Frampton S J, Ward M J A, Sunkaraneni V S, Ismail-Koch H, Sheppard Z A, Salib R J, Jain P K
Department of Otolaryngology, Poole Hospital NHS Foundation Trust, UK.
J Laryngol Otol. 2012 Nov;126(11):1142-9. doi: 10.1017/S002221511200196X. Epub 2012 Sep 11.
This trial aimed to compare the guillotine technique of tonsillectomy with 'cold steel' dissection, the current 'gold standard'.
A single centre, randomised, controlled trial.
One hundred children aged 3 to 11 years who were listed for bilateral tonsillectomy were recruited. Patients had one tonsil removed by each technique, and were blinded to the side. The operative time, intra-operative blood loss, haemostasis requirement and post-operative pain scores were recorded and compared.
Operative time and intra-operative blood loss were both significantly less for the guillotine technique (p < 0.001) and there was a significantly reduced haemostasis requirement (p < 0.001). Pain was also less on the guillotine side (p < 0.001). There were no tonsillar remnants or palatal trauma for either technique. There was no significant difference between techniques in the frequency of secondary haemorrhage.
This study provides level Ib evidence that guillotine tonsillectomy in children with mobile tonsils is an effective and time-efficient procedure which produces less intra-operative blood loss and post-operative pain than cold steel dissection.
本试验旨在比较扁桃体切除术的铡除术式与目前的“金标准”——“冷钢”剥离术式。
单中心随机对照试验。
招募了100名3至11岁计划行双侧扁桃体切除术的儿童。每位患者一侧扁桃体采用一种术式切除，且对手术侧不知情。记录并比较手术时间、术中失血量、止血需求及术后疼痛评分。
铡除术式的手术时间和术中失血量均显著更少（p < 0.001），止血需求也显著降低（p < 0.001）。铡除术侧的疼痛也更轻（p < 0.001）。两种术式均无扁桃体残留或腭部创伤。两种术式在继发性出血频率上无显著差异。
本研究提供了Ib级证据，表明对于可活动扁桃体的儿童，铡除扁桃体切除术是一种有效且高效的术式，与冷钢剥离术相比，术中失血量更少，术后疼痛更轻。
