成人扁桃腺切除與懸雍垂顎咽成型手術後出血：冷觸氣化儀與電漿刀之比較

Postoperative Hemorrhage Following Tonsillectomy and Uvulopalatopharyngoplasty in Adults: A Comparison of Coblation and PEAK PlasmaBlade Tonsillectomy

吳健豪(Chien-Hao Wu) ； 黃朝欽(Chao-Chin Huang) ； 鄭評嘉(Ping-Chia Cheng) ； 鄭博文(Po-Wen Cheng) ； 羅武嘉(Wu-Chia Lo)

《台灣耳鼻喉頭頸外科雜誌》 56卷4期 (2021/12) Pp. 230-236

https://doi.org/10.6286/jtohns.202112_56(4).230

摘要

背景：扁桃腺切除手術為耳鼻喉科中最常執行的手術之一。在台灣，扁桃腺切除術中常使用的器械包含：鈍器撥離、單極或雙極電燒刀、冷觸氣化儀與電漿刀。傳統的熱器械（電燒刀）作用溫度在攝氏400度以上，冷刀器械（冷觸氣化儀與電漿刀）作用溫度則在攝氏100度以內。出血，為扁桃腺切除手術術後最常見與最令人擔心的併發症，回顧國內外文獻，在成人族群之中，對於使用冷刀器械執行扁桃腺切除手術術後發生出血之比較相關研究甚少，故提出此研究。方法：回顧同1名主治醫師於西元2017年1月至2020年12月間所執行的扁桃腺切除或懸雍垂顎咽成型手術。依照病患之年齡、性別、身高體重指數、診斷、手術術式、有無高血壓、有無抽煙進行統計分析。手術器械包含冷觸氣化儀與電漿刀，由病患自由選擇，最後依據病人選擇之手術器械進行分類比較術後初級與次級出血之發生率。結果：共收錄了88名患者，其中男性佔了64名，女性佔了24名；使用冷觸氣化儀的患者為34名，電漿刀則為54名。在兩組的比較中，其年齡、性別、有無肥胖（BMI≧27）、診斷、手術術式、有無高血壓以及有無抽煙方面均無統計學上顯著差異。最終有2名患者（2.2%）發生初級出血，次級出血則在7名（8.0%）患者中出現。在使用冷觸氣化儀的病患中，次級出血的有4名（11.8%）；使用電漿刀的患者有3名（5.6%）發生次級出血，兩組之間無論在初級以及次級出血上的發生率皆不具統計學上的顯著差異。結論：用於扁桃腺切除手術的兩種冷刀器械，冷觸氣化儀與電漿刀，所造成的術後出血情況並無差異，可以依照手術醫師的習慣或是病人的喜好進行選擇。

關鍵字

coblation ； hemorrhage ； postoperative bleeding ； PEAK PlasmaBlade ； tonsillectomy（冷觸汽化儀 ； 出血 ； 術後流血 ； 電漿刀 ； 扁桃腺切除手術）

並列摘要

BACKGROUND: Tonsillectomy is one of the most common surgeries performed by otolaryngologists. The frequently used techniques or instruments include blunt dissection, unipolar electrocautery, bipolar diathermy, coblation, and PEAK PlasmaBlade. Hot instruments destroy organic molecular bonds at a temperature of ≥400°C. Low energy-based instruments, including COBLATOR and PEAK PlasmaBlade, operate at a relatively lower temperature of ＜100°C. Postoperative hemorrhage is the most common and life-threatening complication. This study aimed to compare postoperative bleeding in adults after tonsillectomy using low energy-based instruments. METHODS: We reviewed all tonsillectomy procedures that were performed by the same attending physician between January 2017 and December 2020. The analyses were performed according to the patient's age, sex, obesity, diagnosis, surgical procedure, hypertension, and habit of smoking. Patients were asked to choose between the two surgical instruments, COBLATOR and PEAK PlasmaBlade. These two instruments were compared with regard to the incidence of postoperative primary and secondary hemorrhage. RESULTS: A total of 88 patients, including 64 males and 24 females, were enrolled. Thirty-four patients selected COBLATOR and 54 patients chose PEAK PlasmaBlade for their tonsillectomies. On comparing between the two groups, no statistically significant differences in age, sex, hypertension, obesity, diagnosis and the habit of smoking were observed. Primary hemorrhage was noted in 2 patients (2.2%), and secondary hemorrhage occurred in 7 (8.0%) patients. Among the patients from whom COBLATOR was used, 4 patients (11.8%) had secondary hemorrhage. In the PEAK PlasmaBlade group, three patients (5.6%) had secondary hemorrhage. There was no statistically significant difference in the incidence of primary or secondary hemorrhage between the two groups. CONCLUSIONS: In terms of post-tonsillectomy hemorrhage, there is no difference between the two low energy-based devices. COBLATOR and PEAK PlasmaBlade can be chosen according to the surgeons' habits or patients' preferences.

並列關鍵字

coblation ； hemorrhage ； postoperative bleeding ； PEAK PlasmaBlade ； tonsillectomy