Retrospective Analysis About Different Operative Method For Curettage Of Adenoids In Children

Adenoids in the roof and posterior wall at the junction of the nasopharynx, shape like a half peeled orange, uneven surface, as part of Waldeyer ring. Adenoids have been developed since birth, 6 to 7 years to develop to the maximum, generally 10 years of age and then gradually decline, in adults disappeared. Adenoidal hypertrophy is a common childhood diseases that can lead to children with chronic sinusitis and secretory otitis media, children with obstructive sleep apnea syndrome, maxillofacial developmental disorders and growth retardation and other complications can even lead to alveolar ventilation poor, leading to pulmonary hypertension, and further development will lead to right ventricular hypertrophy, even irreversible right heart failure and other cardiovascular damage. Therefore, once diagnosed should be treated as soon as possible. Diagnosis of the disease than in the past used the direct and indirect palpation nasopharyngeal nasopharyngeal endoscopy, there nasopharyngeal lateral X-ray, CT of nasopharynx and other methods, the current routine or fiberoptic endoscopic microscope Check. The treatment of adenoidal hypertrophy is surgery.Traditional adenoidectomy is carried out in Blindness, but because of poor surgical site exposure, blind to operate as easily lead to residual adenoid or around structural damage, leading to recurrent otitis media and symptoms.To overcome these disadvantages, new surgical techniques continue to improve them, with the endoscopy in otorhinolaryngology extensive use of surgical adenoids also have leap-type development. The application of endoscopy in adenoidectomy under direct vision is possible. This study used the nasal endoscope under direct vision by mouth with a low temperature plasma and electric cutters adenoid removal of two different methods, observed and compared intraoperative, postoperative complications and improvement of symptoms, and by the traditional Oral adenoidectomy compared to explore the advantages and disadvantages of different surgical methods to find the best surgical method to reduce blood loss and residual adenoid, to avoid postoperative complications, and thus improve the efficacy.Objective: Comparison the advantages and disadvantages of three surgical methods,the nasal-endoscopic assisted adenoidectomy through the mouth with low-temperature plasma radiofrequency ablation, the nasal-endoscopic assisted adenoidectomy through the mouth with electrical cutting and the traditional adenoidectomy,in order to find out the best operative procedure. Methods: Patient's clinical diagnosis of adenoid hypertrophy in children with specific 90 cases,collected in Otolaryngology Head and Neck Surgery of China-Japan Friendship Hospital, Jilin University Joint General Hospital of Daqing Oilfield in Heilongjiang Province of Otolaryngology, from February 2008 to August 2009,aged 6 to 12 years old, were randomly divided into 3 groups with different surgical approach to adenoidectomy surgery, Group A: There are 32 cases with low-temperature plasma radiofrequency ablation, group B: There are 34 cases with Electric Cutting, group C: There are 24 cases with traditional adenoidectomy.Three types of surgical operation were analyzed: (1) adenoidectomy time (ie, surgical instruments began to remove adenoid tissue adenoid completely removed up to the time); (2) operative time (ie satisfactory anesthesia After the start of oral device on the opening until the completion of a thorough adenoidectomy bleeding after the evacuation date instruments, accompanied by other operations such as tonsillectomy their time not counted); (3) blood loss; (4) patients complications (including residual adenoid, secondary hemorrhage and recurrent); (5) the recovery of postoperative symptoms (including hearing, snoring, nasal congestion, rhinorrhea) and other indicators were statistically analyzed and compared. Results: Endoscopic / fiberoptic endoscopy and questionnaire forms were followed up for 3 to 12 months. Surgical operation of three statistical analysis and comparison of the situation: (1) the three surgical adenoidectomy time were significantly statistical difference (P <0.01), in which the adenoidectomy time of group A is the longest, followed by the group B, the adenoidectomy time of group C is the shortest one. (2) Compared the operating time of the three types of surgery , group A and group B was no significant difference (P> 0.05), while the operation time of the group A and group B are both longer than group C, there are significant differences (P <0.01 ). (3) Compared the blood loss of the three kinds of surgical , group A to be significantly less than the group B and group C (P <0.01), while the blood loss of the group B and group C was no significant difference (P> 0.05) . (4) three kinds of comparison of complications found, 32 patients of group A had no residual adenoid, eustachian tube injury and no postoperative bleeding, recurrence and other complications, significantly better than the other two groups . group C, 22 patients with varying degrees of residual adenoid, residual rate is 91.67%, with two cases of eustachian tube torus injury, one case of postoperative secondary bleeding; group B, 2 cases had a small amount of residue, residual rate is 5.88% .No eustachian tube injury, one case of postoperative secondary bleeding; The residual rate of group C was higher than group B, statistically significant differences (P <0.01). (5) compared the recovery of postoperative symptoms, hearing: X2 = 1.53, P> 0.05; snoring: X2 = 0.66, P> 0.05; stuffy nose: X2 = 1.48, P> 0.05; rhinorrhea: X2 = 0.57, P> 0.05 . Between the three surgical operation efficiency was no significant difference, P all Greater than 0.05. Conclusion: The best surgical method of the three adenoidectomy surgical procedures is the nasal-endoscopic assisted adenoidectomy through the mouth with low-temperature plasma radiofrequency ablation. The low-temperature plasma radiofrequency ablation adenoid by 70°nasal endoscope can clear operative field, achieve full profile of, side ablation bleeding edge, avoid the removal of adenoids under blindness caused the residual adenoid surgery in less bleeding, less damage, adenoid no residue, no postoperative complications, it received good results.