97655Wrexham Maelor Hospital, BCUHB, Wrexham, United Kingdom.
Ear Nose Throat J. 2021 Feb;100(1_suppl):14S-18S. doi: 10.1177/0145561320961747. Epub 2020 Oct 13.
In 2005, the National Prospective Tonsillectomy Audit was conducted by the Royal College of Surgeons England, reporting hot tonsillectomy techniques being associated with more postoperative pain and hemorrhage when compared with dissection. In 2006, the National Institute of Clinical Excellence declared its position on laser tonsillectomy reporting that bleeding may be less intraoperatively but is more postoperatively, that initial pain may be less but medium term is more and that healing is delayed.
To revisit the literature surrounding laser tonsil surgery and assess the aforementioned factors for any trend changes.
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-style systematic review conducted in July 2019 searched Embase, Medline, and Cochrane databases for randomized controlled trials comparing laser tonsil surgery with other techniques with the terms laser, tonsillectomy, and tonsillotomy for nonmalignant indications. A total of 14 articles were evaluated.
A total of 1133 patients received surgery accounting for a total of 2266 tonsil removals. A variety of laser techniques were used including CO2 (66%) potassium-titanyl-phosphate (19%) and contact diode (15%). Nonlaser techniques included dissection (62%), diathermy (20%), and coblation (18%). The summated conclusions suggest that laser techniques are superior regarding intraoperative bleeding and procedure duration. Laser techniques also provide equivocal or superior outcomes regarding postoperative hemorrhage, pain, and total healing time.
Outcomes following laser surgery in recent years suggest an overall improvement. This could be due to enhanced familiarity with techniques and established centers performing laser procedures more routinely.
2005 年，英国皇家外科学院进行了全国前瞻性扁桃体切除术审计，报告称与解剖相比，热扁桃体切除术技术与更多的术后疼痛和出血相关。2006 年，英国国家临床卓越研究所宣布了其对激光扁桃体切除术的立场，报告称术中出血可能较少，但术后出血较多，初始疼痛可能较少，但中期疼痛较多，愈合延迟。
重新审视围绕激光扁桃体手术的文献，并评估上述因素是否有任何趋势变化。
2019 年 7 月，采用系统评价和荟萃分析首选报告项目（PRISMA）风格进行了系统综述，在 Embase、Medline 和 Cochrane 数据库中搜索了比较激光扁桃体手术与其他技术的随机对照试验，使用的术语为激光、扁桃体切除术和扁桃体切开术，用于非恶性指征。共评估了 14 篇文章。
共有 1133 名患者接受了手术，总共切除了 2266 个扁桃体。使用了多种激光技术，包括 CO2（66%）、钾钛磷酸盐（19%）和接触二极管（15%）。非激光技术包括解剖（62%）、电烙术（20%）和等离子切割术（18%）。综合结论表明，激光技术在术中出血和手术持续时间方面具有优势。激光技术在术后出血、疼痛和总愈合时间方面也提供了相似或更好的结果。
近年来激光手术的结果表明整体有所改善。这可能是由于对技术的熟悉程度提高，以及进行激光手术的既定中心更常规地开展这些手术。
