Sathe Nila, Chinnadurai Sivakumar, McPheeters Melissa, Francis David O
1 Department of Health Policy; Vanderbilt Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
2 Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Otolaryngol Head Neck Surg. 2017 Mar;156(3):456-463. doi: 10.1177/0194599816683916. Epub 2017 Jan 17.
Objective To assess the effectiveness of partial versus total tonsillectomy in children. Data Sources MEDLINE, EMBASE, and Cochrane Library from January 1980 to June 2016. Review Methods Two investigators independently screened studies and extracted data. Investigators independently assessed risk of bias and strength of evidence of the literature. Heterogeneity precluded quantitative analysis. Results In 16 eligible randomized controlled trials (RCTs), definitions of "partial" tonsillectomy varied. In addition to comparing partial with total tonsil removal, 11 studies compared surgical techniques (eg, coblation). In studies comparing the same technique, return to normal diet or activity was faster with partial removal (more favorable outcomes in 4 of 4 RCTs). In studies with differing surgical techniques, return to normal diet and activity was faster with partial versus total tonsillectomy (more favorable outcomes in 5 of 6 studies). In 3 of 4 RCTs, partial tonsillectomy was associated with more throat infections than total tonsillectomy. Differences between groups were generally not statistically significant for obstructive symptom persistence, quality of life, or behavioral outcomes. Across all studies, 10 (6%) of roughly 166 children had tonsillar regrowth after partial tonsillectomy. Conclusions Data do not allow firm conclusions regarding the comparative benefit of partial versus total removal; however, neither surgical technique nor extent of surgery appears to affect outcomes markedly. Partial tonsillectomy conferred moderate advantages in return to normal diet/activity but was also associated with tonsillar regrowth and symptom recurrence. Effects may be due to confounding given differences in populations and surgical approaches/techniques. Heterogeneity and differences in the operationalization of "partial" tonsillectomy limited comparative analyses.
目的 评估儿童部分扁桃体切除术与全扁桃体切除术的有效性。 数据来源 1980年1月至2016年6月的MEDLINE、EMBASE和Cochrane图书馆。 综述方法 两名研究人员独立筛选研究并提取数据。研究人员独立评估文献的偏倚风险和证据强度。异质性排除了定量分析。 结果 在16项符合条件的随机对照试验（RCT）中，“部分”扁桃体切除术的定义各不相同。除了比较部分扁桃体切除术与全扁桃体切除术外，11项研究还比较了手术技术（如低温等离子消融术）。在比较相同技术的研究中，部分切除术后恢复正常饮食或活动的速度更快（4项RCT中有4项结果更有利）。在手术技术不同的研究中，部分扁桃体切除术与全扁桃体切除术相比，恢复正常饮食和活动的速度更快（6项研究中有5项结果更有利）。在4项RCT中的3项中，部分扁桃体切除术比全扁桃体切除术更容易引发咽喉感染。在阻塞性症状持续时间、生活质量或行为结果方面，两组之间的差异通常无统计学意义。在所有研究中，约166名儿童中有10名（6%）在部分扁桃体切除术后出现扁桃体再生。 结论 数据无法就部分切除与全切除的相对益处得出确凿结论；然而，手术技术和手术范围似乎均未对结果产生明显影响。部分扁桃体切除术在恢复正常饮食/活动方面具有一定优势，但也与扁桃体再生和症状复发有关。鉴于人群和手术方法/技术的差异，这些影响可能是由于混杂因素所致。“部分”扁桃体切除术操作的异质性和差异限制了比较分析。
