两种扁桃体切除术临床疗效对比的Meta分析

[目的]评价扁桃体切除术电刀凝切术和常规剥离术对病人临床效果的影响。[方法]计算机检索PubMed、EMbase、the Cochrane Library、CINAHL、CBM、CNKI、WanFang Data、VIP数据库、SUMsearch和Google搜索引擎,查找自建库以来至2019年2月1日关于电刀凝切术与常规剥离术的随机对照试验(RCT)。由2名评价员独立筛选文献、提取资料和评价纳入研究偏倚风险后,采用RevMan 5.3软件进行Meta分析。[结果]纳入32个RCT,共3203例病人。Meta分析结果显示:电刀凝切组病人扁桃体手术切除时间[SMD=-2.88,95%CI(-3.28,-2.48),P<0.00001]、术中出血量[SMD=-3.82,95%CI(-4.43,-3.21),P<0.00001]、术后平均疼痛时间[MD=-0.73,95%CI(-1.30,-0.17),P=0.01]、术后6 h疼痛[SMD=-2.17,95%CI(-3.06,-1.28),P<0.00001]、24 h疼痛[SMD=-1.49,95%CI(-2.13,-0.85),P<0.00001]、48 h疼痛[SMD=-1.60,95%CI(-1.85,-1.34),P<0.00001]和72 h疼痛[SMD=-1.72,95%CI(-2.30,-1.13),P<0.00001]均明显小于常规剥离组;而术后恢复正常饮食时间[MD=2.06,95%CI(0.90,3.23),P=0.0005]和术后白膜脱落时间[MD=1.51,95%CI(0.41,2.61),P=0.007]明显长于常规剥离组;两组病人术后原发性出血发生率[OR=0.35,95%CI(0.12,1.07),P=0.07]和继发性出血发生率[OR=1.74,95%CI(0.91,3.34),P=0.10]差异无统计学意义。[结论]当前证据显示,与常规剥离术相比,电刀凝切术可明显缩短病人手术时间,减少术中出血量,缩短术后平均疼痛时间,减轻术后6 h、24 h、48 h、72 h疼痛程度,但术后较晚恢复正常饮食,且白膜脱落时间延迟。鉴于受纳入文献限制,上述研究结果尚需更多高质量的RCT加以验证。

Meta-analysis of clinical effects of two kinds of tonsillectomy

Objective:To evaluate the effects of electrocautery resection and conventional dissection in tonsillectomy on clinical outcomes of patients.Methods:Randomized controlled trials(RCTs)on electrocautery resection and conventional dissection for tonsillectomy were retrieved from PubMed,EMbase,the Cochrane Library,CINAHL,CBM,CNKI,WanFang Data,VIP database,SUMsearch,and Google search engine from databases establishment to 1 February,2019.Screening of literatures,extraction of data and evaluation of bias risk of included studies were implemented by two reviewers independently.And Meta-analysis of extracted data was carried out using RevMan 5.3 software.Results:A total of 32 RCTs were included,involving 3203 patients.The results of Meta-analysis showed that the duration of operation[SMD=-2.88,95%CI(-3.28,-2.48),P<0.00001],average intraoperative blood loss[SMD=-3.82,95%CI(-4.43,-3.21),P<0.00001],average postoperative pain time[MD=-0.73,95%CI(-1.30,-0.17),P=0.01],pain in 6 hours after surgery[SMD=-2.17,95%CI(-3.06,-1.28),P<0.00001],pain in 24 hours after surgery[SMD=-1.49,95%CI(-2.13,-0.85),P<0.00001],pain in 48 hours after surgery[SMD=-1.60,95%CI(-1.85,-1.34),P<0.00001],and pain in 72 hours after surgery[SMD=-1.72,95%CI(-2.30,-1.13),P<0.00001]among patients in electrocautery resection group were all significantly lower than those of the conventional dissection group.While the time needed to regain the normal diet[MD=2.06,95%CI(0.90,3.23),P=0.0005]and exfoliation time of white membrane[MD=1.51,95%CI(0.41,2.61),P=0.007]in electrocautery resection group were significantly longer than the conventional dissection group.Meanwhile,there were no statistically significant differences in two groups on incidence rates of primary hemorrhage[OR=0.35,95%CI(0.12,1.07),P=0.07]and secondary hemorrhage[OR=1.74,95%CI(0.91,3.34),P=0.10].Conclusions:Current evidence showed that,compared with the conventional dissection,the electrocautery resection could significantly shorten the duration of operation,decrease intraoperative blood loss,shorten the postoperative overall pain time and alleviate pain degree during 6,24,48,78 hours after surgery.But time to regain normal diet and exfoliation time of white membrane were delayed in electrocautery resection group.Due to limitation of included RCTs,the above conclusions still need to be verified by implementing more high quality RCTs.