fa مقایسه پیامدهای حین و پس از جراحی تانسیلکتومی در دو روش cold dissection و LigaSure: یک مطالعه کارآزمایی بالینی گوش و حلق و بيني Otolaryngology or ENT پژوهشي-کامل Research(Original) <span style="line-height:2;"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><span lang="FA"><span b="" koodak="" style="font-family:"><span style="letter-spacing:-.2pt">سابقه و هدف:</span></span></span></b> <span lang="FA"><span b="" style="font-family:" zar="">تانسیلکتومی یکی ازشایع‌ترین جراحی‌های انجام‌ شده در جمعیت کودکان می‌باشدکه عوارض متعددی مانند درد و خون‌ریزی دارد. این مطالعه با هدف مقایسه دو روش جراحی تانسیلکتومی </span></span><span dir="LTR" style="font-size:10.0pt">LigaSure</span><span b="" style="font-family:" zar=""> و </span><span dir="LTR" style="font-size:10.0pt">cold dissection</span><span lang="FA"><span b="" style="font-family:" zar=""> از نظر مدت زمان جراحی، میزان خونریزی حین و پس از عمل، و بروز عوارض پس از عمل شامل تهوع و استفراغ، گلو درد و گوش درد، انجام پذیرفت.</span></span><span lang="FA"><span b="" roya="" style="font-family:"><span style="letter-spacing:-.2pt"></span></span></span></span></span><br> <span style="direction:rtl"><span style="unicode-bidi:embed"><b><span lang="AR-SA"><span b="" koodak="" style="font-family:"><span style="letter-spacing:-.2pt">مواد و روش </span></span></span></b><b><span lang="FA"><span b="" koodak="" style="font-family:"><span style="letter-spacing:-.2pt">‌</span></span></span></b><b><span lang="AR-SA"><span b="" koodak="" style="font-family:"><span style="letter-spacing:-.2pt">ها:</span></span></span></b> <span lang="AR-SA"><span b="" style="font-family:" zar="">این مطالعه کارآزمایی بالینی یک سوکور </span></span><span lang="FA"><span b="" style="font-family:" zar="">بود که </span></span><span lang="AR-SA"><span b="" style="font-family:" zar="">بر روی بیماران کاندید جراحی تانسیلکتومی در بیمارستان بوعلی شهرستان ساری انجام شد. 60 بیمار (بزرگسال و خردسال)</span></span><span lang="FA"><span b="" style="font-family:" zar=""> به‌طور تصادفی به روش </span></span><span dir="LTR" style="font-size:10.0pt">Block Randomization</span><span lang="FA"><span b="" style="font-family:" zar=""> به دو گروه تقسیم شدند و</span></span><span lang="AR-SA"><span b="" style="font-family:" zar=""> تحت عمل </span></span><span lang="FA"><span b="" style="font-family:" zar="">تانسیلکتومی به روش </span></span><span dir="LTR" style="font-size:10.0pt">LigaSure</span><span b="" style="font-family:" zar=""> و </span><span dir="LTR" style="font-size:10.0pt">cold dissection</span><span lang="FA"><span b="" style="font-family:" zar=""> قرار گرفتند. </span></span><span lang="AR-SA"><span b="" style="font-family:" zar="">مدت زمان جراحی از زمان تعبیه </span></span><span dir="LTR" style="font-size:10.0pt">gagmouth</span><span lang="AR-SA"><span b="" style="font-family:" zar=""> تا اتمام جراحی در نظر گرفته</span></span> <span lang="AR-SA"><span b="" style="font-family:" zar="">شد. خونریزی حین عمل توسط ساکشن مدرج ثبت شد و اطلاعات به صورت انفرادی ثبت شد. تمام بیماران در 24 ساعت اول</span></span><span lang="FA"><span b="" style="font-family:" zar="">،</span></span><span lang="AR-SA"><span b="" style="font-family:" zar=""> 7 و 14 روز پس از عمل نظر خونریزی در بستر لوزه و گوش درد و گلو درد و</span></span> <span lang="AR-SA"><span b="" style="font-family:" zar="">استفراغ مورد بررسی قرا</span></span><span lang="FA"><span b="" style="font-family:" zar="">ر گرفتند</span></span><span lang="AR-SA"><span b="" style="font-family:" zar="">.</span></span><span lang="FA"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt"></span></span></span></span></span><br> <span style="direction:rtl"><span style="unicode-bidi:embed"><b><span lang="AR-SA"><span b="" koodak="" style="font-family:"><span style="letter-spacing:-.2pt">یافته</span></span></span></b><b><span lang="FA"><span b="" koodak="" style="font-family:"><span style="letter-spacing:-.2pt">‌</span></span></span></b><b><span lang="AR-SA"><span b="" koodak="" style="font-family:"><span style="letter-spacing:-.2pt">ها:</span></span></span></b> <span lang="AR-SA"><span b="" style="font-family:" zar="">در هر دو گروه از نظر سن، وزن و جنس اختلاف معنی‌دار وجود نداشت. مدت‌ زمان جراحی در گروه</span></span><br> <span dir="LTR" style="font-size:10.0pt">cold dissection</span> <span lang="AR-SA"><span b="" style="font-family:" zar="">2/7</span></span><span lang="AR-SA"><span cambria="" style="font-family:">&plusmn;</span></span><span lang="AR-SA"><span b="" style="font-family:" zar="">13/5 دقیقه و در گروه </span></span><span dir="LTR" style="font-size:10.0pt">LigaSure</span> <span lang="AR-SA"><span b="" style="font-family:" zar="">1/6</span></span><span lang="AR-SA"><span cambria="" style="font-family:">&plusmn;</span></span><span lang="AR-SA"><span b="" style="font-family:" zar="">7/4 دقیقه بود و اختلاف معنی‌دار وجود داشت (0/001></span></span><span dir="LTR" style="font-size:10.0pt">P</span><span lang="FA"><span b="" style="font-family:" zar="">). </span></span><span lang="AR-SA"><span b="" style="font-family:" zar="">خون‌ریزی حین عمل در گروه </span></span><span dir="LTR" style="font-size:10.0pt">cold dissection</span><span lang="FA"><span b="" style="font-family:" zar=""> 76/6</span></span><span lang="FA"><span cambria="" style="font-family:">&plusmn;</span></span><span lang="FA"><span b="" style="font-family:" zar="">93/2 سی سی &nbsp;و در گروه </span></span><span dir="LTR" style="font-size:10.0pt">LigaSure</span><span b="" style="font-family:" zar=""> 0/9</span><span lang="FA"><span cambria="" style="font-family:">&plusmn;</span></span><span lang="FA"><span b="" style="font-family:" zar="">0/4&nbsp; سی سی بود </span></span><span lang="AR-SA"><span b="" style="font-family:" zar="">و اختلاف معنی‌دار وجود داشت</span></span><span lang="FA"><span b="" style="font-family:" zar="">. درد گلو در 24 ساعت بعد از عمل جراحی در </span></span><span dir="LTR" style="font-size:10.0pt">cold</span><span lang="FA"><span b="" style="font-family:" zar=""> بیش‌تر ولی در روز 7 ام و 14 ام میزان درد گلو در </span></span><span dir="LTR" style="font-size:10.0pt">LigaSure</span><span b="" style="font-family:" zar=""> بیش‌تر بود.</span><span lang="AR-SA"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt"></span></span></span></span></span><br> <span style="direction:rtl"><span style="unicode-bidi:embed"><b><span lang="FA"><span b="" koodak="" style="font-family:"><span style="letter-spacing:-.1pt">استنتاج:</span></span></span></b><span lang="FA"><span b="" style="font-family:" zar=""> با توجه به کاهش مدت زمان جراحی، میزان کم‌ترخونریزی حین عمل و بروز عوارض کم‌تر در گروه </span></span><span dir="LTR" style="font-size:10.0pt">ligasure</span><span lang="FA"><span b="" style="font-family:" zar=""> نسبت به </span></span><span dir="LTR" style="font-size:10.0pt">cold dissection</span><span lang="FA"><span b="" style="font-family:" zar="">، به نظر می رسد</span></span> <span lang="FA"><span b="" style="font-family:" zar="">استفاده از</span></span> <span lang="FA"><span b="" style="font-family:" zar="">این روش می تواند گزینه ای مناسب برای انجام تانسیلکتومی باشد.</span></span><span lang="AR-SA"><span style="font-family:"B Zar""></span></span></span></span><br> <span style="direction:rtl"><span style="unicode-bidi:embed"><i><span lang="FA" style="font-size:10.0pt"><span style="font-family:"B Zar""></span></span></i></span></span><br> <i><span dir="RTL" lang="FA" style="font-size:10.0pt"><span b="" style="font-family:" zar="">شماره ثبت کارآزمایی بالینی: </span></span><span style="font-size:10.0pt"><span new="" roman="" style="font-family:" times="">IRCT</span></span> <span style="font-size:10.0pt"><span new="" roman="" style="font-family:" times="">IRCT20190816044539N1</span></span></i></span> <span style="line-height:2;"><b><span style="font-size:10.0pt"><span arial=""><span style="letter-spacing:-.1pt">Background and purpose:</span></span></span></b> <span style="font-size:10.0pt">Tonsillectomy is one of the most commonly performed surgical procedures in children and is associated with several complications, including pain and bleeding. The aim of this study was to compare two tonsillectomy techniques - LigaSure and cold dissection - in terms of intraoperative outcomes (operation time and intraoperative bleeding) and postoperative complications, including nausea, vomiting, sore throat, ear pain, and bleeding.<span style="line-height:125%"></span></span><br> <b><span style="font-size:10.0pt"><span arial=""><span style="letter-spacing:-.2pt">Materials and methods:</span></span></span></b> <span style="font-size:10.0pt">A single-blind randomised clinical trial was conducted on patients scheduled for tonsillectomy at Buali Hospital in Sari. A total of 60 adult and paediatric patients were randomly allocated into two groups using block randomisation and underwent tonsillectomy using either the LigaSure or cold dissection technique. Surgical time was recorded from gag insertion (mouth opening with retractor placement) to completion of the procedure. Intraoperative bleeding was measured using a graded suction system, and all data were recorded individually for each participant. Patients were followed up at 24 hours, 7 days, and 14 days postoperatively, during which tonsillar bleeding, earache, sore throat, and vomiting were assessed.<span style="line-height:125%"></span></span><br> <b><span style="font-size:10.0pt"><span arial=""><span style="letter-spacing:-.2pt">Results:</span></span></span></b><b> </b><span style="font-size:10.0pt">There were no significant differences between the two groups in terms of age, weight, or gender. The mean operation time was 13.5 &plusmn; 2.7 minutes in the cold dissection group and 7.4 &plusmn; 1.6 minutes in the LigaSure group, showing a statistically significant difference (P< 0.001). Intraoperative bleeding was 93.2 &plusmn; 76.6 mL in the cold dissection group compared with 0.4 &plusmn; 0.9 mL in the LigaSure group, which was also statistically significant. Postoperatively, earache was more frequently reported in the cold dissection group at 24 hours, whereas sore throat was more common in the LigaSure group at 7 and 14 days after surgery.<span style="line-height:125%"></span></span><br> <b><span style="font-size:10.0pt"><span arial="">Conclusion:</span></span></b><span style="font-size:10.0pt"> Considering the shorter operative time, reduced intraoperative bleeding, and lower complication rates associated with the LigaSure technique compared with cold dissection, it is recommended that the LigaSure method be preferred for tonsillectomy in children.<span style="line-height:125%"></span></span><br> <span dir="RTL" lang="AR-SA" style="font-size:2.0pt"><span style="letter-spacing:-.1pt"></span></span><br> <span style="font-size:9.0pt"><span style="letter-spacing:-.1pt">(Clinical Trials Registry Number: </span></span><i><span style="font-size:9.0pt">IRCT</span></i><i> </i><i><span style="font-size:9.0pt">IRCT20190816044539N1</span></i><span style="font-size:9.0pt"><span style="letter-spacing:-.1pt">)</span></span><br> &nbsp;</span> تانسیلکتومی, cold dissection, لیگاشور tonsillectomy, cold dissection, LigaSure 4 12 http://jmums.mazums.ac.ir/browse.php?a_code=A-10-16863-2&slc_lang=fa&sid=1 Maliheh Shirzad ملیحه شیرزاد m.shirzad9389@gmail.com 1003194753284600185763 1003194753284600185763 No Instructor, Department of Operating Room, Faculty of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran مربی، گروه اتاق عمل ،دانشکده پیراپزشکی ، دانشگاه علوم پزشکی مازندران، ساری، ایران Rostam Poormosa رستم پورموسی samadi.zahra1373@gmail.com 1003194753284600185764 1003194753284600185764 No Assistant Professor, Department of Otolaryngology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran استادیار ،گروه جراحی گوش و حلق و بینی، دانشکده پزشکی ، دانشگاه علوم پزشکی مازندران، ساری، ایران Ehsan Memarbashi احسان معمارباشی ehsan.memar1991@gmail.com 1003194753284600185765 1003194753284600185765 No Instructor, Department of Paramedical Sciences, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran مربی، کارشناس ارشد اتاق عمل، گروه پیراپزشکی، دانشکده علوم پزشکی فردوس، دانشگاه علوم پزشکی بیرجند، بیرجند، ایران Ebrahim Nasiri Formi ابراهیم نصیری rezanf2002@yahoo.com 1003194753284600185766 1003194753284600185766 Yes Department of Anesthesiology, Operating Room and Emergencies, Faculty of Allied Medical Sciences, Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran دانشیار، گروه هوشبری و اتاق عمل، دانشکده پیراپزشکی ، مرکز تحقیقات طب سنتی و مکمل وپژوهشکده اعتیاد ساری، دانشگاه علوم پزشکی مازندران، ساری، ایران