低温等离子与传统扁桃体切除术后创面白膜情况比较

Comparison of wound white film after low temperature plasma and traditional tonsillectomy

摘要:

目的 探讨低温等离子扁桃体切除术与传统扁桃体切除术后所形成的白膜有无差异，以及白膜是否可以作为术后创面恢复情况的观察指标。方法 选取2018年10月—2019年10月在山西医科大学附属汾阳医院耳鼻咽喉头颈外科行扁桃体切除术的患者60例，采用随机数字表法分为低温等离子扁桃体切除术组和传统扁桃体切除术组，每组30例。比较两组术后白膜的形成情况、形成时间及脱落时间。实验ICR小鼠30只，所有小鼠两侧口腔黏膜分别采用低温等离子术与传统手术制备创面，获取白膜后制作病理切片，比较两种术式后白膜的病理形态学特征。结果 低温等离子扁桃体切除术组白膜形成情况优于传统扁桃体切除术组（P <0.05）；低温等离子扁桃体切除术组白膜形成时间早于传统扁桃体切除术组（P <0.05）；低温等离子扁桃体切除术组白膜开始脱落、完全脱落时间晚于传统扁桃体切除术组（P <0.05）。小鼠口腔右侧采用低温等离子刀切割后形成的白膜是由变性的胶原蛋白与炎症细胞组成，小鼠口腔左侧采用传统手术刀切割后形成的白膜由浸润的炎症细胞与增生的纤维组织组成。结论 低温等离子扁桃体切除术具有白膜形成早、生长好的优势，有助于患者术后恢复；但白膜脱落时间长于传统扁桃体切除术。在扁桃体切除术后的预防感染方面，传统手术则更有优势。

Abstract:

Objective To investigate the difference of the white membrane formed after coblation tonsillectomy and conventional tonsillectomy and the feasibility of the white membrane can be used as the observation index of wound recovery.Methods From October 2018 to October 2019, 60 patients who underwent tonsillectomy in our department were randomly divided into two groups: 30 patients who underwent coblation tonsillectomy (coblation tonsillectomy group) and 30 patients who underwent conventional tonsillectomy (conventional tonsillectomy group). The formation of white membrane, the time of forming white membrane, and the time of falling off were compared between the two groups. Besides above, 30 ICR mice were selected. The oral mucosa on both sides of the mice were prepared with coblation and conventional. The pathological sections were made after obtaining the white membrane, and the histomorphological characteristics of the white membrane were compared.Results The formation of white membrane in the coblation tonsillectomy group was better than that in the conventional tonsillectomy group (P < 0.05). The time of forming white membrane in the coblation tonsillectomy group was earlier than that in the conventional tonsillectomy group (P < 0.05). The time of falling off of white membrane in the coblation tonsillectomy group was later than that in the conventional tonsillectomy group (P < 0.05). The pathological results of the white membrane on the oral mucosa of mice showed that the white membrane formed by coblation was composed of denatured collagen and inflammatory cells, while the white membrane formed by conventional operation was composed of infiltrated inflammatory cells and proliferated fibrous tissue.Conclusion Coblation tonsillectomy has the advantages for early formation of white membrane and good growth of white membrane, which is helpful to the recovery of patients after operation. However, the time of falling off of white membrane is longer than that of conventional tonsillectomy. Through the analysis of pathological results of white membrane, it is suggested that the traditional peeling off has more advantages in the prevention of infection after tonsillectomy.