Posttonsillektomi kanama: Çocuklar ve yetişkinler arasındaki farklar

Amaç: Tonsillektomi veya adenotonsillektomi yapılan erişkin ve çocuk hastalarda görülen posttonsillektomi kanamaların (PTK) özelliklerini incelemek ve karşılaştırmakMateryal ve Metod: Bu retrospektif kesitsel çalışmada 1 Ocak 2014 ile 30 Eylül 2018 arasında Tokat Devlet Hastanesinde bipolar elektrokoter ile tonsillektomi veya adenotonsillektomi yapılan 421 hastanın elektronik medikal kayıtları incelendi. Hastaların yaş, cinsiyet, uygulanan cerrahi prosedürler, PTK' nın gerçekleştiği gün, PTK için kan transfüzyonu gerekliliği, PTK da hemostazın tipi gibi özellikleri değerlendirildi.Bulgular: PTK, erişkinlerde (yaş≥16) %6,10, çocuklarda (yaş<16) % 2,41 oranında görüldü. Primer PTK bir erişkin hastada görülürken,çocuk hastalarda primer PTK görülmedi. Sekonder PTK erişkinlerde sekiz (%6,10) hastada görülürken, çocuklarda yedi (%2,41) hastada görüldü. PTK insidansı erişkinlerde çocuklara göre anlamlı düzeyde yüksek bulundu (p<0,05). Kan tranfüzyonu ihtiyacı iki erişkin PTK’lı hastada olurken, çocuk hastalardaki PTK’ ların hiçbirinde kan transfüzyonu ihtiyacı olmadı. PTK görülen yedi çocuk hastanın üçünde spontan hemostaz görülürken, dört hastada hemostaz genel anestezi altında sağlandı. PTK görülen 9 erişkin hastanın birinde spontan hemostaz görüldü. Altı hastada ise hemostaz genel anestezi altında sağlandı. Sonuç: Erişkinlerde PTK çocuklara göre daha fazla görülmektedir. Genel olarak PTK nın en sık görüldüğü günler postoperatif 6.-8. Günler arasıdır. Spontan hemostaz çocuklarda erişkinlere göre daha fazla görülürken, çocuklardaki PTK da genel anestezi altında hemostaz oranı daha yüksektir.

Anahtar Kelimeler:

Posttonsillektomi kanama, Tonsillektomi, Çocuk, Erişkin

Posttonsillectomy bleeding: Difference between children and adults

Background: To examine and compare the characteristics of posttonsillectomy bleeding (PTB) in adult and pediatric patients who underwent tonsillectomy or adenotonsillectomy.Methods: In this retrospective cross-sectional study, medical records of 421 patients who underwent bipolar elecrtocautery with tonsillectomy or adenotonsillectomy in Tokat State Hospital between 1 January 2014 and 30 September 2018 were examined. The characteristics of the patients such as age, gender, surgical procedures performed, the day of PTB, necessity of blood transfusion for PTB, type of hemostasis in PTB were evaluated. Results: PTB was 6.10% in adults (age≥16) and 2.41% in children (age <16). While PTB was seen in an adult patient, primary PTB was not seen in pediatric patients. Secondary PTB was seen in eight (6.10%) patients in adults and in seven (2.41%) patients in children. The incidence of PTB was significantly higher in adults than in children (p <0.05). The need for blood transfusion was in two adult patients with PTB, but none of the PTBs required blood transfusion in pediatric patients. Spontaneous hemostasis was seen in three of seven children with PTB, and hemostasis was performed in four patients under general anesthesia. Spontaneous hemostasis was observed in one of the nine adult patients with PTB. In six patients, hemostasis was performed under general anesthesia. Conclusions: PTB is more common in adults than in children. In general, the most common days of PTB are postoperative 6.-8. days. Spontaneous hemostasis is more common in children than in adults, whereas in children, PTB has a higher rate of hemostasis under general anesthesia.

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