Clinical Pathology Research About Harmonic Scalpel For Tonsillectomy

Objective To explore the advantages and disadvantages of applying harmonic scalpel in tonsillectomy and further evaluate it’s feasibility by compared with conventional technique and needle-electrocautery.Methods Forty patients who were needed to received tonsillectomy from May to October in 2014 were divided into A and B groups and were conducted by self-controlled study. The A group (30 cases) was treated by conventional technique on the left tonsil and the B (10 cases) group was treated by needle-electrocautery on the left tonsil, while all the patients were treated by harmonic scalpel on the right tonsil simultaneously. The operating time and blood loss during operation and the degree of pain and the growth condition of the tunica albuginea as well as the degree and depth of injury under microscopy were observed. Furthermore, the removed tonsils were stained with hematoxylin-eosin. Then, the histological characters and the damage depth were observed and measured under microscope. And then, the differences of damage depths by three operation methods were processed statistical analysis. Finally, the feasibility of applying harmonic scalpel in tonsillectomy were investigated on the basis of clinical observed index and pathology observations.Results ①In A groups:the median of the operating time and bleeding during operation were 5 minutes and 0 milliliter by treated with harmonic scalpel while the median of the operating time and bleeding during operation were 33 minutes and 22 milliliter by treated with conventional technique. And both the data were lower by harmonic scalpel and there was statistical difference(P<0.05). In B groups:the median of the operating time and bleeding during operation were 4.6 minutes and 0 milliliter by treated with harmonic scalpel while the median of the operating time and bleeding during operation were 17.3 minutes and 19 milliliter by treated with needle-electrocautery. And both the data were lower by harmonic scalpel and there was statistical difference(P<0.05).②Postoperative pain during 7 days with visual analogue scale was lighter by harmonics calpei compared with conventional technique, while there were no statistical difference comp ared to needle-electrocautery. Neither primary hemorrhage cases nor secondary hemorrhage cases were found in two groups, while two secondary hemorrhage cases accounted for 5% were found in the group treated by harmonic scalpel.③Postoperative wound reaction degree:A group, there were 2 leases of mild reaction and 9 cases of moderate reaction treated with harmonic scalpel,while 24cases of mild reaction and 6 cases of moderate reaction by conventional technique. B group:here were 8cases of mild reaction and 2 cases of moderate reaction treated with harmonic scalpel,while9cases of mild reaction and 1 case of moderate reaction by needle-electrocautery. Serve reaction has not been found in all subjectives.④ In A groups The median time of tunica albuginea peeling was 6 days treated by harmonic scalpel, slightly delayed than that 5days treated by conventional technique. In B groups:there were no statistical differences between harmonic scalpel and needle-electrocautery. The degree of tunica albuginea peeling on the day of discharge:A group:there were 7cases of I degree and 23 cases of Ⅱ degrees treated with harmonic scalpel,while 1 leases of I degree and 19 cases of Ⅱ degrees by conventional technique. B group:there were 4 cases of I degree and 6 cases of II degrees treated with harmonic scalpel, while 5 cases of I degree and 5 cases of II degrees by needle-electrocautery.⑤The depth of thermal injury in deep layers of tonsils was 0.60 mm in the harmonic scalpel group and that in the needle-electrocautery group was 0.53 mm while it was 0.25mm in the conventional technique group. The damage depths caused by the three different operation methods were statistical difference (P<0.05). Observation results of tonsil tissue under microscopy as followed, completed tonsil organization structure、ruddy surgical wound and blood clot on the surface were found in conventional technique group, while completed tonsil organization structure、much less ruddy surgical wound and burning black eschar around the surgical wound were found in the harmonic scalpel group. And completed tonsil organization structure、much more burning black eschar and no obvious blood clot were found in the needle-electrocautery group. By pathological observation, we found that tonsil were infiltrated with inflammatory cells and serve tissue injury treated with harmonic scalpel. And we also found that much blood clots around the wound edge and crush injury cellular in the needle-electrocautery group, while cellular degradation, interstitial edema and obviourly congestion of small blood vessels were found in the conventional technique group.Conclusion The application of harmonic scalpel in tonsillectomy has the advantages of the reducer times of the operations and the improvements of the efficiency of the operations. And it was safe, efficient and feasible, which had a nice application prospect in the field of otolaryngology...