What Is Post-Tonsillectomy Hemorrhage?

Tonsillectomy is a common and basic operation in ENT. It is required to completely remove the entire tonsill with the capsule to treat recurrent chronic tonsillitis, which has a certain effect. However, it is necessary to take a serious and cautious attitude towards tonsillectomy, otherwise complications may occur and even serious consequences may result.

Tonsillectomy

Tonsillectomy is a common and basic operation in ENT. Requires complete removal of the entire tonsil with capsule to treat recurring

1. Diseases of the tonsil itself are repeated

1.

Although tonsil surgery is simple, it should not be performed hastily. The following examinations should be done before surgery:

1. Learn more about medical history, whether there is bleeding disease,

1. Children's larger tonsils can be squeezed under surface or general anesthesia

There are two types of local anesthesia tonsillectomy and general anesthesia tonsillectomy.

Local anesthesia tonsillectomy

1. The patient usually takes a seated position. The operator sits opposite to the patient with the light source on the patient's head.

2. Inject anesthetic and take 20% 1% procaine, add 4 to 6 drops of adrenaline solution of 1: 1000, and then withdraw a half of the above anesthetic with a 10ml syringe, and use a tongue depressor in front of the tongue 2/3 and after Squeeze the 1/3 junction to expose the pharynx. Inject 3 to 4ml of anesthetic into the upper, middle, and lower parts of the tongue and palate arches; first pierce the needle tip under the mucosa and inject a little, then prick the needle tip around the tonsils Into. In addition to the anesthetic effect, the injected anesthetic can separate the tonsils from the tonsil fossa. Between the upper part of the pharyngeal arch and the upper pole of the tonsil, a little anesthetic () is also injected, and the opposite side is anesthetized according to this method. At this time, the patient felt the pharynx swollen and had difficulty swallowing. After the injection was completed, surgery was performed after 5 minutes.

3. Incision with a tonsil knife along the tongue and palatine arch, 1 to 2 mm away from the free margin, cut down from the upper pole of the tonsil to the base of the tongue and palatine arch (), and then bypass the upper pole to extend the incision and cut the pharyngeal arch. However, care must be taken during the operation. The incision should not be too deep, and the mucosa should only be opened. If it is cut too deeply, it will damage the pharynx. Or cut into the tonsil tissue, it is easy to cause bleeding and wound infection.

4. To peel the tonsils, use the tonsil stripper from the tongue and palate incision. First, peel the tongue and palate from the front of the tonsil. Then press down the upper pole of the tonsil. Use the tonsil grasping forceps to hold the upper part of the tonsil. Squash the tonsils to separate them from the tonsil fossa, leaving a small pedicle at the lower pole. When peeling, the peeler cannot be dug deep into the fossa, so as not to damage the superior pharyngeal contractile muscle or blood vessels and cause bleeding ().

5. Trap Removal Put the tonsil grasping forceps at the tonsil snare into place, use the tonsil grasping forceps to grasp the tonsil inward and pull upwards, and pull the snare outwards to cover the pedicle, tighten the snare, and remove the tonsils (). Use a tonsil hemostatic forceps to clamp the cotton ball, put it into the tonsil fossa to compress the hemostasis, and check whether the tonsil is intact and there is no tissue damage ().

6. To check the wound, pull out the tongue and palate arch with tonsil hooks, check whether there is bleeding in the tonsil fossa, and whether there is residual tonsil tissue, especially in the lower triangular triangular folds of the tonsil.

1. The most common complication after tonsillectomy is bleeding, which is usually caused by too little resection (residual) or too much resection (damaging surrounding tissue), so the operation needs to be careful, and the peeling is performed along the outside of the capsule.

2. Before the snare is tightened, avoid the grasping forceps slipping off and prevent the tonsils from falling into the trachea.

1. The patient should be observed for bleeding, and the patient should be told to spit out all bloody secretions in the mouth, and do not swallow. For children with general anesthesia, pay attention to frequent swallowing movements to estimate the possibility of bleeding. If blood spit out, check for hemostasis in time.

2. It is advisable to drink cold juice on the first day after operation and a semi-liquid diet on the second day, but not too hot. 1

1. In the case of acute tonsillitis, surgery is generally not performed, and surgery can be performed 3-4 weeks after the inflammation subsides. Because at this time the patient is generally feverish, the tonsils are congested, and the wound is prone to bleeding or secondary infection after surgery.

2. In polio and influenza, women's menstrual period and premenstrual period are not suitable for surgery.

3. After tonsil surgery, the blood vessels in the tonsil fossa will shrink by themselves, and the blood will coagulate to stop bleeding. And coagulation and decreased blood vessel elasticity caused by various reasons can cause postoperative bleeding. Therefore, diseases such as hemophilia, aplastic anemia, leukemia, and purpura are not suitable for surgery.

4. Surgery should not be performed during the active phase of diseases such as blood diseases, hypertension, compensatory insufficiency, heart disease, hepatitis, and active tuberculosis. Surgery will worsen the condition and even cause serious complications.

5, rheumatic fever and nephritis and other systemic symptoms should not be surgery.

6. The immunoglobulin deficiency or the high incidence of autoimmune disease in the family members of patients. Those with a white blood cell count below 3000.