Clinical Outcomes Of Tonsillectomy By Coblator Assisted Dissection For Children

Objective:To compare and analyze the clinical outcomes and operative complications of tonsillectomy by the method of coblator assisted dissection and ablation resection for children.Methods:A total of 96 children aged 2 to 14 years,with tonsil and adenoid hypertrophy hospitalization for surgical treatment,were collected between September 2017 and August 2018 in our department.The patients were randomly divided into coblator assisted dissection group and ablation resection group(Respectively referred as dissection group and ablation group),including 39 cases in dissection group and 57 cases in ablation group.Surgical methods: In dissection group,referred to the traditional ‘cold 'steel dissection,coblator was used to cut the mucosa at the edge of the palatoglossal arch with coagulation pattern,separate tissue for revealing the capsule carefully,and remove the tonsils by dissection against the capsule.Pay attention to preserving the palatoglossal arch,avoiding damaging normal tissues around the capsule,and keeping intact of the surface epithelium as far as possible.In ablation group,the tonsils were removed by ablation pattern,but the palatine arch could not be preserved adequately in this pattern of operating.Adenoidectomy in both groups was operated by ablation pattern.Related questionnaire surveives were conducted by the patients' caregivers after surgery.The investigation of operative time,intraoperative and postoperative bleeding,postoperative fever,the degree of pharyngeal pain,postoperative feeding recovery,sleep and respiratory quality improvement and long-term pharyngeal discomfort symptoms of the two groups were performed,The data were analyzed and compared statistically.Results:The operative time of dissection group was(32.46±7.61)min,while ablation group was(29.57±7.13)min,there was no different between the two groups(P>0.05).The intraoperative blood loss was 3(1)ml in dissection group and 3(4)ml in ablation group,and there was no difference between the two groups(P>0.05).At the first to third days after operation,the daily degree of pharyngeal pain in dissection group was lighter than the ablation group,and the daily recovery of eating was better than the ablation group,the differences were significant(P<0.05).In terms of the postoperative bleeding,there was no primary bleeding(within 24 hours after surgery)occurred in either group;there were 2 cases(5.26%)of secondary bleeding occurred in the dissection group,and 7 cases(13.21%)of secondary bleeding occurred in the ablation group.There was 1 case in ablation group and 0 case in dissection group with severe bleeding(requiring hemostatic bleeding in operating room).There was no significant difference in postoperative bleeding rate between the two groups(P>0.05).Postoperative fever was found in 7 cases(17.94%)in dissection group and in 25 cases(43.86%)in ablation group,the differences were significant(P< 0.05).There was no difference in the recovery of normal diet time and the improvement of sleep breathing quality between the two groups(P>0.05).Pharyngeal discomfort occurred in 2 cases(5.26%)in dissection group and in 12 cases(22.64%)in ablation group,there was a difference between the two groups(P<0.05).Conclusion:There was no significant differences in operative time and intraoperative blood loss between the two groups of ablation resection and coblator assisted dissection tonsillectomy in children.But compare to the ablation resection,but the degree of postoperative pharyngeal pain and fever were lower,postoperative feeding recovery is better,and long-term pharyngeal discomfort symptoms were less in the group of coblator assisted dissection.Although there was no obvious difference in postoperative hemorrhage rate in terms of statistics,a lower risk of postoperative hemorrhage severity was observed in the group of coblator assisted dissection owing to the less invasive procedures.