Zusammenfassung
Hintergrund und Methode: In der vorliegenden Arbeit wird erstmals der Einfluss des intraoperativ angewandten
bipolaren Koagulationsstromes auf den postoperativen Verlauf quantitativ untersucht.
Es wurden bei 63 Patienten die applizierte Energiemenge des Koagulationsstromes gemessen,
der Blutverlust, die Operationszeit, der postoperative Analgetikaverbrauch und die
postoperativen Schmerzen mit einem Schmerzscore sowie die Nachblutungen und der Ausbildungsstand
der Operateure erfasst und ausgewertet. Ergebnisse: Die Energiemenge des verwendeten Koagulationsstromes korrelierte mit dem mittleren
intraoperativen Blutverlust bei den Kindern (p = 0,029) und den Erwachsenen (p = 0,038)
sowie mit der subjektiv empfundenen Schmerzintensität in der späten postoperativen
Phase. Der Erfahrungsstand der Operateure wirkte sich auf den intraoperativen Blutverlust,
die Nachblutungsrate und die Operationszeit aus. Die Energiemenge des Koagulationsstromes
war hingegen abhängig von der individuellen Operationstechnik. Schlussfolgerung: Die Menge des intraoperativ applizierten Koagulationsstromes wirkt sich signifikant
auf die Schmerzen im späteren postoperativen Verlauf (10. - 14. Tag) aus. Dies kann
durch eine verstärkte Gewebeschädigung durch die Diathermie erklärt werden. Eine sorgfältige,
schonende Operationstechnik sowie ein sparsamer Umgang mit der Diathermie begrenzt
somit die postoperativen Schmerzen.
Abstract
Background und Methods: Postoperative pain after tonsillectomy is greater using diathermy compared to the
use of ligatures for hemostasis. In the present paper, the influence of coagulation
current on the postoperative course is assessed quantitatively. The applied coagulation
current was registered in Watt per second (Ws) in 63 patients. Intraoperative blood
loss, operation time, experience of the surgeon, postoperative pain and the consumption
of analgesics were registered. Results: The mean intraoperative blood loss was correlated to the amount of applied coagulation
current. Operation time was reduced with increased coagulation current. The energy
of the applied coagulation current correlated significantly with pain in the late
postoperative period. There was no influence in the amount of coagulation current
on the consumption of analgesics or postoperative hemorrhage. Blood loss was less
and operation time was shorter with more experienced surgeons. Six secondary postoperative
hemorrhages were observed. Hemorrhage occured more often with inexperienced surgeons.
The applied coagulation current was, however, not dependent on the surgeon’s experience
but on his individual technique for intraoperative control of hemostasis. Conclusions: Pain following tonsillectomy is related to the amount of intraoperatively applied
coagulation current, especially in the late postoperative course (days 10 - 14). This
may be explained by tissue damage and increased eschar due to coagulation. Careful
and reserved use of intraoperative coagulation will reduce postoperative pain.
Schlüsselwörter
Tonsillektomie · Koagulationsstrom · Heilungsverlauf
Key words
Tonsillectomy · hemostasis · coagulation · postoperative pain
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Dr. Esther Genoveva Thomaser
Kantonsspital Liestal, Klinik für Hals-, Nasen- und Ohrenkrankheiten, Hals- und Gesichtschirurgie
Rheinstraße 26 · CH-4410 Liestal
eMail: Esther.Thomaser@ksli.ch
