本文關(guān)鍵詞： 低溫等離子射頻 兒童 腺樣體肥大 手術(shù) 出血　出處：《大連醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的： 通過對2組腺樣體肥大的患兒分別施行低溫等離子射頻消融術(shù)和傳統(tǒng)刮除手術(shù),觀察患兒術(shù)中出血情況,出血部位,分析兒童腺樣體切除術(shù)術(shù)中出血的相關(guān)因素及低溫等離子射頻消融術(shù)消融腺樣體在減少術(shù)中出血方面的優(yōu)勢。 方法： 分析2007年6月至2009年6月腺樣體肥大的患兒100例,其中65例行低溫等離子射頻消融術(shù),35例行傳統(tǒng)的刮除術(shù),計(jì)算兩種不同術(shù)式的術(shù)中出血量,觀察出血部位,同時對患兒年齡、病程及腺樣體大小進(jìn)行變量轉(zhuǎn)換后用SPSS軟件進(jìn)行多元線性相關(guān)分析,計(jì)算各項(xiàng)指標(biāo)對腺樣體手術(shù)術(shù)中出血量的偏相關(guān)系數(shù),探討影響術(shù)中出血的因素。 結(jié)果： 1.兩種術(shù)式術(shù)中出血量的測量結(jié)果(見附表及附圖1) 35例傳統(tǒng)的刮除手術(shù)患兒術(shù)中出血量平均為32±5.86ml,65例低溫等離子射頻消融術(shù)的患兒術(shù)中出血量平均為4.23±2.5 ml,經(jīng)配對t檢驗(yàn),P0.01,差異有統(tǒng)計(jì)學(xué)意義。 2.術(shù)中觀察出血部位的結(jié)果 35例傳統(tǒng)手術(shù)的患兒腺樣體刮除后均出現(xiàn)創(chuàng)面的廣泛滲血,其中10例術(shù)中創(chuàng)面滲血較嚴(yán)重,8例出血量約30ml左右,反復(fù)長時間行紗球壓迫止血,血止；有2例患兒術(shù)中出血較劇烈分別為35.4ml和42.3ml,紗球壓迫止血效果不佳,出血點(diǎn)位于鼻中隔后端,行雙極電凝止血,血止。 低溫等離子射頻消融術(shù)的患兒術(shù)中出血較少,平均為5ml,35例術(shù)中出血量小于1ml,45例患兒術(shù)中腺樣體彌漫性滲血,量約3ml左右,30例患兒術(shù)中出血集中在與鼻中隔相交界處�？紤]此處為腺樣體主要供血血管進(jìn)出腺樣體處。術(shù)中使用低溫等離子射頻止血。 3.統(tǒng)計(jì)學(xué)分析術(shù)中出血量的相關(guān)因素 通過SPSS統(tǒng)計(jì)統(tǒng)計(jì)軟件進(jìn)行腺樣體出血的多重線性回歸計(jì)算偏相關(guān)系數(shù)患兒年齡、病程及腺樣體大小進(jìn)行變量轉(zhuǎn)換后用SPSS軟件進(jìn)行多元相關(guān)分析,所得患兒年齡、病程及腺樣體大小對出血量的偏相關(guān)系數(shù)分別為0.40、0.59、0.25,P0.05,有顯著的統(tǒng)計(jì)學(xué)意義。提示等離子射低溫等離子術(shù)術(shù)中出血量與患兒年齡、病程及腺樣體大小相關(guān)。(見附圖2,3,4) 結(jié)論： 1.低溫等離子射頻消融手術(shù)大大降低了腺樣體切除術(shù)中的出血量,同時可充分止血,是一種更加安全,微創(chuàng),有效的治療方式。 2.通過對影響腺樣體手術(shù)術(shù)中出血量的相關(guān)因素分析,可以得出患兒年齡越大、病程越長及腺樣體越大,患兒術(shù)中越容易出血,其出血量越多。 3.低溫等離子射頻腺樣體消融術(shù)的手術(shù)方式為從中間向周圍逐層消融,對于引起阻塞及壓迫癥狀的肥大腺樣體組織應(yīng)予徹底切除,而對于腺樣體下緣尤其是靠近口咽部處的腺體組織只需切除50%～80%即可。 4.在臨床大量手術(shù)中,常常見到鼻中隔后端出血較多,是否與腺樣體的滋養(yǎng)血管經(jīng)此進(jìn)入有關(guān),供應(yīng)腺樣體未見文獻(xiàn)報道,需要進(jìn)一步進(jìn)行相關(guān)基礎(chǔ)學(xué)研究。
[Abstract]:Objective:. Two groups of children with adenoid hypertrophy were treated with low temperature plasma radiofrequency ablation and traditional curettage respectively. To analyze the factors related to bleeding during adenoidectomy in children and the advantages of radiofrequency ablation of low temperature plasma in reducing intraoperative bleeding. Methods:. From June 2007 to June 2009, 100 cases of adenoid hypertrophy were analyzed. 65 cases were treated with low temperature plasma radiofrequency ablation (RFA) and 35 cases were treated with traditional curettage. The amount of intraoperative bleeding was calculated and the location of bleeding was observed. At the same time, the age, course of disease and the size of adenoid were analyzed by multivariate linear correlation analysis with SPSS software. The partial correlation coefficient of blood loss during adenoidectomy was calculated, and the factors influencing the bleeding were discussed. Results:. 1. Measurement of intraoperative bleeding in two types of operations (see attached table and figure 1). The average blood loss in 35 cases of traditional curettage operation was 32 鹵5.86 ml and 65 cases of low temperature plasma radiofrequency ablation was 4.23 鹵2.5 ml, the difference was statistically significant. 2. Intraoperative observation of bleeding site. 35 cases of children with traditional operation had extensive bleeding after adenoid curettage, of which 10 cases had severe bleeding and 8 cases had about 30ml blood loss. The bleeding was stopped by gauze ball compression for a long time. There were 2 cases with severe intraoperative bleeding of 35.4ml and 42.3ml respectively. The bleeding point was located at the posterior end of nasal septum and the bleeding point was at the back of nasal septum. The bleeding was stopped by bipolar electrocoagulation. The intraoperative bleeding was less in children with low temperature plasma radiofrequency ablation, and the average intraoperative bleeding was 5 ml or less in 45 cases with less than 1 ml of intraoperative bleeding, and there was diffuse blood leakage from adenoids in 45 cases. The volume of intraoperative bleeding was about 3 ml in 30 children. The bleeding was concentrated at the junction with nasal septum, which was considered to be the place where the main blood supply vessels of adenoids came into and out of adenoids. Low temperature plasma radio frequency hemostasis was used during the operation. 3.The factors related to intraoperative bleeding were analyzed statistically. SPSS statistical software was used to calculate the age of children with partial correlation coefficient by multiple linear regression of adenoid hemorrhage, the course of disease and the size of adenoid were converted into variables, and then multivariate correlation analysis was carried out with SPSS software. The partial correlation coefficients of course of disease and size of adenoid to bleeding volume were 0.400.59 ~ 0.25g / p 0.05, respectively, with significant statistical significance. It is suggested that the amount of blood loss in plasma plasma hypothermia plasma surgery is related to the age, course of disease and size of adenoid (see figure 2 / 3 ~ (4)). Conclusion:. 1. Low temperature plasma radiofrequency ablation is a safe, minimally invasive and effective method for the treatment of adenoidectomy. 2. Through the analysis of the factors affecting the amount of blood loss during adenoidectomy, it can be concluded that the older the age, the longer the course of disease and the larger the adenoid, the easier the bleeding is, and the more the amount of bleeding is. 3. The procedure of radiofrequency radiofrequency adenoidectomy is from the middle to the periphery, and the hypertrophic adenoid tissue that causes obstruction and compression should be removed completely. For adenoid inferior margin, especially near oropharynx, only 50% of adenoid tissue should be excised. 4. In a large number of clinical operations, it is often found that there is more bleeding at the posterior end of nasal septum, whether it is related to the entry of the nutrient vessels of adenoids, and the supply of adenoids has not been reported in literature, so it is necessary to carry out further basic research.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R766

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