Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disorders
Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disorders
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患有出血性疾病的儿童和年轻人腺样体扁桃体切除术的出血并发症
DOI：
10.1111/hae.12577
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发表时间：
2015
期刊：
影响因子：
3.9
通讯作者：
V. Rodriguez
中科院分区：
文献类型：
--
作者：
D. Warad;F. Hussain;A. Rao;S. Cofer;V. Rodriguez
出血并发症仍然是出血性疾病患者外科手术的一个挑战。在儿童和年轻人中，最常进行的手术是扁桃体切除术和/或腺样体切除术。这些出血性疾病患者的充分止血集中于全面的围手术期止血支持和灵巧的手术技术。本研究的目的是评估患有已知出血性疾病的儿童和年轻人的扁桃体切除术和/或腺样体切除术的术后出血并发症。对1992年7月至2012年7月期间在马约诊所（罗切斯特MN）接受扁桃体切除术和/或腺样体切除术的所有年龄<25岁且患有已知出血性疾病的患者进行回顾性审查。与报告的文献相反，尽管有积极的止血支持和适当的手术技术，我们观察到出血并发症的发生率更高（10/19，53%）。迟发性出血（术后> 24小时）比早期出血更常见;复发性出血与年龄较大有关。患有出血性体质的儿童和年轻人接受腺样体扁桃体切除术后延迟出血的风险较高，需要在术后长时间内密切监测止血支持。需要一个统一的方法来管理这些患者围手术期建立标准的实践指南，并最终减少术后出血并发症。
Haemorrhagic complications remain a challenge with surgical procedures in patients with bleeding disorders. In children and young adults, the most commonly performed surgeries are tonsillectomies and/or adenoidectomies. Adequate haemostasis in these patients with bleeding disorders is centred on comprehensive perioperative haemostatic support and dexterous surgical technique. The aim of this study was to assess postoperative bleeding complications with tonsillectomy and/or adenoidectomy in children and young adults with known bleeding disorders. Retrospective review of all patients aged <25 years with known bleeding disorders who underwent tonsillectomy and/or adenoidectomy at Mayo Clinic, Rochester MN between July 1992 and July 2012. In contrast to reported literature, we observed a higher rate of bleeding complications (10/19, 53%) despite aggressive haemostatic support and appropriate surgical techniques. Delayed bleeding (>24 h postoperatively) was more common than early bleeding; and recurrent bleeding was associated with older age. Children and young adults with haemorrhagic diatheses undergoing adenotonsillectomy are at a higher risk of delayed bleeding and require close monitoring with haemostatic support for a prolonged duration in the postoperative period. A uniform approach is needed to manage these patients perioperatively by establishing standard practice guidelines and ultimately reduce postsurgical bleeding complications.