Lee Ho Seok, Yoon Ho Young, Jin Ho Joon, Hwang Se Hwan
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Laryngoscope. 2018 Mar;128(3):732-744. doi: 10.1002/lary.26886. Epub 2017 Oct 25.
We performed a systemic review and meta-analysis regarding the postoperative pain, perioperative, and postoperative morbidity of powered intracapsular tonsillectomy and adenoidectomy (PITA) using a microdebrider as a method of tonsillectomy.
Five databases (PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials) in their entirety through March 2017.
We included studies in which there was a comparison between groups of patients who underwent PITA (PITA group) and those who had extracapsular tonsillectomy (control group). Articles assessing effects of PITA in the pediatric patient were systemically and independently reviewed by two researchers. The outcomes of interest were intraoperative morbidity (operative time and bleeding), postoperative morbidity (postoperative pain, recovery time, tonsil regrowth, and postoperative bleeding rate), and improvement of sleep breath disorder (apnea-hypopnea index [AHI] and symptomatic scores).
PITA did not significantly increase operative time or intraoperative blood loss. With PITA, there was significantly decreased postoperative pain, amount of analgesia, time to resumption of normal diet and activity, and incidence of postoperative admissions (due to dehydration or postoperative bleeding control) compared to those of the control group. In contrast, the incidence of postoperative tonsil regrowth was statistically higher in the PITA group than in the control group. The PITA improved AHI and obstructive sleep apnea 18-item questionnaire scores significantly, which were similar with the control group.
With regard to intraoperative morbidity and postoperative morbidity, PITA is a safe procedure. However, there are high levels of heterogeneity with regard to several measured parameters. Therefore, further large, well-designed trials are required to substantiate our findings. Laryngoscope, 128:732-744, 2018.
我们使用微型切割器作为扁桃体切除术的一种方法，对动力性囊内扁桃体切除术和腺样体切除术（PITA）的术后疼痛、围手术期和术后发病率进行了系统评价和荟萃分析。
截至2017年3月，全面检索了五个数据库（PubMed、Scopus、Embase、Web of Science和Cochrane对照试验中央注册库）。
我们纳入了对接受PITA的患者组（PITA组）和接受囊外扁桃体切除术的患者组（对照组）进行比较的研究。两名研究人员对评估PITA对儿科患者影响的文章进行了系统且独立的综述。感兴趣的结果包括术中发病率（手术时间和出血情况）、术后发病率（术后疼痛、恢复时间、扁桃体再生长和术后出血率）以及睡眠呼吸障碍的改善情况（呼吸暂停低通气指数[AHI]和症状评分）。
PITA并未显著增加手术时间或术中失血量。与对照组相比，采用PITA时，术后疼痛、镇痛量、恢复正常饮食和活动的时间以及术后入院率（因脱水或术后出血控制）均显著降低。相比之下，PITA组术后扁桃体再生长的发生率在统计学上高于对照组。PITA显著改善了AHI和阻塞性睡眠呼吸暂停18项问卷评分，与对照组相似。
关于术中发病率和术后发病率，PITA是一种安全的手术方法。然而，在几个测量参数方面存在高度异质性。因此，需要进一步进行大规模、设计良好的试验来证实我们的研究结果。《喉镜》，2018年，第128卷：732 - 744页。
