Mafra Marcela, Cabral Thamiris Dias Delfino, Roca Mora Maria Meritxell, de Mesquita Cynthia Florencio, Pertzborn David, Mühlig Anna, von Eggeling Ferdinand, Guntinas-Lichius Orlando
Department of Otorhinolaryngology, Jena University Hospital, Jena, Thuringia, Germany.
Federal Hospital of Bonsucesso, Rio de Janeiro, Rio de Janeiro State, Brazil.
Lasers Surg Med. 2025 Oct;57(8):645-657. doi: 10.1002/lsm.70058. Epub 2025 Aug 25.
Severe recurrent acute tonsillitis (RAT) is commonly treated by removing the palatine tonsils, namely tonsillectomy (TE). Laser TE has been suggested as an alternative to cold steel dissection, although its efficacy and safety for the surgical treatment of RAT remain unclear. Therefore, we conducted a systematic review and meta-analysis comparing laser TE to cold steel dissection TE in patients with RAT.
We systematically searched PubMed, Embase, and Cochrane Central for eligible studies. Outcomes of interest were intraoperative blood loss, operation time, quality of life, postoperative pain, and postoperative hemorrhage. Subgroup and sensitivity analyses were performed. RStudio v4.1.0 and Review Manager v5.4 were used for statistical analysis. A prospective protocol was registered in PROSPERO (CRD42024533742).
Nine studies, including six randomized trials, met eligibility criteria, comprising 612 patients with RAT. In total, 1224 tonsils were excised; 612 (50%) were submitted to laser TE, and the remaining to cold steel dissection. Laser was associated with lower intraoperative blood loss (mean difference [MD] -35.89; 95% confidence interval [CI] [-53.08, -18.71]; p < 0.01; I² = 100%) and operation time (MD -10.46; 95% CI [-16.63, -4.29]; p < 0.01; I² = 99%). No significant differences between interventions were found in postoperative pain, quality of life, or postoperative hemorrhage.
In patients with RAT, laser TE yielded reduced intraoperative blood loss and operation time, with comparable hemorrhage risk, postoperative pain, and quality of life to cold steel dissection. Yet, the occurrence of post-surgery sore throat remains uncertain, highlighting the need for further randomized trials reporting long-term outcomes after tonsil surgery.
重度复发性急性扁桃体炎（RAT）通常通过切除腭扁桃体来治疗，即扁桃体切除术（TE）。激光扁桃体切除术已被建议作为冷钢剥离术的替代方法，但其对RAT手术治疗的疗效和安全性仍不明确。因此，我们进行了一项系统评价和荟萃分析，比较激光扁桃体切除术与冷钢剥离术治疗RAT患者的效果。
我们系统检索了PubMed、Embase和Cochrane Central数据库，以查找符合条件的研究。感兴趣的结局指标包括术中出血量、手术时间、生活质量、术后疼痛和术后出血。进行了亚组分析和敏感性分析。使用RStudio v4.1.0和Review Manager v5.4进行统计分析。一项前瞻性方案已在PROSPERO（CRD42024533742）中注册。
9项研究符合纳入标准，其中包括6项随机试验，共纳入612例RAT患者。总共切除了1224个扁桃体；612个（50%）接受了激光扁桃体切除术，其余接受了冷钢剥离术。激光扁桃体切除术与较低的术中出血量（平均差[MD]-35.89；95%置信区间[CI][-53.08，-18.71]；p<0.01；I²=100%）和手术时间（MD -10.46；95%CI[-16.63，-4.29]；p<0.01；I²=99%）相关。在术后疼痛、生活质量或术后出血方面，两种手术方法之间未发现显著差异。
对于RAT患者，激光扁桃体切除术可减少术中出血量和手术时间，出血风险、术后疼痛和生活质量与冷钢剥离术相当。然而，术后喉咙痛的发生率仍不确定，这凸显了进一步进行随机试验以报告扁桃体切除术后长期结局的必要性。
