Windfuhr J P, Savva K
Klinik für HNO-Krankheiten, Plastische Kopf- und Hals-Chirurgie, Allergologie, Kliniken Maria Hilf, Sandradstr. 43, 41061, Mönchengladbach, Deutschland.
HNO. 2017 Jan;65(1):30-40. doi: 10.1007/s00106-016-0237-4.
Tonsillotomy procedures (TT) are being increasingly performed owing to the low postoperative morbidity compared with extracapsular tonsillectomy (TE). Patients may experience regrowth of tonsillar tissue or tonsillitis in the tonsillar remnants eventually resulting in a secondary tonsillectomy.
A review of the literature was undertaken to evaluate the current indications and contraindications, surgical instruments, risks of surgery, and the need for further research related to TT.
A search of the PubMed database was performed with the following terms: "tonsillotomy," "partial tonsillectomy," "subtotal tonsillectomy," "intracapsular tonsillectomy," "RFITT," and "tonsil ablation." Filters included language (English; German) and publication date (1960-2016). Articles were excluded if they were not related to tonsil surgery, did not provide clinical data, dealt with uncommon surgical techniques, or presented only data from polysomnographic studies.
In all, 104 papers encompassing 97 studies and seven national surveys were eligible for analysis. In total, 13,270 patients had undergone TT and were compared with 11,485 patients after TE. Partial resection of the tonsils was most commonly accomplished with a microdebrider (51.5 %), and less frequently with coblation (20.5 %), radiofrequency (9.1 %), CO laser (6.6 %), or other surgical instruments. The age in the study groups ranged between 6 months and 78 years (median: 6.0 years). The prevailing indication for surgery was upper airway obstruction resulting from tonsillar hyperplasia with (n = 20) or without (n = 60) a history of tonsillits. In seven studies, TT was explicitly performed to resolve tonsillitis, while three authors did not specify the indication for surgery. The hemorrhage rate after TT was 0.2 % on average.
TT is predominantly indicated for tonsillar hyperplasia, with or without tonsillitis. Restrictions related to age or surgical instruments are not reported in the literature data. Data concerning operation time, intraoperative bleeding, and outcome favor TT over TE. The median values for regrowth (3.0 %), postoperative tonsillitis (2.85 %), and secondary TE (1.37 %) emphasize the high success rate of TT. Further research utilizing a uniform terminology is mandatory to clarify the benefit of TT over TE in the long term and to resolve sleep-related breathing disorders resulting from tonsillar hyperplasia or tonsillitis.
与扁桃体囊外切除术（TE）相比，扁桃体切开术（TT）术后发病率较低，因此该手术的开展越来越多。患者可能会出现扁桃体组织再生或扁桃体残体发生扁桃体炎，最终导致二次扁桃体切除术。
对文献进行综述，以评估TT目前的适应证和禁忌证、手术器械、手术风险以及与TT相关的进一步研究需求。
在PubMed数据库中进行检索，检索词如下：“扁桃体切开术”“部分扁桃体切除术”“次全扁桃体切除术”“囊内扁桃体切除术”“射频感应扁桃体切除术（RFITT）”和“扁桃体消融术”。筛选条件包括语言（英语；德语）和出版日期（1960 - 2016年）。如果文章与扁桃体手术无关、未提供临床数据、涉及不常见的手术技术或仅呈现多导睡眠图研究的数据，则将其排除。
共有104篇论文符合分析条件，包括97项研究和7项全国性调查。总共有13270例患者接受了TT，并与11485例TE术后患者进行了比较。扁桃体部分切除术最常用的器械是微型切割器（51.5%），使用低温等离子消融术的频率较低（20.5%），射频（9.1%）、CO2激光（6.6%）或其他手术器械的使用频率更低。研究组患者年龄在6个月至78岁之间（中位数：6.0岁）。手术的主要适应证是扁桃体增生导致的上气道阻塞，有（n = 20）或无（n = 60）扁桃体炎病史。在7项研究中，明确进行TT是为了解决扁桃体炎，而3位作者未明确手术适应证。TT术后平均出血率为0.2%。
TT主要适用于有或无扁桃体炎的扁桃体增生。文献数据中未报道与年龄或手术器械相关的限制。关于手术时间、术中出血和手术效果的数据表明，TT优于TE。扁桃体再生（3.0%）、术后扁桃体炎（2.85%）和二次TE（1.37%）的中位数强调了TT的高成功率。必须采用统一术语进行进一步研究，以长期阐明TT相对于TE的优势，并解决由扁桃体增生或扁桃体炎引起的睡眠相关呼吸障碍。
