied by tonsillectomy and other operation is not the time to count); (3) hand The amount of bleeding; (4) postoperative complications (including residual adenoids, hemorrhage and recurrence); (5) the recovery of postoperative symptoms (including listening, snoring, nasal congestion, rhinorrhea) and other indicators were statistically analyzed and compared.
緇撴灉:閲囩敤榧誨唴闀，

本文編號：1535729