Mølhave Martin, Ovesen Therese, Madzak Adnan
University Clinic for Flavour, Balance and Sleep, Department of Otorhinolaryngology, Head and Neck Surgery, Gødstrup Hospital, Herning, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
BMJ Surg Interv Health Technol. 2025 Mar 27;7(1):e000370. doi: 10.1136/bmjsit-2024-000370. eCollection 2025.
To assess the impact of visual guidance and instrument choice on obstructive sleep apnea (OSA) and otitis media with effusion (OME) symptom recurrence and reoperation rates following adenoidectomy in pediatric patients.
Systematic review of randomized controlled trials (RCTs).
A comprehensive literature search was conducted in Embase, PubMed/Medline, the Cochrane Library, and Scopus, with the final search on September 23, 2024. Reference lists were also screened.
Eligible studies included RCTs published from 2000 onwards, with ≥25 pediatric patients undergoing adenoidectomy for OSA or OME. Comparisons included visually guided versus blinded and cold versus hot adenoidectomy techniques. Studies involving concurrent procedures, craniofacial abnormalities, or non-primary adenoidectomy cases were excluded.
The primary outcomes were OSA and OME symptom recurrence and reoperation rates following adenoidectomy. Risk of bias was assessed using Cochrane Risk of Bias tool, and evidence quality was evaluated using Grading of Recommendations Assessment, Development and Evaluation.
Of 2302 screened articles, 35 underwent full-text review, and 4r studies (373 participants) met inclusion criteria. All studies compared hot and cold techniques, with hot techniques being visually guided. Only one study directly compared both hot and cold techniques under visual guidance, reporting lower OSA recurrence rates with the hot technique, though with a high risk of bias. Other studies found no significant differences, and none reported reoperation rates. Study heterogeneity prevented meta-analysis. Overall risk of bias and evidence quality were moderate.
There is insufficient evidence to determine whether visual guidance reduces symptom recurrence following adenoidectomy. Further high-quality RCTs are needed to provide more sound conclusions.
CRD42024513408.
评估视觉引导和器械选择对小儿腺样体切除术后阻塞性睡眠呼吸暂停（OSA）和分泌性中耳炎（OME）症状复发率及再次手术率的影响。
随机对照试验（RCT）的系统评价。
在Embase、PubMed/Medline、Cochrane图书馆和Scopus中进行全面的文献检索，最后一次检索于2024年9月23日进行。还筛选了参考文献列表。
符合条件的研究包括2000年以后发表的RCT，其中≥25名小儿患者因OSA或OME接受腺样体切除术。比较包括视觉引导与盲法以及冷刀与热刀腺样体切除技术。排除涉及同期手术、颅面畸形或非原发性腺样体切除病例的研究。
主要结局为腺样体切除术后OSA和OME症状复发率及再次手术率。使用Cochrane偏倚风险工具评估偏倚风险，并使用推荐分级评估、制定和评价（GRADE）评估证据质量。
在筛选的2302篇文章中，35篇进行了全文审查，4项研究（373名参与者）符合纳入标准。所有研究均比较了热刀和冷刀技术，热刀技术采用视觉引导。只有一项研究在视觉引导下直接比较了热刀和冷刀技术，报告热刀技术的OSA复发率较低，但偏倚风险较高。其他研究未发现显著差异，且均未报告再次手术率。研究异质性妨碍了荟萃分析。总体偏倚风险和证据质量为中等。
尚无足够证据确定视觉引导是否能降低腺样体切除术后的症状复发率。需要进一步开展高质量的RCT以得出更可靠的结论。
PROSPERO注册号：CRD42024513408。
