| Objective:To investigate the advantages and disadvantages of the traditional adenoid curet resection and the adenoid hypothermia plasma ablation under the TV endoscope,the clinical treatment methods are further standardized to improve the therapeutic effect by comparing and reduce the recurrence rate,complications and reduce the family burden.Methods:In this study,patients admitted to the third hospital affiliated to qiqihar medical college from January 2011 to January 2017 were selected as subjects.The patients were divided into experimental group(52 cases of adenoid hypothermia under TV endoscopy)and control group(50 cases of adenoid curet excision)by according to the surgical methods.To collect the general situation,diagnosis,history and operation of the two groups were collected,compared with the perioperative operation(operation time,bleeding volume,hospitalization time,hospitalization expenses,etc.),and the postoperative follow-up 1~2 years to understand the occurrence of complications and follow up 1~2 years to understand the recurrence rate.Results:1.the basic situation of all patients In 102 cases of adenoidal hypertrophy,76.47%were male and 23.53%were female.The average age was(6.65±2.74)years old,the average height was(1.05±0.21)m,the average weight was(28.70±13.34)kg,and the average preoperative BMI was(25.05±4.63)kg/m~2.Education level:59.80%before school age,36.27%in primary school,2.94%in junior high school and0.98%in senior high school.The size of adenoids accounted for 6.86%of 1/3 in the posterior nostril,24.51%in the posterior nostril 1/2,14.71%in the posterior nostril2/3,50.98%in the posterior nostril 3/4,1.96%in the posterior nostril 4/5,and 0.98%in the patients with the posterior nostrils completely blocked.The cause of the disease:20.59%of the patients with bacterial infection,28.43%of the upper respiratory tract infection,10.78%of sinusitis,24.51%for allergic rhinitis and 15.69%for chronic tonsillitis.50 patients(49.02%)with adenoidal hypertrophy were treated with traditional operation and 52 patients(50.98%)were treated with hypothermic plasma ablation.The average operation time was(79.18±25.99)min,average intraoperative bleeding(7.96±2.34)ml,average hospitalization days(7.96±2.34)days,average hospitalization expenses(2860.21±860.24)yuan,average postoperative pain score(3.92±1.55),and average pain time(2.26±1.18)days.The clinical manifestations of the patients before the operation were:86.27%of the patients with hearing problems,86.27%for nasal congestion,65.69%for suffocating,87.25%for snoring,76.47%in patients with dyspnea,55.88%in sleepy patients and 55.88%in other problems.Postoperative pain score:36.27%of patients with less than 3 points,56.86%of patients with 4~6 score,and 6.86%of patients with 7~10 scores.Complications:secondary bleeding accounted for 17.65%,pharyngeal injury accounted for 11.76%,drinking water reflux accounted for 16.67%,other patients accounted for 9.80%.The patients with adenoid residue accounted for 16.67%,and mucosal reaction:(+)accounted for 31.37%,and(++)patients accounted for 19.61%.18.63%of the patients were followed up.Postoperative patients'clinical manifestations were 9.80%,2.94%of snoring,6.89%for nasal congestion,6.89%for rhinorrhea,and 4.90%in other patients.2.the basic situation of the two groups There was no significant difference for the gender,age,BMI,education,cause and other general data between the two groups(P>0.05).The two groups were comparable.3.Compared the operation and postoperative conditions of the two groups The difference of the amount of bleeding,the time of operation,the time of hospitalization,the hospitalization cost,the pain score and the duration of pain were compared between the two groups was statistically significant(P<0.05).The difference of the postoperative pain scores of the two groups was statistically significant(P<0.05).The difference of the recovery of hearing problems,snoring,nasal obstruction,rhinorrhea and other clinical manifestations in the two groups was statistically significant(P<0.05).4.the curative effect comparison between the two groups after treatment 37cases were cured,accounting for 74%;13 cases improved,accounting for 26%and 0cases failed in the control group.47 cases were cured,accounting for 90.38%,4 cases improved,accounting for 7.69%,and 1 cases were invalid,accounting for 1.92%in the observation group.The difference of the curative effect of the two groups was statistically significant(?~2=6.919,P=0.031)and the cure rate of the observation group was higher than that of the control group.5.compared the postoperative complications and follow-up cases of the two groups the difference of the incidence of postoperative complications was compared between the two groups was statistically significant(P<0.05)and the incidence of complications in the observation group was lower than that of the control group.The difference of the two groups of patients with secondary bleeding,pharynx injury,water reflux and other incidence was statistically significant(P<0.05)and the incidence of all kinds of complications in the observation group was lower than that of the control group.The residual rate of adenoids in the observation group was lower than that in the control group.The difference of the incidence of mucosal reactions in the two groups was statistically significant(P<0.05)and the mucosal response rate in the observation group was lower than that in the control group.After follow-up,15patients with recurrence in the traditional operation group,accounting for 30.00%.There were 4 cases of recurrence in the low temperature plasma ablation group,accounting for 7.69%.The recurrence rate of the two groups was significantly lower than that of the control group(P<0.05).Conclusion:1.Adenoid hypertrophy is a common disease in males,and the majority of the cases are children under 10 years old.The main causes are bacterial infection,upper respiratory tract infection and allergic rhinitis.2.The complications of adenoid hypertrophy treated by low temperature plasma ablation under video endoscope are less than those of adenoid curettage,but the cost of operation is higher.3.The cure rate of adenoid hypertrophy treated by low temperature plasma ablation under video endoscope is higher than that by adenoidectomy.The residual rate,mucosal reaction rate and recurrence rate of low temperature plasma ablation under video endoscope is lower than those of adenoid curettage. |
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