Reynolds Army Community Hospital, Fort Sill, Oklahoma 73505, USA.
Otolaryngol Head Neck Surg. 2012 Jun;146(6):871-9. doi: 10.1177/0194599812439017. Epub 2012 Mar 6.
Intracapsular tonsillotomy continues to gain acceptance as an alternative to traditional tonsillectomy. Despite large clinical studies, there is a lack of consensus as to which technique offers lower complication rates. This study seeks to analyze the available data and surmise the complication rates of partial tonsillectomy as compared with traditional tonsillectomy. Data Sources. MEDLINE was searched using multiple search terms.
After the MEDLINE search, the following inclusion criteria were applied: English language, human subjects, and related to partial tonsillectomy. Multiple tonsillotomy techniques were included. The results of these studies were summated and the results analyzed. Subgroup analysis was then performed.
Thirty-three studies met inclusion criteria. Tonsillotomy had a lower postoperative bleeding rate, lower postoperative dehydration rate requiring medical care, reduced days of analgesic use, and reduced days to return to normal diet compared with tonsillectomy. When separated into higher versus lower quality studies, the differences in bleeding and dehydration were negligible, while differences in return to diet and days of analgesic use persisted. Mean intraoperative blood loss was similar for both techniques. Insufficient data were available to assess tonsil regrowth rates.
Tonsillotomy appears to be a safe technique that may offer some advantages over tonsillectomy in terms of postoperative morbidity, but differences in hemorrhage and dehydration were not evident in high-quality studies. Data regarding tonsil regrowth rates and efficacy in treating sleep-disordered breathing are not yet sufficient for formal analysis, which may preclude widespread acceptance of this technique.
扁桃体囊内切开术作为传统扁桃体切除术的替代方法继续得到认可。尽管有大量的临床研究，但对于哪种技术能降低并发症发生率仍缺乏共识。本研究旨在分析现有数据，并推测扁桃体部分切除术与传统扁桃体切除术的并发症发生率。
使用多个搜索词在 MEDLINE 上进行了搜索。
方法：在 MEDLINE 搜索之后，应用了以下纳入标准：英语语言、人类受试者以及与扁桃体部分切除术相关。纳入了多种扁桃体切开术技术。对这些研究的结果进行了总结和分析。然后进行了亚组分析。
结果：有 33 项研究符合纳入标准。与扁桃体切除术相比，扁桃体切开术具有较低的术后出血率、较低的需要医疗护理的术后脱水率、减少了镇痛药的使用天数以及恢复正常饮食的天数。当分为高质量研究和低质量研究时，出血和脱水的差异可以忽略不计，而饮食恢复和镇痛药使用天数的差异仍然存在。两种技术的术中平均失血量相似。关于扁桃体再生率的数据不足，无法进行评估。
结论：扁桃体切开术似乎是一种安全的技术，在术后发病率方面可能优于扁桃体切除术，但高质量研究中并未明显出现出血和脱水的差异。关于扁桃体再生率以及治疗睡眠呼吸障碍的疗效的数据还不足以进行正式分析，这可能会阻碍该技术的广泛应用。
