Metcalfe Christopher, Muzaffar Jameel, Daultrey Charles, Coulson Christopher
Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK.
Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2637-2647. doi: 10.1007/s00405-017-4529-4. Epub 2017 Mar 18.
Coblation is one of the more recent techniques for tonsillectomy; however, it remains unclear whether it exhibits any benefit or increased risk when compared to other techniques. This review provides an updated assessment of coblation tonsillectomy and how it compares to other tonsillectomy techniques. Systematic review and descriptive analysis of published literature. Electronic searches of MEDLINE, EMBASE, Web of Science and the Cochrane Database were performed. We included all randomized control trials comparing coblation tonsillectomy (not 'tonsillotomy') with any other tonsillectomy technique. Studies were excluded if tonsils, rather than individuals, were randomized. 16 eligible studies were identified, including a total of 567 patients, both adults and children. Coblation was compared with a variety of other tonsillectomy techniques. Outcomes included pain, primary and secondary haemorrhage, intraoperative bleeding and operation time. Postoperative pain was the primary outcome in most studies. There was a trend towards less pain in the coblation group in seven of the included studies. More recent studies appeared to fare more favourably in terms of pain outcomes and operating time. The coblation technique appears to be comparable with other commonly employed techniques for tonsillectomy; however, there is still no strong evidence to suggest that it possesses any definitive benefits. Findings would advocate further work being done through carefully designed randomised control trials, which compare coblation with cold dissection as the 'gold standard' and place an emphasis on reducing the amount of adjuvant electrocautery used so as to maximise the benefits of coblation and the lower temperature it generates.
低温等离子消融术是扁桃体切除术的最新技术之一；然而，与其他技术相比，它是否具有任何优势或增加风险仍不明确。本综述对低温等离子消融扁桃体切除术及其与其他扁桃体切除技术的比较进行了最新评估。对已发表文献进行系统综述和描述性分析。对MEDLINE、EMBASE、科学网和考克兰数据库进行了电子检索。我们纳入了所有比较低温等离子消融扁桃体切除术（而非“扁桃体部分切除术”）与任何其他扁桃体切除技术的随机对照试验。如果随机分组的是扁桃体而非个体，则排除该研究。共确定了16项符合条件的研究，包括567例患者，既有成人也有儿童。将低温等离子消融术与多种其他扁桃体切除技术进行了比较。结果包括疼痛、原发性和继发性出血、术中出血及手术时间。在大多数研究中，术后疼痛是主要结果。在纳入的7项研究中，低温等离子消融术组有疼痛减轻的趋势。就疼痛结果和手术时间而言，较新的研究似乎更有利。低温等离子消融术似乎与其他常用的扁桃体切除技术相当；然而，仍然没有有力证据表明它具有任何明确的优势。研究结果主张通过精心设计的随机对照试验进一步开展工作，将低温等离子消融术与作为“金标准”的冷剥离术进行比较，并强调减少辅助电灼的使用量，以最大限度地发挥低温等离子消融术及其产生的较低温度的优势。
