目的 观察鼻内镜下低温等离子切除术治疗儿童腺样体肥大(AH)的临床疗效及对患儿创伤应激和并发症的影响。方法 选取2019年3月至2022年3月安康市汉滨区第一医院接诊的腺样体肥大患儿110例，根据手术方式的不同分为A组(鼻内镜下动力切割术，53例)、B组(鼻内镜下低温等离子切除术，57例)。比较A、B组手术时间、术中出血量;比较术前、术后A、B组创伤应激指标;比较A、B组临床疗效、并发症及复发率。结果 A组、B组手术时间分别为(22±4)min、(18±3)min，术中出血量分别为(13。2±2。7)ml、(6。1±1。0)ml。B组手术时间短于A组，术中出血量少于A组(P＜0。05)。术后1 d A组、B组血清皮质醇(Cor)水平分别为(390±46)nmol/L、(350±44)nmol/L，前列腺素E2(PEG2)水平分别为(200±25)µg/L、(160±20)μg/L，P 物质(SP)水平分别为(14。3±3。6)pg/ml、(9。5±1。8)pg/ml。术后 3 d A 组、B 组血清 Cor 水平分别为(297±40)nmol/L、(258±41)nmol/L，PEG2 水平分别为(143±20)µg/L、(120±21)μg/L，SP 水平分别为(10。3±2。7)pg/ml、(6。2±1。2)pg/ml。术后 1、3 d B组血清Cor、PEG2、SP水平均低于A组(P＜0。05)。A、B组临床总有效率比较，差异无统计学意义(P＞0。05)。B组术后出血率8％低于A组0(P＜0。05);A、B组术后躁动、软腭损伤发生率，复发率比较，差异无统计学意义(P＞0。05)。结论 鼻内镜下低温等离子切除术治疗儿童腺样体肥大的临床疗效确切，且可减轻患儿创伤应激，减少术后出血，具有临床推广价值。
Clinical efficacy of low-temperature plasma resection under nasal endoscope in the treatment of adenoid hypertrophy in children and its effect on traumatic stress and complications
Objective To observe the clinical efficacy of low-temperature plasma resection under nasal endoscope in the treatment of children with adenoid hypertrophy(AH)and the effects on traumatic stress and complications in children.Methods A total of 110 children with adenoid hypertrophy treated in Ankang Hanbin District First Hospital from March 2019 to March 2022 were selected and divided into group A(nasal endoscopic dynamic resection,53 cases)and group B(nasal endoscopic low-temperature plasma resection,57 cases)according to different surgical methods.Operation time and intraoperative blood loss were compared between group A and group B.The traumatic stress indexes between group A and group B were compared before and after the operation.The ultrastructure of nasal mucosa in group A and group B was observed by transmission electron microscope.The clinical efficacy,complications,and recurrence rate between group A and group B were compared.Results The operative time of group A and group B were(22±4)min and(18±3)min,and the intraoperative blood loss was(13.2±2.7)ml and(6.1±1.0)ml,respectively.The operation time of group B was shorter than that of group A,and the intraoperative blood loss was less than that of group A(P＜0.05).The serum cortisol(Cor)levels in group A and group B were(390±46)nmol/1 and(350±44)nmol/L,the prostaglandin E2(PEG2)levels were(200±25)μg/L and(160±20)μg/L,the substance P(SP)levels were(14.3±3.6)pg/ml and(9.5±1.8)pg/ml 1 day after surgery.The serum Cor levels in group A and group B were(297±40)nmol/L and(258±41)nmol/L,the PEG2 levels were(143±20)μg/L and(120±21)μg/L,the SP levels were(10.3±2.7)pg/ml and(6.2±1.2)pg/ml 3 days after surgery.The levels of serum Cor,PEG2 and SP in group B were lower than those in group A 1 and 3 days after surgery(P＜0.05).There was no significant differ-ence in total clinical effective rate between group A and group B(P＞0.05).The postoperative bleeding rate of group B(8％)was lower than that of group A(0)(P＜0.05).There were no significant differences between group A and group B in the incidence of postoperative agitation,soft palate injury,and recurrence(P＞0.05).Conclusion Low-temperature plasma resection under the nasal endoscope has definite clinical efficacy in the treatment of adenoid hypertrophy in children.It can reduce traumatic stress and postoperative bleeding in children,which has clinical promotion value.
万方数据
维普
