采用儿童射频消融囊内扁桃体切除术通过质量改进框架减少扁桃体切除术后出血
Adopting pediatric radiofrequency ablation intracapsular tonsillectomy to reduce post-tonsillectomy hemorrhage through a quality improvement framework.
文献信息
| PMID | 42815164 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Jess Rhee |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada; Department of Otolaryngology-Head and Neck Surgery, Children's Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada. |
| 期刊 | International journal of pediatric otorhinolaryngology |
| SCI 分区 | Q2 |
| IF | 1.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 囊内扁桃体切除术可减少继发性扁桃体切除术后出血（PTH），但囊外入路仍是扁桃体切除术中最主要的方法。对于扁桃体切除术等常见手术，转变手术技术可能具有挑战性，需要仔细规划。
目的： 通过在学术性儿科中心采用射频消融囊内扁桃体切除术（广泛报道为Coblation囊内扁桃体切除术，CIT），减少继发性PTH。
方法： 这项质量改进（QI）计划应用了医疗保健改进研究所的改进模型，通过四个计划-执行-研究-行动（PDSA）循环，并按照SQUIRE 2.0报告。对2024年1月至2025年6月的扁桃体切除术进行了干预前后设计评估。使用统计过程控制（SPC）图评估每月继发性PTH率，并将继发性、过程和平衡指标与囊外单极扁桃体切除术（EMT）进行比较。
结果： 在474例扁桃体切除术中，262例为CIT，212例为EMT。SPC显示与CIT采用同时出现的特殊原因变异：因出血就诊急诊科的比例从6.2%降至1.0%，返回手术室的比例从3.0%降至0.1%。没有CIT患者因继发性PTH需要再次手术，而EMT患者为1.9%（p = .026）。CIT的手术时间更长（35.7 vs 28.6分钟，p < .001）。住院医师参与了92.0%的CIT病例。一名CIT患者发生术中动脉出血，需要栓塞治疗，并完全康复。
结论： 在QI框架内采用CIT与继发性PTH和医疗资源利用的持续减少相关，尽管手术时间更长且存在学习曲线。所描述的实施路径，包括其安全教训，可能有助于其他有兴趣向CIT过渡的人。
英文摘要
BACKGROUND: Intracapsular tonsillectomy reduces secondary post-tonsillectomy hemorrhage (PTH) but extracapsular approach remains the most predominant approach in tonsillectomy. Transitioning the surgical technique for common procedures like tonsillectomy can be challenging and require careful planning.
OBJECTIVE: To reduce secondary PTH by adopting radiofrequency ablation intracapsular tonsillectomy, widely reported as Coblation intracapsular tonsillectomy (CIT), at an academic paediatric centre.
METHODS: This quality improvement (QI) initiative applied the Institute for Healthcare Improvement Model for Improvement through four plan-do-study-act (PDSA) cycles, reported per SQUIRE 2.0. Tonsillectomies from January 2024 to June 2025 were evaluated in a pre- and post-intervention design. Monthly secondary PTH rate was assessed with statistical process control (SPC) charts, and secondary, process, and balancing measures were compared with extracapsular monopolar tonsillectomy (EMT).
RESULTS: Of 474 tonsillectomies, 262 were CIT and 212 EMT. SPC showed special-cause variation coinciding with CIT adoption: emergency department visits for hemorrhage fell from 6.2% to 1.0% and returns to the operating room from 3.0% to 0.1%. No CIT patient required reoperation for secondary PTH versus 1.9% of EMT patients (p = .026). CIT had longer operative times (35.7 vs 28.6 min, p < .001). Residents participated in 92.0% of CIT cases. One CIT patient sustained intraoperative arterial hemorrhage requiring embolization and recovered fully.
CONCLUSION: Adopting CIT within a QI framework was associated with sustained reductions in secondary PTH and healthcare utilization despite longer operative times and a learning curve. The implementation pathway, including its safety lessons, described may aid others interested in transitioning toward CIT.