Mink Jonah W, Shaha Steven H, Brodsky Linda
Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel.
Int J Pediatr Otorhinolaryngol. 2009 Nov;73(11):1499-506. doi: 10.1016/j.ijporl.2009.02.022. Epub 2009 Apr 5.
With the increase in new technology and changing indications for tonsillectomy, the literature has exploded during the last 20 years with scores of publications reporting the relative effectiveness of many different techniques. Despite this "wealth of information," no single technique has been adopted by most surgeons.
To systematically analyze the usefulness of this literature of the past 20 years concerning tonsillectomy technique in children. To propose the use of specific study parameters that could optimize clinical decision-making and future research.
Detailed review of the methodologies and findings in articles which compared one or more tonsillectomy techniques in clinical trials of children, ages 1-23 years from 1987 through 2007.
The Medline search revealed 255 papers of which 89 studies were suitable for inclusion in our review. In these 89 studies (found in 87 papers), 9 dissection techniques, 3 planes of dissection, 8 methods of hemostasis, and 41 different outcome measures were reported. Forty-four (49%) were described as randomized, 63 (71%) prospective, 25 retrospective (28%), 1 case report, 1 matched pair, and 9 case series papers. Sixteen (18%) trials were non-blind, 23 (26%) were single blind, 17 (19%) were double blind, and 7 (8%) were not stated. Seventy-five (84%) were comparative and 14 (16%) non-comparative. Eight (9%) studies reported power analyses. Twelve (13%) had no follow-up; 67 (75%) of the studies performed had short-term follow-up in the peri-operative period; 10 (11%) had follow-up for greater than 1 year. Eleven (12%) mentioned outcomes related to the effectiveness of the procedure itself in relieving symptoms for which the surgery was done.
Tonsillectomy technique research is of obvious interest to the otolaryngologist. We found deficits in: the precise reporting of surgical techniques, adequate study design and useful outcome measures, all of which make the literature less useful than it could be. Guidelines for study design parameters which could lead to more valuable information for the clinician are suggested.
随着新技术的增加以及扁桃体切除术适应证的变化，在过去20年里，相关文献大量涌现，众多出版物报道了许多不同技术的相对有效性。尽管有这些“丰富的信息”，但大多数外科医生尚未采用单一技术。
系统分析过去20年有关儿童扁桃体切除技术的文献的实用性。提出使用可优化临床决策和未来研究的特定研究参数。
详细回顾1987年至2007年1至23岁儿童临床试验中比较一种或多种扁桃体切除技术的文章的方法和结果。
医学数据库检索显示255篇论文，其中89项研究适合纳入我们的综述。在这89项研究（见于87篇论文）中，报道了9种解剖技术、3个解剖层面、8种止血方法以及41种不同的结局指标。44项（49%）被描述为随机对照研究，63项（71%）为前瞻性研究，25项（28%）为回顾性研究，1项病例报告，1项配对研究以及9项病例系列论文。16项（18%）试验为非盲法，23项（26%）为单盲法，17项（19%）为双盲法，7项（8%）未说明。75项（84%）为比较性研究，14项（16%）为非比较性研究。8项（9%）研究报告了效能分析。12项（13%）没有随访；67项（75%）进行的研究在围手术期进行了短期随访；10项（11%）随访时间超过1年。11项（12%）提到了与手术本身缓解手术所针对症状的有效性相关的结局。
扁桃体切除技术研究显然是耳鼻喉科医生感兴趣的。我们发现存在以下不足：手术技术的精确报告、充分的研究设计和有用的结局指标，所有这些都使得文献的实用性不如其可能达到的程度。建议制定研究设计参数指南，以便为临床医生提供更有价值的信息。
