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題 名 | A Combined Method of Transoral and Transnasal Endoscopic Adenoidectomy=經口及經鼻內視鏡腺樣體摘除術 |
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作 者 | 陳哲文; 李飛鵬; 陳瀚聰; 黃弘孟; | 書刊名 | 慈濟醫學 |
卷 期 | 14:5 2002.10[民91.10] |
頁 次 | 頁289-294 |
分類號 | 416.8 |
關鍵詞 | 經口或經鼻; 內視鏡; 腺樣體摘除術; Transoral and transnasal; Endoscopic; Adenoidectomy; |
語 文 | 英文(English) |
中文摘要 | 目的:改善傳統術式未能清晰目視下操作,可能傷及耳咽管或後鼻孔之缺點。病人與方法:1995年1月至1999年12月間,105位小兒病患接受此術式。手術採全身麻醉下進行,所有步驟皆於經口進入之4.0mm或2.7mm的70°內視鏡下操作,以腺樣體刮匙刮除腺樣體。若鼻咽上方或耳咽管旁仍有殘留腺樣體組織,則以4.0mm或2.7mm之0°或30°內視鏡經鼻觀視,並以摘除鉗經鼻摘除。術後以H2O2浸泡之紗布填塞止血即可。結果:所有105位小兒病患皆無術後出血、傷及耳咽管或後鼻孔之情形。結論:此術式較傳統術式更能提供清晰的手行視野,避免發生合併症,值得一試。 |
英文摘要 | Objective: Conventional adenoidectomy is usually performed with either a curette or an adenotome under blind or indirect visualization. The possibility of injury to the Eustachian tube or posterior choanae can not be excluded during surgery. We present a safe and more effective technique, which can be performed using endoscopic direct visualization during the whole procedure Patients and Methods: Between January 1995 and December 1999, 105 children underwent this new surgical procedure under general anesthesia. All procedures were performed under endoscopic direct visualization. Using guidance via a 40 mm or 27 mm 70° endoscope, there was a clear operative field transorally. The adenoid curette was applied transorally to the nasopharynx to remove the main bulk of the adenoids and a 90° Blakesly forceps was also used to perform a peritubal adenoidectomy under intraoral visualization. To remove any residual adenoid tissue obstructing the orifice of the eustachian tube or posterior choanae, we adopted a transnasal approach with a 45° or straight Blackesley forceps using a 40 mm or 27 mm 0° or 30° endoscope for guidance Epinephrine-and H2O2-rinsed gauze was packed in the nasopharynx for post-operative hemostasis. Results: The method was successfully applied in all patients. None of the 105 patients had complications, such as post-operative nasopharyngeal hemorrhage or mjury to the Eustachian tube or posterior choanae. Conclusions: The combined method of a transoral 70° and transnasal 0° or 30° endoscopic approach offered a clear and stable operative field. The surgical procedures were all performed under direct visualization. Damage to the Eustachian tube or posterior choanae was not a problem. This method has the potential to become the procedure of choice for adenoidectomy. |
本系統中英文摘要資訊取自各篇刊載內容。