Analysis of the causes of immediate bleeding after pediatric adenoidectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the incidence of postoperative hemorrhage in children undergoing adenoidectomy, and to discuss its possible causes.</p><p><b>METHODS</b>Included in this study were children who underwent adenoid and/or tonsil surgery at Shenzhen Children's Hospital between January 2004 and November 2009. The change of hemoglobin (Hb) and hematocrit (Hct) were retrospectively analysed. The blood loss was estimated by the change of Hct.</p><p><b>RESULTS</b>There were 2078 cases that accomplished the inclusion criteria in the period of study. Ten children bled 0.5 - 4.0 hours after surgery, without superfluous hemorrhage during the operation and post-tonsillectomy. This represented an incidence of 0.48%of immediate postoperative haemorrhage among the 2078 procedures analyzed. Statistical differences were found between boys (0.21%) and girls (1.10%, χ² = 5.597, P < 0.05). The change of Hb and Hct was positively correlated (r = 0.95, P < 0.01), the blood loss was positively correlated with the bleeding time (r = 0.66, P < 0.05). The causes of postoperative hemorrhage were coagulation system deficits, chronic nasopharyngitis, deficient hemostasis and immoderate ravage. To control the postoperative hemorrhage, 2 postnasal packing under topical anaesthesia and 8 electrocautery under general anaesthesia were applied.</p><p><b>CONCLUSIONS</b>Poor operative technique and deficient hemostasis are the major causes of primary hemorrhage. Prompt operation to control the postoperative bleeding should be done 2 hours after bleeding under general anesthesia in order to avoid severe complications.</p>

Etiology of inspiratory laryngeal stridor in children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Retrospective analysis was performed on the etiology of inspiratory laryngeal stridor in children. The purpose is to raise the diagnosis and cure rate of the disease.</p><p><b>METHODS</b>All patients were hospitalized in Children's Hospital from Jan, 2005 to Jan, 2007. Among of them, 245 cases were male and 133 cases were female. The median age was 4 months (range from 12 hours to 30 months). All the patients had chest X-ray examination. Two hundred and eighteen cases received chest CT scan, video laryngoscope, direct laryngoscope and bronchofibroscopy.</p><p><b>RESULTS</b>The diagnosis were as follows: acute laryngitis (140 cases), laryngomalacia (117 cases), acute laryngotracheal bronchitis (54 cases), vocal cord paralysis (18 cases), congenital tracheomalacia (9 cases), congenital laryngeal webs (8 cases), congenital cleft of larynx (6 cases), laryngeal cyst (6 cases), laryngeal papilloma (6 cases), acute epiglottitis (4 cases), congenital infraglottic stenosis (3 cases), tracheobronchial foreign body (3 cases), cysts thyrolinguals (1 case). All cases were cured except congenital tracheomalacia (9 cases), congenital cleft of larynx (6 cases), laryngeal papilloma (6 cases), congenital infraglottic (3 cases).</p><p><b>CONCLUSIONS</b>The etiology of inspiratory laryngeal stridor in children are very complicated. Video laryngoscope is recommended for all cases except for the acute inflammation disease. Chest CT scan and bronchofibroscopy may be necessary for some cases.</p>