显微技术在扁桃体切除术中的应用优势及疗效分析_第三期_2026_医学理论研究

1.蚌埠医科大学，安徽蚌埠 233030 2.蚌埠医科大学第一附属医院，安徽蚌埠 233099

摘要：目的：探讨显微镜技术在扁桃体切除术中的临床应用价值，重点分析其对扁桃体术后出血等并发症发生率的影响。方法：回顾性选取2024年1月—2025年12月于我院耳鼻喉科接受扁桃体切除术的患者220例，按手术方式分为显微镜组（112例，显微镜辅助下扁桃体切除术）与传统组（108例，传统肉眼直视下扁桃体切除术）。对比两组术中出血量、手术时间、术后原发性出血、继发性出血、伤口感染等并发症发生率，以及术后疼痛评分、住院时长。结果：显微镜组术中平均出血量（12.5±3.2）ml，显著少于传统组（38.6±8.5）ml（P<0.001）；手术时间（24.3±4.1）min，短于传统组（32.7±5.6）min（P<0.001）。术后原发性出血率：显微镜组（0.9%）小于传统组（5.6%）（P<0.05）；显微镜组的继发性出血率（1.8%）明显小于传统组（6.0%）（P<0.05）；显微镜组伤口感染率（0.9%）明显小于传统组（4.6%）（P<0.05）。显微镜组术后24h（4.2±1.1）、48h（3.1±0.9）、72h （2.0±0.7）VAS疼痛评分均低于传统组（6.5±1.5、4.8±1.2、3.3±1.0）（P<0.05）。结论：显微镜技术辅助下扁桃体切除术可显著降低术中、术后出血等并发症风险，减轻术后疼痛，显示出更好的安全性与有效性。

关键词：显微镜技术；扁桃体切除术；术中出血；术后出血；术后并发症

参考文献：

[1]Sundstrom B, et al. Postoperative bleeding after tonsillectomy-a risk factor study on 28,254 patients. Acta Otolaryngol, 2025, 145(5): 412-418.

[2]Koca A, et al. Retrospective Analysis of Hemorrhage After Pediatric Tonsillectomy. Turk Arch Otorhinolaryngol, 2025, 63(2): 79-84.

[3]Patel N, et al. The Efficacy of Tranexamic Acid in Pediatric Tonsillectomy: A Systematic Review and Meta-Analysis. Cureus, 2025, 17(9):e389336.

[4]Yangi K ,Gok E ,Goyal M , et al.Current State of the Art in Neurosurgical Operative Microscopes.Cureus,2026,18(2):e104305-e104305.

[5]Dhakal A ,Shrestha L B ,Pokharel M , et al.Microscopic Assistance in Cold Dissection Tonsillectomy-Does it Improve Surgical Outcome?Journal of College of Medical Sciences-Nepal,2022,18(3):185-193.

[6]Xu H ,Qiu S ,Wang J , et al.Hemorrhage risk after coblation tonsillectomy in Chinese pediatric: a multicenter, prospective, observational cohort study.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology-Head and Neck Surgery,2024,282(4):1-9.

[7]Pang Y ,Gong J ,Huang J , et al.Coblation tonsillectomy under surgical microscopy: A retrospective study.Journal of International Medical Research,2016,44(4):923-930.

[8]M S E E ,A A S E ,R E N E , et al.Ultrastructure of the palatine tonsils of the donkey (Equus asinus): New insights by light, scanning, and transmission electron microscopy.Microscopy research and technique,2022,85(12):3793-3803.

[9]Eğilmez K O ,Elden H ,Kandemir A .Preoperative immunonutritional and inflammatory indices as predictors of secondary post-tonsillectomy hemorrhage in children.International journal of pediatric otorhinolaryngology,2026,204112803.

[10]Colombo G ,Ferreli F ,Bari D M , et al.Introducing the High-definition 3D exoscope in ear surgery: preliminary analysis of advantages and limits compared with operative microscope.European Archives of Oto-Rhino-Laryngology,2021,278(11):1-7.

[11]Saravakos P ,Kourtidis S ,Preyer S .POSTOPERATIVE BLEEDING AFTER MICRODEBRIDER-ASSISTED INTRACAPSULAR TONSILLECTOMY AND EXTRACAPSULAR TONSILLECTOMY. A RETROSPECTIVE COHORT STUDY.International Research Journal of Otolaryngology,2022,5.

[12]Allon R ,Zloczower E ,Chebotaryov M , et al.National survey on peritonsillar abscess treatment and attitudes toward quinsy tonsillectomy.Postgraduate medicine,2024.

[13]Ozdogan F ,Ozturk E F ,Ozdas T , et al.Role of infection in late period post-tonsillectomy bleedings.Turkish Archives of Otorhinolaryngology,2013,50(4):63-65.

[14]James J ,Aaron V ,Natasha D , et al.Our experience of the increased rates of post tonsillectomy haemorrhage in 1538 children with pre-operative infective symptoms or signs.Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery,2020,45(6):944-945.

[15]N A ,A B ,E P , et al.PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations.Anaesthesia,2020,76(7):947-961.

[16]Howitz F M ,Barfred M ,Vilhelmsen J F , et al.Cold versus hot haemostasis in tonsillectomy: impact on post-tonsillectomy haemorrhage and pain perception - results from a randomized clinical trial.European Archives of Oto-Rhino-Laryngology,2026,(prepublish):1-11.

[17]Qi X ,Li Y ,Zhang M , et al.Impact of patient-centered care (PCC)-based personalized interventions on postoperative pain management and recovery in children undergoing adenotonsillectomy: A retrospective study.American journal of otolaryngology,2025,46(5):104706.

[18]Fatih M B ,Asude Ü ,Fatih Y , et al.Comparison of two modern and conventional tonsillectomy techniques in terms of postoperative pain and collateral tissue damage.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery,2019,276(7):2061-2067.

[19]Zhila M ,Reza M F .Accelerated wound healing and its promoting effects of topical codeine on the healing of full-thickness cutaneous wound, evidences for modulating cytokines involved in pain, inflammation and collagen biosynthesis.European journal of trauma and emergency surgery : official publication of the European Trauma Society,2022,48(6):4735-4744.

[20]Lyu D ,Pan S ,Lei L , et al.[Clinical practice guideline for perioperative pain management in pediatric low-temperature plasma tonsillectomy].Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery,2026,40(2):109-119.

[21]Karolina E ,Hessén A S ,Joacim S , et al.Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery,2016,273(8):2249-56.