鼻内镜下两种入路电动吸切器对Ⅲ~Ⅳ度腺样体肥大患儿手术切除的比较

摘要

Objective To investigate the surgical effect on adenoidal hypertrophy at Ⅲ~Ⅳ degrees removed under nasal endoscope via two different approaches for powered debrider in a comparative way. Methods Sixty children cases with Ⅲ~Ⅳ degree of adenoidal hypertrophy were included in this study, treated in our Hospital from January 2012 to August 2014. They were operated on under nasal endoscope with powered debrider to remove the hypertrophied adenoid, either via transnasal approach (nasal approaching group, NAG) or via transoral approach (oral approaching group, OAG), with 30 cases in each group. A period of postoperative following up lasted for 6 months was carried out among them to compare the differences in therapeutic effect and incidence of surgery related complications between these two groups of children. Results There was no statistical significance in the differences of operating time (t=0.537, P=0.296), content of blood lost (t=-0.860, P=0.196) and postoperative headache within the first week following the surgery (t=0.728, P=0.524) between the two groups, while the incidences of mucosal injury occurred during the operation (X2=10.153, P=0.001), nasal blockage feeling after the operation (X2=9.017, P=0.003) and postoperative soft palate edema (X2=12.342, P=0.001) were significantly higher in NAG than that in OAG. Conclusions Operation via transoral approach holds such advantage as to control the performing process easier but slightly difficult to just the depth of ablation, while operation via transnasal approach is simpler to perform but followed relatively higher incidences of postoperative nasal adhesion and adenoidal residue following the surgery.%目的 比较鼻内镜下不同入路电动吸切器切除Ⅲ~Ⅳ度肥大腺样体的手术效果. 方法 2012年1月至2013年8月在我院拟行鼻内镜下手术治疗的Ⅲ~Ⅳ度腺样体肥大患儿60例,分别经鼻入路(鼻入路组)和经口入路(口入路组)行电动吸切器腺样体切除术,每组30例;术后随访6个月. 对比分析两组病例的治疗效果和并发症发生率. 结果 鼻入路组和口入路组患儿的手术时间(t=0.537,P=0.296)、术中出血量(t=-0.860,P=0.196)和术后一周内头痛发生率(t=0.728,P=0.524)的差异比较均未见统计学意义,但鼻入路组的黏膜损伤(X2=10.153,P=0.001)、鼻塞症状(X2=9.017,P=0.003)和软腭水肿(X2=12.342,P=0.001)发生率显著高于口入路组. 结论 鼻内镜下经口入路腺样体切除术术中可控度高,但切除深度不易把握;经鼻入路操作简便,但术后鼻腔粘连和腺样体残留发生率较高.