Tonsillectomy

The tonsillectomy has the advantages of simple equipment, only a squeeze knife and a tongue depressor, which can be operated, and the operation time is short. However, it is difficult to master the operation more skillfully. Before the operation, it is necessary to understand the anatomy of the tonsils and to master the peeling method. Otherwise, when the squeezing method is used rashly, it will bring more tissue damage and even tonsil residuals and other adverse consequences. Treatment of diseases: pharyngeal tonsil hypertrophy Indication Extrusion method is generally applicable to tonsils with large volume of tonsils and prominent and less adhesion. Preoperative preparation Although tonsill surgery is simple, it should not be carried out rashly. The following checks should be done before surgery: 1. A detailed history of the disease, with or without bleeding, infectious diseases, rheumatism and nephritis, and physical examination. 2. Blood routine tests and clotting time should be checked. For patients with a history of rheumatism, check for anti-"o", erythrocyte sedimentation rate, mucin, etc. Patients with a history of nephritis should check their urine routine to choose surgery during a stable period. 3. Care should be taken to clean the mouth before surgery, and rinse with 1:5000 nitrofurazone solution or saline. 4. Patients with tonsils due to lesions, such as rheumatism, nephritis, etc., use antibiotics before surgery to prevent postoperative lesions, generally preoperative injection of penicillin 3d. 5. Take phenobarbital 0.1g 2 hours before surgery, subcutaneous injection of atropine 0.5mg half an hour before surgery to reduce the excessive secretion of oral secretions during surgery. Children's dosage should be reduced according to age. 6. Carry out missions before surgery to reduce unnecessary concerns of patients and make the operation go smoothly. Surgical procedure 1. Take the lying position or sitting position, the child takes the supine position, the head leans back, and the bolster under the shoulder. The assistant holds and fixes the head, and the other assistant fixes the shoulder and the two hands. The surgeon stands on the left side of the patient and holds the tongue depressor on the left. Hold the cutter in the right hand. 2. Adults and children generally do not need a mouthparts. Children who do not cooperate need to use a mouthparts. Use a tongue depressor to press down the right side of the tongue, exposing the lower toe of the right tonsil, and cutting the knife ring from the lower pole. In, move upward along the longitudinal axis of the tonsil, rotate the cutter so that the direction of the knife ring is parallel to the longitudinal axis, and move the handle to the opposite side angle. 3. Place the knife ring between the pharyngeal arch and the tonsils, and lift it up. At this time, the tonsils have been mostly inserted into the knife ring, and a small part is located under the tongue arch, above the knife ring, in the tongue bow. Form a raised bag. 4. Use your left thumb or index finger to press the raised bag into the knife ring until the thumb or thumb of the thumb can click on the edge of the knife ring. Be careful not to press the tongue and the mucous membrane into the knife ring to avoid tearing it. 5. Tighten the blade, at which point the entire tonsil should be below the knife ring. The handle is twisted, and the operator immediately changes position, moving from the left side of the patient to the back of the head. Move the tongue depressor to press down the left tongue surface to expose the lower toe of the left tonsil. At this time, the right hand will pull the tonsil out and cut it. Quickly insert the knife ring into the lower part of the left tonsil and cut the left tonsil according to the above method. Let the sick child sit up and spit out the blood. 6. Check the wound after the tonsil is removed, use a tongue depressor to lower the back of the tongue, check for residual tonsils, active bleeding, and tearing around the tissue. If there is residual tonsil tissue, it can be cut again with a small knife ring, or the residual tonsil tissue can be bitten with a biopsy forceps. complication 1. Bleeding is the most common complication. The bleeding within 24 hours after surgery is primary, often caused by large surgical damage, incomplete hemostasis, and residual tonsils. Hemorrhage in the 5th to 6th day after surgery is secondary, often caused by local leukorrhea, wound infection and so on. When hemostasis, first check the wound, understand the bleeding site, clean up the wound, and remove the blood clot. If a small amount of oozing, you can use cotton balls or yarn balls to dip 1 adrenaline, stop bleeding powder; active bleeding, then use hemostats to clamp and suture and stop bleeding. Such as tonsil nest infection, and diffuse bleeding, simple compression can not stop bleeding, can be filled with sterile yarn balls in the nest, then suture the tongue and pharyngeal arch stitches, so that the ball is fixed after 24 hours of compression , remove the yarn ball. However, the stitching must be tight to prevent the yarn from falling off, blocking the glottis, and causing an accident. 2. Wound infection Infection of tonsil after surgery is caused by factors such as less strict disinfection during surgery, uncontrolled tonsil inflammation, and poor systemic resistance. It is characterized by no growth of white film after surgery, or the white film does not grow well, or appears as a thick gray or gray-green film, local congestion is obvious. Should pay attention to clean the mouth, appropriate use of antibiotics to control infection. 3. Heart and kidney disease For patients with uncontrolled rheumatic fever, heart disease, nephritis, arthritis, surgery may lead to acute attacks of heart, kidney and other diseases, and even bacteria in the tonsils can enter the blood, bacteremia occurs after surgery. Sepsis, subacute bacterial endocarditis, etc. Therefore, patients with original heart disease, nephritis, arthritis, if performing tonsillectomy, should be treated with caution in the choice of timing of surgery, antibiotics should be given before and after surgery. 4. Pneumonia, lung abscess, tracheobronchial foreign body is mainly caused by blood, secretions or foreign bodies inhaled into the respiratory tract during surgery. Those who perform surgery under general anesthesia are more likely to perform surgery than under local anesthesia. Keep the airway open during the operation and timely remove the blood and secretions accumulated in the pharynx. Note that this complication can be avoided by leaving the pharynx in the foreign body. 5. Soft palate, uvula edema, which is often involved in surgery or injury, caused by local tissue circulation disorder after surgery, so the operation should be gentle. 6. Pharyngeal scars, uvula and tongue and arch injury are more common due to the heavier injury during surgery and a wider scar in the pharynx. The soft palate is tightened, the uvula disappears, and the nasopharyngeal cavity is incomplete. Therefore, the tissue around the tonsils should be damaged as little as possible during surgery.