Bellussi Luisa M, Marchisio Paola, Materia Enrico, Passàli Francesco M
ENT Clinic University of Siena, Siena, Italy.
Adv Otorhinolaryngol. 2011;72:142-5. doi: 10.1159/000324772. Epub 2011 Aug 18.
Five years after publishing the document on 'The clinical and organizational appropriateness of tonsillectomy and adenoidectomy' in 2003, a multidisciplinary group of experts came together again to update this document and to publish a guideline with grading of evidences and recommendations. Major revisions of the previous document were addressed to: (1) the diagnosis and indications for adenotonsillectomy in presence of OSAS in children, (2) the analysis of advantages of new surgical techniques in terms of effectiveness, costs or the risk of postsurgery bleeding and recurrences, and (3) the efficacy of perioperative management in reducing the incidence and duration of post-operative events. In fact, in the last years, a relevant number of evidence became available on the above-mentioned items making the need for a continuing updating of guidelines tangible. As a premise to the guideline, it is stressed how the previous document impact was prominent: the decrease of total number of tonsillectomy in Italy was evident and accompanied by a decrease of variations in the regional rates. Besides the document contributed to strengthen the multidisciplinary collaboration, especially between pediatricians and otorhinolaryngologists, and to divulge the Evidence-Based Medicine culture.
2003年发布关于“扁桃体切除术和腺样体切除术的临床及组织适宜性”的文件五年后，一个多学科专家小组再次齐聚，更新该文件并发布一份带有证据分级和建议的指南。对上一份文件的主要修订涉及：（1）儿童阻塞性睡眠呼吸暂停综合征（OSAS）患者腺样体扁桃体切除术的诊断和指征；（2）从有效性、成本或术后出血及复发风险方面分析新手术技术的优势；（3）围手术期管理在降低术后事件发生率和持续时间方面的疗效。事实上，在过去几年里，关于上述项目已有大量证据，使得持续更新指南变得切实必要。作为该指南的一个前提，强调了上一份文件的显著影响：意大利扁桃体切除术总数的下降很明显，同时地区发病率的差异也有所减少。此外，该文件有助于加强多学科协作，尤其是儿科医生和耳鼻喉科医生之间的协作，并传播循证医学文化。
