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03/12/2022
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Trần, V. B., & Lê, T. T. (2022). TỔNG QUAN XỬ TRÍ CHẢY MÁU SAU CẮT AMIĐAN. Tạp chí Tai Mũi Họng Việt Nam, 67(58), 36-47. https://tapchitaimuihong.vn/index.php/tmh/article/view/5
TỔNG QUAN XỬ TRÍ CHẢY MÁU SAU CẮT AMIĐAN
Nội dung chính của bài viết
Tóm tắt
Chảy máu sau phẫu thuật là biến chứng phổ biến và nguy hiểm nhất của phẫu thuật cắt amiđan, là mối quan tâm hàng đầu của phẫu thuật viên tai mũi họng, mặc dù đã có nhiều nỗ lực trong việc cải thiện phương pháp phẫu thuật và cầm máu nhằm hạn chế biến chứng này. Trong khi đó, hiện chưa có hướng dẫn nào dựa trên bằng chứng được đưa ra nhằm giúp bác sĩ lâm sàng xử trí biến chứng này. Vì vậy, mục tiêu của nghiên cứu này là tổng hợp các bằng chứng hiện có và đưa ra các đề xuất chung cho việc xử trí chảy máu sau cắt amiđan, nhằm góp phần vào việc kiểm soát tỷ lệ biến chứng này.
Chi tiết bài viết
Từ khóa
cắt amiđan, chảy máu sau phẫu thuật, biến chứng
Tài liệu tham khảo
1. BuSaba N, D.S., Tonsillectomy in adults: Indications. In T.W.Post, Aronson MD, Deschler DG, Kunins L (Eds). Uptodate 2018. Available from
https://www.uptodate.com/contents/ton sillectomy-in-adults-indications.
2. Cullen, K.A., M.J. Hall, and A. Golosinskiy, Ambulatory surgery in the United States, 2006. Natl Health Stat Report, 2009(11): p. 1-25.
3. Lee, W.T., et al., Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement. Otolaryngol Head Neck Surg, 2016. 155(1): p. 28-32.
4. Mitchell, R.B., et al., Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg, 2019. 160(1_suppl): p. S1-S42.
5. Goldman, J.L., et al., Mortality and major morbidity after tonsillectomy: etiologic factors and strategies for prevention. Laryngoscope, 2013. 123(10): p. 2544-53.
6. Sarny, S., et al., Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope, 2011. 121(12): p. 2553-60.
7. Tolska, H.K., et al., Post-tonsillectomy haemorrhage more common than previously described--an institutional chart review. Acta Otolaryngol, 2013. 133(2): p. 181-6.
8. Gay, J.C., et al., Epidemiology of 15-Day Readmissions to a Children's Hospital. Pediatrics, 2011. 127(6): p. e1505-12.
9. Belyea, J., et al., Post-tonsillectomy complications in children less than three years of age: a case-control study. Int J Pediatr Otorhinolaryngol, 2014. 78(5): p. 871-4.
10. Colclasure, J.B. and S.S. Graham, Complications of outpatient tonsillectomy and adenoidectomy: a review of 3,340 cases. Ear Nose Throat J, 1990. 69(3): p. 155-60.
11. Ikoma, R., et al., Risk factors for post- tonsillectomy hemorrhage. Auris Nasus Larynx, 2014. 41(4): p. 376-9.
12. Myssiorek, D. and A. Alvi, Post- tonsillectomy hemorrhage: an assessment of risk factors. Int J Pediatr Otorhinolaryngol, 1996. 37(1): p. 35-43.
13. De Luca Canto, G., et al., Adenotonsillectomy Complications: A Meta-analysis. Pediatrics, 2015. 136(4): p. 702-18.
14. Lescanne, E., et al., Pediatric tonsillectomy: clinical practice guidelines. Eur Ann Otorhinolaryngol Head Neck Dis, 2012. 129(5): p. 264-71.
15. Lowe, D., et al., Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope, 2007. 117(4): p. 717-24.
16. Subramanyam, R., et al., Future of pediatric tonsillectomy and perioperative outcomes. Int J Pediatr Otorhinolaryngol, 2013. 77(2): p. 194- 9.
17. Fox, S.L., Bleeding following tonsillectomy. Laryngoscope, 1952. 62(4): p. 414-25.
18. Kumar, R., Secondary haemorrhage following tonsillectomy/adenoidectomy. J Laryngol Otol, 1984. 98(10): p. 997-8.
19. Handler, S.D., et al., Post- tonsillectomy hemorrhage: incidence, prevention and management. Laryngoscope, 1986. 96(11): p. 1243- 7.
20. Richmond, K.H., R.F. Wetmore, and C.C. Baranak, Postoperative complications following tonsillectomy and adenoidectomy--who is at risk? Int J Pediatr Otorhinolaryngol, 1987. 13(2): p. 117-24.
21. Guida, R.A. and K.F. Mattucci, Tonsillectomy and adenoidectomy: an inpatient or outpatient procedure? Laryngoscope, 1990. 100(5): p. 491-3.
22. Watson, M.G., et al., A study of haemostasis following tonsillectomy comparing ligatures with diathermy. J Laryngol Otol, 1993. 107(8): p. 711-5.
23. Kang, J., et al., Coagulation profile as a predictor for post-tonsillectomy and adenoidectomy (T + A) hemorrhage. Int J Pediatr Otorhinolaryngol, 1994. 28(2-3): p. 157-65.
24. Windfuhr, J. and M. Seehafer, Classification of haemorrhage following tonsillectomy. J Laryngol Otol, 2001. 115(6): p. 457-61.
25. Mathews, J., et al., Guillotine tonsillectomy: a glimpse into its history and current status in the United Kingdom. J Laryngol Otol, 2002. 116(12): p. 988-91.
26. Tomkinson, A., et al., Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope, 2011. 121(2): p. 279-88.
27. Windfuhr, J.P., Y.S. Chen, and S. Remmert, Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg, 2005. 132(2): p. 281-6.
28. Wei, J.L., C.W. Beatty, and R.O. Gustafson, Evaluation of posttonsillectomy hemorrhage and risk factors. Otolaryngol Head Neck Surg, 2000. 123(3): p. 229-35.
29. Perkins, J.N., et al., Risk of post- tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope, 2012. 122(10): p. 2311-5.
30. Akin, R.C., R. Holst, and L.P. Schousboe, Risk factors for post- tonsillectomy haemorrhage. Acta Otolaryngol, 2012. 132(7): p. 773-7.
31. Hessen Soderman, A.C., et al., Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope, 2011. 121(11): p. 2322-6.
32. Lowe, D., J. van der Meulen, and A. National Prospective Tonsillectomy, Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet, 2004. 364(9435): p. 697-702.
33. Burton, M.J. and C. Doree, Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev, 2007(3): p. CD004619.
34. Francis, D.O., et al., Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg, 2017. 156(3): p. 442-455.
35. Botting, R.M., Vane's discovery of the mechanism of action of aspirin changed our understanding of its clinical pharmacology. Pharmacol Rep, 2010. 62(3): p. 518-25.
36. Riggin, L., et al., A 2013 updated systematic review & meta-analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti- inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol, 2013. 38(2): p. 115-29.
37. Czarnetzki, C., et al., Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA, 2008. 300(22): p. 2621-30. 38. Geva, A. and M.T. Brigger, Dexamethasone and tonsillectomy bleeding: a meta-analysis. Otolaryngol Head Neck Surg, 2011. 144(6): p. 838- 43.
39. Prim, M.P., et al., Analysis of the causes of immediate unanticipated bleeding after pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol, 2003. 67(4): p. 341-4.
40. Witmer, C.M., et al., Incidence of bleeding complications in pediatric patients with type 1 von Willebrand disease undergoing adenotonsillar procedures. J Pediatr, 2009. 155(1): p. 68-72.
41. El Rassi, E., A. de Alarcon, and D.
Lam, Practice patterns in the management of post-tonsillectomy hemorrhage: An American Society of Pediatric Otolaryngology survey. Int J Pediatr Otorhinolaryngol, 2017. 102: p. 108-113.
42. Isaacson, G., Tonsillectomy care for the pediatrician. Pediatrics, 2012. 130(2): p. 324-34.
43. Liu, J.H., et al., Posttonsillectomy hemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg, 2001. 127(10): p. 1271-5.
44. Wall, J.J. and K.Y. Tay, Postoperative Tonsillectomy Hemorrhage. Emerg Med Clin North Am, 2018. 36(2): p. 415-426.
45. Fields, R.G., F.J. Gencorelli, and R.S.Litman, Anesthetic management of the pediatric bleeding tonsil. Paediatr Anaesth, 2010. 20(11): p. 982-6.
46. Windfuhr, J.P., et al., Post- tonsillectomy pseudoaneurysm: an underestimated entity? J Laryngol Otol, 2010. 124(1): p. 59-66.
47. Gardner, J.F., Sutures and disasters in tonsillectomy. Arch Otolaryngol, 1968. 88(5): p. 551-5.
48. Hendrix, R.A., C.K. Bacon, and M.E. Hoffer, Localization of the carotid artery within the tonsillar fossa by Doppler flow mapping. Laryngoscope, 1990. 100(8): p. 853-6.
49. Gratacap, M., et al., Embolization in the management of recurrent secondary post-tonsillectomy haemorrhage in children. Eur Radiol, 2015. 25(1): p. 239-45.
50. W. Peyton Shirley, A.L.W., Brian J. Wiatrak, Pharyngitis and Adenotonsillar Disease, in Flint PW, Haughey BH, Lund VJ, et al., eds. Cummings Otolaryngology Head & Neck Surgery. Philadelphia: Elsevier Mosby; 2010:2782-2802.
51. Cressman, W.R. and C.M. Myer, 3rd, Management of tonsillectomy hemorrhage: results of a survey of pediatric otolaryngology fellowship programs. Am J Otolaryngol, 1995. 16(1): p. 29-32.
52. Yuen, S., et al., Do post-tonsillectomy patients who report bleeding require observation if no bleeding is present on exam? Int J Pediatr Otorhinolaryngol, 2017. 95: p. 75-79.
53. Steketee, K.G. and E.J. Reisdorff, Emergency care for posttonsillectomy and postadenoidectomy hemorrhage. Am J Emerg Med, 1995. 13(5): p. 518- 23.
https://www.uptodate.com/contents/ton sillectomy-in-adults-indications.
2. Cullen, K.A., M.J. Hall, and A. Golosinskiy, Ambulatory surgery in the United States, 2006. Natl Health Stat Report, 2009(11): p. 1-25.
3. Lee, W.T., et al., Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement. Otolaryngol Head Neck Surg, 2016. 155(1): p. 28-32.
4. Mitchell, R.B., et al., Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg, 2019. 160(1_suppl): p. S1-S42.
5. Goldman, J.L., et al., Mortality and major morbidity after tonsillectomy: etiologic factors and strategies for prevention. Laryngoscope, 2013. 123(10): p. 2544-53.
6. Sarny, S., et al., Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope, 2011. 121(12): p. 2553-60.
7. Tolska, H.K., et al., Post-tonsillectomy haemorrhage more common than previously described--an institutional chart review. Acta Otolaryngol, 2013. 133(2): p. 181-6.
8. Gay, J.C., et al., Epidemiology of 15-Day Readmissions to a Children's Hospital. Pediatrics, 2011. 127(6): p. e1505-12.
9. Belyea, J., et al., Post-tonsillectomy complications in children less than three years of age: a case-control study. Int J Pediatr Otorhinolaryngol, 2014. 78(5): p. 871-4.
10. Colclasure, J.B. and S.S. Graham, Complications of outpatient tonsillectomy and adenoidectomy: a review of 3,340 cases. Ear Nose Throat J, 1990. 69(3): p. 155-60.
11. Ikoma, R., et al., Risk factors for post- tonsillectomy hemorrhage. Auris Nasus Larynx, 2014. 41(4): p. 376-9.
12. Myssiorek, D. and A. Alvi, Post- tonsillectomy hemorrhage: an assessment of risk factors. Int J Pediatr Otorhinolaryngol, 1996. 37(1): p. 35-43.
13. De Luca Canto, G., et al., Adenotonsillectomy Complications: A Meta-analysis. Pediatrics, 2015. 136(4): p. 702-18.
14. Lescanne, E., et al., Pediatric tonsillectomy: clinical practice guidelines. Eur Ann Otorhinolaryngol Head Neck Dis, 2012. 129(5): p. 264-71.
15. Lowe, D., et al., Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope, 2007. 117(4): p. 717-24.
16. Subramanyam, R., et al., Future of pediatric tonsillectomy and perioperative outcomes. Int J Pediatr Otorhinolaryngol, 2013. 77(2): p. 194- 9.
17. Fox, S.L., Bleeding following tonsillectomy. Laryngoscope, 1952. 62(4): p. 414-25.
18. Kumar, R., Secondary haemorrhage following tonsillectomy/adenoidectomy. J Laryngol Otol, 1984. 98(10): p. 997-8.
19. Handler, S.D., et al., Post- tonsillectomy hemorrhage: incidence, prevention and management. Laryngoscope, 1986. 96(11): p. 1243- 7.
20. Richmond, K.H., R.F. Wetmore, and C.C. Baranak, Postoperative complications following tonsillectomy and adenoidectomy--who is at risk? Int J Pediatr Otorhinolaryngol, 1987. 13(2): p. 117-24.
21. Guida, R.A. and K.F. Mattucci, Tonsillectomy and adenoidectomy: an inpatient or outpatient procedure? Laryngoscope, 1990. 100(5): p. 491-3.
22. Watson, M.G., et al., A study of haemostasis following tonsillectomy comparing ligatures with diathermy. J Laryngol Otol, 1993. 107(8): p. 711-5.
23. Kang, J., et al., Coagulation profile as a predictor for post-tonsillectomy and adenoidectomy (T + A) hemorrhage. Int J Pediatr Otorhinolaryngol, 1994. 28(2-3): p. 157-65.
24. Windfuhr, J. and M. Seehafer, Classification of haemorrhage following tonsillectomy. J Laryngol Otol, 2001. 115(6): p. 457-61.
25. Mathews, J., et al., Guillotine tonsillectomy: a glimpse into its history and current status in the United Kingdom. J Laryngol Otol, 2002. 116(12): p. 988-91.
26. Tomkinson, A., et al., Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope, 2011. 121(2): p. 279-88.
27. Windfuhr, J.P., Y.S. Chen, and S. Remmert, Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg, 2005. 132(2): p. 281-6.
28. Wei, J.L., C.W. Beatty, and R.O. Gustafson, Evaluation of posttonsillectomy hemorrhage and risk factors. Otolaryngol Head Neck Surg, 2000. 123(3): p. 229-35.
29. Perkins, J.N., et al., Risk of post- tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope, 2012. 122(10): p. 2311-5.
30. Akin, R.C., R. Holst, and L.P. Schousboe, Risk factors for post- tonsillectomy haemorrhage. Acta Otolaryngol, 2012. 132(7): p. 773-7.
31. Hessen Soderman, A.C., et al., Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope, 2011. 121(11): p. 2322-6.
32. Lowe, D., J. van der Meulen, and A. National Prospective Tonsillectomy, Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet, 2004. 364(9435): p. 697-702.
33. Burton, M.J. and C. Doree, Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev, 2007(3): p. CD004619.
34. Francis, D.O., et al., Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg, 2017. 156(3): p. 442-455.
35. Botting, R.M., Vane's discovery of the mechanism of action of aspirin changed our understanding of its clinical pharmacology. Pharmacol Rep, 2010. 62(3): p. 518-25.
36. Riggin, L., et al., A 2013 updated systematic review & meta-analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti- inflammatory agents on the risk of bleeding after tonsillectomy. Clin Otolaryngol, 2013. 38(2): p. 115-29.
37. Czarnetzki, C., et al., Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA, 2008. 300(22): p. 2621-30. 38. Geva, A. and M.T. Brigger, Dexamethasone and tonsillectomy bleeding: a meta-analysis. Otolaryngol Head Neck Surg, 2011. 144(6): p. 838- 43.
39. Prim, M.P., et al., Analysis of the causes of immediate unanticipated bleeding after pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol, 2003. 67(4): p. 341-4.
40. Witmer, C.M., et al., Incidence of bleeding complications in pediatric patients with type 1 von Willebrand disease undergoing adenotonsillar procedures. J Pediatr, 2009. 155(1): p. 68-72.
41. El Rassi, E., A. de Alarcon, and D.
Lam, Practice patterns in the management of post-tonsillectomy hemorrhage: An American Society of Pediatric Otolaryngology survey. Int J Pediatr Otorhinolaryngol, 2017. 102: p. 108-113.
42. Isaacson, G., Tonsillectomy care for the pediatrician. Pediatrics, 2012. 130(2): p. 324-34.
43. Liu, J.H., et al., Posttonsillectomy hemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg, 2001. 127(10): p. 1271-5.
44. Wall, J.J. and K.Y. Tay, Postoperative Tonsillectomy Hemorrhage. Emerg Med Clin North Am, 2018. 36(2): p. 415-426.
45. Fields, R.G., F.J. Gencorelli, and R.S.Litman, Anesthetic management of the pediatric bleeding tonsil. Paediatr Anaesth, 2010. 20(11): p. 982-6.
46. Windfuhr, J.P., et al., Post- tonsillectomy pseudoaneurysm: an underestimated entity? J Laryngol Otol, 2010. 124(1): p. 59-66.
47. Gardner, J.F., Sutures and disasters in tonsillectomy. Arch Otolaryngol, 1968. 88(5): p. 551-5.
48. Hendrix, R.A., C.K. Bacon, and M.E. Hoffer, Localization of the carotid artery within the tonsillar fossa by Doppler flow mapping. Laryngoscope, 1990. 100(8): p. 853-6.
49. Gratacap, M., et al., Embolization in the management of recurrent secondary post-tonsillectomy haemorrhage in children. Eur Radiol, 2015. 25(1): p. 239-45.
50. W. Peyton Shirley, A.L.W., Brian J. Wiatrak, Pharyngitis and Adenotonsillar Disease, in Flint PW, Haughey BH, Lund VJ, et al., eds. Cummings Otolaryngology Head & Neck Surgery. Philadelphia: Elsevier Mosby; 2010:2782-2802.
51. Cressman, W.R. and C.M. Myer, 3rd, Management of tonsillectomy hemorrhage: results of a survey of pediatric otolaryngology fellowship programs. Am J Otolaryngol, 1995. 16(1): p. 29-32.
52. Yuen, S., et al., Do post-tonsillectomy patients who report bleeding require observation if no bleeding is present on exam? Int J Pediatr Otorhinolaryngol, 2017. 95: p. 75-79.
53. Steketee, K.G. and E.J. Reisdorff, Emergency care for posttonsillectomy and postadenoidectomy hemorrhage. Am J Emerg Med, 1995. 13(5): p. 518- 23.