腺样体扁桃体手术的技术优化：关于改善手术暴露、安全性和可视化的策略的实用性叙述性综述

文献信息

中文摘要

目的： 批判性地综合并整合旨在优化腺样体扁桃体手术过程中可视化、手术暴露、组织保护和/或止血控制的术中技术策略。
方法： 采用结构化叙述性综述，检索PubMed/MEDLINE、Scopus、ScienceDirect和Cochrane Library，以识别1996年1月至2026年5月间发表的研究。检索策略结合了与腺样体扁桃体切除术、术中可视化、手术暴露、止血、组织保护、显微镜、内镜和吸引辅助技术相关的MeSH术语和自由文本关键词。经过标题和摘要筛选以及全文评估，最终定性综合纳入38项研究。
结果： 现有证据表明，多种互补的术中策略可以提高腺样体扁桃体手术中的手术精确性和手术安全性。显微镜和内镜辅助技术增强解剖可视化，促进靶向止血，并改善对残留淋巴组织和隐匿出血部位的识别。颊部扩张器和改良牵开系统增加横向手术暴露并改善器械可操作性。保护措施，包括唾液棉卷和湿纱布，可能减少涉及口角、悬雍垂和后咽壁的压力相关和热相关黏膜损伤。镜像辅助可视化和使用Nelaton导管进行软腭牵拉可优化腺样体切除术中的鼻咽部检查。其他止血措施，包括局部血管收缩剂、纱布填塞、温盐水冲洗、持续吸引和吸引凝血，可能减少术中出血，同时尽量减少不必要的热损伤。
结论： 优化腺样体扁桃体手术不仅仅在于选择手术器械。简单、廉价且可重复的技术改良可以显著改善可视化、手术暴露、止血控制、组织保护和手术 ergonomics，从而有助于更安全、更标准化且可能更有效的手术操作。

英文摘要

OBJECTIVE: To critically synthesize and integrate intraoperative technical strategies designed to optimize visualization, surgical exposure, tissue protection, and/or hemostatic control during adenotonsillar surgery.
METHODS: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, ScienceDirect, and the Cochrane Library to identify studies published between January 1996 and May 2026. The search strategy combined MeSH terms and free-text keywords related to adenotonsillectomy, operative visualization, surgical exposure, hemostasis, tissue protection, microscopy, endoscopy, and suction-assisted techniques. Following title and abstract screening and full-text assessment, 38 studies were included in the final qualitative synthesis.
RESULTS: The available evidence indicates that multiple complementary intraoperative strategies can improve operative precision and surgical safety during adenotonsillar surgery. Microscope- and endoscope-assisted techniques enhance anatomical visualization, facilitate targeted hemostasis, and improve the identification of residual lymphoid tissue and occult bleeding sites. Cheek expanders and modified retraction systems increase transverse surgical exposure and improve instrument maneuverability. Protective measures, including salivary cotton rolls and moist gauze, may reduce pressure- and thermal-related mucosal injury involving the oral commissures, uvula, and posterior pharyngeal wall. Mirror-assisted visualization and soft palate retraction using a Nelaton catheter optimize nasopharyngeal inspection during adenoidectomy. Additional hemostatic measures, including topical vasoconstrictors, gauze packing, warm saline irrigation, continuous suction, and suction coagulation, may reduce intraoperative bleeding while minimizing unnecessary thermal injury.
CONCLUSIONS: Optimizing adenotonsillar surgery extends beyond the choice of surgical device. Simple, inexpensive, and reproducible technical modifications can substantially improve visualization, surgical exposure, hemostatic control, tissue preservation, and operative ergonomics, thereby contributing to safer, more standardized, and potentially more effective surgical procedures.