低温等离子消融与微切割器在儿童囊内扁桃体部分切除术中的比较：效率、出血与修正手术的比较
Coblation Versus Microdebrider in Pediatric Intracapsular Tonsillotomy: A Comparison of Efficiency, Bleeding, and Revision Surgery.
文献信息
| PMID | 42808703 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Alexa J Kacin |
| 作者单位 | Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. |
| 期刊 | Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 囊内扁桃体切除术或“扁桃体部分切除术”因出血风险和疼痛降低，正日益成为囊外扁桃体切除术的替代方案。低温等离子消融和微切割器是最常用的两种方法，但比较二者的研究有限。我们旨在比较这些技术在效率、术后出血和修正手术需求方面的差异。
研究设计： 回顾性病例系列。
地点： 2018年至2024年间的一家四级儿童医院。
方法： 本研究纳入接受微切割器（13名外科医生）或低温等离子消融（2名外科医生）行扁桃体部分切除术联合腺样体切除术的儿科患者。采用逻辑回归模型识别与术后出血和修正手术相关的独立因素。
结果： 共纳入1734例扁桃体部分切除术联合腺样体切除术（低温等离子消融=385例；微切割器=1349例）。平均（标准差）年龄为4.95（2.2）岁，其中948例（54.7%）为男性。低温等离子消融的中位手术时间（22分钟）显著短于微切割器（24分钟）（P<.001）。低温等离子消融组（1%）与微切割器组（0.9%）在术后出血患者比例上无显著差异（OR 1.1，95% CI [0.35, 3.47]）。低温等离子消融组（0.5%）与微切割器组（1%）在接受修正手术的患者比例上无显著差异（OR 0.85，95% CI [0.23, 3.15]）。较年轻的年龄与修正手术需求相关（OR 0.59，95% CI [0.41, 0.85]）。
结论： 在扁桃体部分切除术中，低温等离子消融比微切割器更具时间效率，且术后出血或修正手术无显著差异。较年轻的年龄被注意到是修正扁桃体切除术的风险因素。未来研究方向包括相对成本效益和术后疼痛差异的研究。
英文摘要
OBJECTIVE: Intracapsular tonsillectomy or "tonsillotomy" is an increasingly popular alternative to extracapsular tonsillectomy due to decreased bleeding risk and pain. Coblation and microdebrider are most frequently used, but studies comparing them are limited. We aimed to compare efficiency, postoperative bleeding, and need for revision surgery between these techniques.
STUDY DESIGN: Retrospective case series.
SETTING: Quaternary children's hospital between 2018 and 2024.
METHODS: This study included pediatric patients undergoing tonsillotomy with adenoidectomy using the microdebrider (13 surgeons) or coblation (2 surgeons). Logistic regression models were used to identify independent factors associated with postoperative bleeding and revision surgery.
RESULTS: A total of 1734 tonsillotomy with adenoidectomy procedures were included (coblation = 385; microdebrider = 1349). The mean (SD) age was 4.95 (2.2) years and 948 (54.7%) were male. Median surgical time was significantly less (P < .001) with coblation (22 minutes) compared to microdebrider (24 minutes). There was no significant difference in the proportion of patients experiencing postoperative bleeding (OR 1.1, 95% CI [0.35, 3.47]) between coblation (1%) and the microdebrider (0.9%). There was no significant difference in the proportion of patients undergoing revision (OR 0.85, 95% CI [0.23, 3.15]) between coblation (0.5%) and the microdebrider (1%). Younger age was associated with need for revision surgery (OR 0.59, 95% CI [0.41, 0.85]).
CONCLUSIONS: Coblation was more time efficient than microdebrider for tonsillotomy without a significant difference in postoperative bleeding or revision surgery. Younger age was noted to be a risk factor for revision tonsillectomy. Future directions to study include relative cost efficiency and differences in postoperative pain.