Paradise J L, Bluestone C D, Bachman R Z, Colborn D K, Bernard B S, Taylor F H, Rogers K D, Schwarzbach R H, Stool S E, Friday G A
N Engl J Med. 1984 Mar 15;310(11):674-83. doi: 10.1056/NEJM198403153101102.
We studied the efficacy of tonsillectomy, or tonsillectomy with adenoidectomy, in 187 children severely affected with recurrent throat infection. Ninety-one of the children were assigned randomly to either surgical or nonsurgical treatment groups, and 96 were assigned according to parental preference. In both the randomized and nonrandomized trials, the effects of tonsillectomy and of tonsillectomy with adenoidectomy were similar. By various measures, the incidence of throat infection during the first two years of follow-up was significantly lower (P less than or equal to 0.05) in the surgical groups than in the corresponding nonsurgical groups. Third-year differences, although in most cases not significant, also consistently favored the surgical groups. On the other hand, in each follow-up year many subjects in the nonsurgical groups had fewer than three episodes of infection, and most episodes among subjects in the nonsurgical groups were mild. Of the 95 subjects treated with surgery, 13 (14 per cent) had surgery-related complications, all of which were readily managed or self-limited. These results warrant the election of tonsillectomy for children meeting the trials' stringent eligibility criteria, but also provide support for nonsurgical management. Treatment for such children must therefore be individualized.
我们研究了扁桃体切除术或扁桃体切除术联合腺样体切除术对187名严重复发性咽喉感染儿童的疗效。其中91名儿童被随机分配至手术治疗组或非手术治疗组，另外96名儿童则根据家长的意愿进行分组。在随机和非随机试验中，扁桃体切除术以及扁桃体切除术联合腺样体切除术的效果相似。通过多种衡量标准，在随访的前两年中，手术组咽喉感染的发生率显著低于相应的非手术组（P≤0.05）。尽管在大多数情况下，第三年的差异并不显著，但仍始终有利于手术组。另一方面，在非手术组中，每年都有许多受试者感染次数少于三次，且大多数感染症状较轻。在接受手术治疗的95名受试者中，有13名（14%）出现了与手术相关的并发症，所有这些并发症都易于处理或为自限性。这些结果表明，对于符合试验严格入选标准的儿童，选择扁桃体切除术是合理的，但同时也为非手术治疗提供了支持。因此，对此类儿童的治疗必须个体化。
