鼻内镜下经口低温等离子腺样体环岛根切术的临床应用

摘要

目的：探讨鼻内镜下经口低温等离子腺样体环岛根切术的临床应用效果。方法：回顾性分析本院耳鼻喉外科2012年12月-2015年12月收治的78例腺样体肥大患儿的完整临床资料，所有患儿均在30°鼻内镜下经口行低温等离子腺样体环岛根切术治疗。结果：78例患儿均顺利于鼻内镜下经口行低温等离子腺样体环岛根切术下完整切除腺样体，并获取标本送病理检查。患儿腺样体平均切除时间为（15.83±3.42）min，平均手术时间为（35.22±7.54）min，术中平均出血量为（2.16±1.01）mL。术后所有患儿一般情况均良好，精神良好51例，精神尚可27例。术后疼痛程度：78例均为轻度疼痛，VAS评分为（1.9±0.3）分。术后1 d均可自由进食，均无迟发性出血。患儿均于术后2~4 d出院。住院时间2~5 d，平均（3.25±1.14）d。出院时，所有患儿行耳内镜鼻咽部检查提示术区白膜均生长良好，均无腺体组织残留。术后对所有患儿进行为期6~12个月的随访观察，患儿鼻塞、打鼾、张口呼吸、耳痛症状均彻底消失，行耳内镜鼻咽部检查，未发现复发及鼻腔粘连、圆枕坏死等并发症，复发率及并发症发生率均为0。结论：鼻内镜下经口低温等离子腺样体环岛根切术治疗腺样体肥大效果显著，等离子刀头损耗小，手术时间短，术中出血少，术后能获取标本，值得临床推广。%Objective: To investigate the clinical effect of endoscopic transoral low temperature plasma adenoid island undercutting operation.Method:The clinical data of 78 children with adenoid hypertrophy in the Department ENT Surgery of our hospital from December 2012 to December 2015 were retrospectively analyzed, all of the patients were at 30° under nasal endoscope transoral mouth for low temperature plasma adenoid island undercut surgery.Result:78 patients were successfully in the endoscopic incision for plasma adenoid island operation undercut complete resection of adenoids,and obtain specimens for pathological examination.Adenoids in children with average removal time was (15.83±3.42)min,the mean operation time was (35.22±7.54)min, the mean intraoperative blood loss was (2.16±1.01)mL.After all children generally were good,the spirit of good in 51 cases,27 cases of spirit still.Postoperative pain:78 cases were mild pain,VAS score was (1.9±0.3) points. Postoperative 1 d were free eating,no delayed bleeding.Patients were discharged on postoperative 2-4 d.Length of stay 2-5 d,the average hospital stay was (3.25±1.14) d.At discharge,all children underwent ear surgery endoscopic examinations showed nasopharyngeal region albuginea grew well,no glandular tissue residues.All patients after surgery for a period of 6 to 12 months of follow-up study of children with nasal obstruction,snoring, mouth breathing,earache symptoms had completely disappeared,line ear endoscopy nasopharynx examination found no recurrence and nasal adhesions,torus necrosis and other complications,recurrence rate and complication rate was zero.Conclusion:The low temperature plasma adenoid island undercut surgery in the treatment of adenoidal hypertrophy under nasal endoscope effect significantly,plasma cutter head loss,shorter operation time, less intraoperative bleeding,postoperative specimens can be obtained,which is worthy of clinical application.