Transoral Endoscopic Low-temperature Plasma Assisted Adenoidectomy Down To The Surface Of Pharyngobasilar Fascia,Pharyngeal Tubercles And Occipital Periosteum

Objective:To explore the procedure,the clinical effects,the availability and the safety of that transoral endoscopic low-temperature plasma assisted adenoidectomy(LTPA)down to the surface of pharyngobasilar fascia,pharyngeal tubercles and occipital periosteum.Methods:The case information of adenoid hypertrophy patients include 52 cases by LTPA and 58 cases by the transoral endoscopic power-assisted adenoidectomy(PA),which were performed by the same surgeon in the Affiliated Zhongshan Hospital of Dalian University from January 2010 to January 2018.The observed indexes include preoperative and postoperative upper airway obstruction(A/N ratio);preoperative and postoperative symptoms(nasal obstruction,snoring,mouth breathing),which were evaluated by Visual Analogue Scale(VAS);complications and especially recorded and compared the intraoperative blood loss and operative time of two techniques.Results:LTPA group and PA group all can expose the pharyngobasilar fascia,pharyngeal tubercles and occipital periosteum completely.After the statistical analysis with SPSS 19.0,the results were obtained:(1)Preoperative A/N ratio of LTPA is 0.76±0.10,preoperative A/N ratio of PA is 0.75±0.06,postoperative A/N ratio of LTPA is 0.18+0.09,postoperative A/N ratio of PA is 0.17±0.09.a.There was no significant difference in preoperative A/N ratio between the LTPA group and the PA group(P>0.05);b.There was no significant difference in postoperative A/N ratio between the LTPA group and the PA group(P>0.05);c.There was significant difference in preoperative A/N ratio and postoperative A/N ratio in the LTPA group(P<0.05);d.There was significant difference in preoperative A/N ratio and postoperative A/N ratio in the PA group(P<0.05);(2)Preoperative nasal obstruction VAS scores of LTPA is 6.88±2.69,preoperative nasal obstruction VAS scores of PA is 5.81±3.84,postoperative nasal obstruction VAS scores of LTPA is 1.64±1.57,postoperative nasal obstruction VAS scores of PA is 1.22±1.19.a.There was no significant difference in preoperative nasal obstruction VAS scores between the LTPA group and the PA group(P>0.05);b.There was no significant difference in postoperative nasal obstruction VAS scores between the LTPA group and the PA group(P>0.05);c.There was significant difference in preoperative nasal obstruction VAS scores and postoperative nasal obstruction VAS scores in the LTPA group(P<0.05);d.There was significant difference in preoperative nasal obstruction VAS scores and postoperative nasal obstruction VAS scores in the PA group(P<0.05);(3)Preoperative snoring VAS scores of LTPA is 7.79±2.44,preoperative snoring VAS scores of PA is 7.74±2.66,postoperative snoring VAS scores of LTPA is 1.33±1.29,postoperative snoring VAS scores of PA is 1.24±1.22.a.There was no significant difference in preoperative snoring VAS scores between the LTPA group and the PA group(P>0.05);b.There was no significant difference in postoperative snoring VAS scores between the LTPA group and the PA group(P>0.05);c.There was significant difference in preoperative snoring VAS scores and postoperative snoring VAS scores in the LTPA group(P<0.05);d.There was significant difference in preoperative snoring VAS scores and postoperative snoring VAS scores in the PA group(P<0.05);(4)Preoperative mouth breathing VAS scores of LTPA is 7.60±2.95,preoperative mouth breathing VAS scores of PA is 7.29±3.02,postoperative mouth breathing VAS scores of LTPA is 1.24±1.22,postoperative mouth breathing VAS scores of PA is 0.90±0.79.a.There was no significant difference in preoperative mouth breathing VAS scores between the LTPA group and the PA group(P>0.05);b.There was no significant difference in postoperative mouth breathing VAS scores between the LTPA group and the PA group(P>0.05);c.There was significant difference in preoperative mouth breathing VAS scores and postoperative mouth breathing VAS scores in the LTPA group(P<0.05);d.There was significant difference in preoperative mouth breathing VAS scores and postoperative mouth breathing VAS scores in the PA group(P<0.05);(5)Operative time of LTPA is 29.17±7.61min,operative time of PA is 39.33±13.77min,there was significant difference in operative time between the LTPA group and the PA group(P<0.05);(6)Intraoperative blood loss of LTPA is 4.70±1.57ml,intraoperative blood loss of PA is 17.84±8.89ml,there was significant difference in intraoperative blood loss between the LTPA group and the PA group(P<0.05).Meanwhile,there is no postoperative regrowth and postoperative bleeding was found during the follow-up studies in the both groups.Conclusion:LTPA and PA all can expose and resect hypertrophic adenoid tissue from the surface of pharyngobasilar fascia,pharyngeal tubercles and occipital periosteum intactly,and have the same clinical effects.Compared with PA,LTPA have less intraoperative blood loss and shorter operative time.Therefore,LTPA is more advantageous for children patients.