低温等离子射频消融术切除扁桃体的安全性及可行性Meta分析

Safety and feasibility of coblation assisted tonsillectomy: a meta-analysis

目的评价低温等离子射频消融术切除扁桃体的安全性及可行性。方法计算机检索Medline数据库、P u b m e d、中国生物医学数据库(C BM)、C N K I及万方数据库国内外关于低温等离子射频消融术与传统扁桃体剥除术的随机对照试验及临床对照试验。运用Rev Man 5.1软件对两种手术方式在术中、术后指标进行Meta分析。结果共纳入20个随机对照试验和5个临床对照试验,共4162例患者。低温等离子射频消融术与传统扁桃体剥除术相比,显著缩短了手术时间[MD=-16.04,95%CI(-20.24,-11.84),P<0.0 0 0 01],减少了术中出血量[M D=-50.07,95%CI(-6 6.0 3,-3 4.11),P<0.0 0 0 01],缩短了住院时间[MD=-3.18,95%CI(-5.72,-0.63),P=0.01],加快了恢复饮食时间[MD=-1.98,95%CI(-3.11,-0.85),P=0.0006],减轻了患者疼痛程度(术后6、24、48、72 h)(VAS评分)(P<0.05),减少了术后并发症发生率[MD=0.65,95%CI(0.46,0.93),P=0.02],同时延长了白膜脱落时间[MD=1.84,95%CI(0.24,3.44),P=0.02],而平均疼痛时间无显著差别。结论现有的研究表明,低温等离子射频消融术切除扁桃体在应用价值上具有创伤小、恢复快,更加安全和有效,但是由于数量少,期待更多高质量的试验提供高质量的证据。

OBJECTIVE To assess the safety and feasibility of coblation assisted tonsillectomy. METHODS Literature search was performed in Medline, Pubmed, Chinese Biomedical Database （CBM）, CNKI and Wanfang to identify randomized controlled clinical trials and clinical controlled trials on coblation assisted tonsillectomy and traditional tonsillectomy. RevMan 5.1 software was used for statistical analysis on the outcomes concerning intraoperative, postoperative parameters of the two groups. RESULTS A total of 25 studies involving 4162 patients were included. Meta-analysis showed that compared with traditional tonsillectomy, time of procedure [MD=- 16.04, 95%CI （-20.24, -11.84）, P〈0.00001], amount of bleeding during operation [MD=-50.07, 95%C1 （-66.03, -34.11）, P〈0.00001], patients＇ stay in hospital [MD=- 3.18, 95%CI （-5.72, -0.63）, P=0.01], earlier of feed [MD=- 1.98, 95%CI （-3.11, -0.85）, P=0.0006], and the degree of the patients＇ pain （6 hour, 24 hour, 48 hour and 72 hour of postoperative） （VAS scoring） were shortened or decreased. The incidence of postoperative complications [MD=0.65, 95%CI （0.46, 0.93）, P-0.02] was reduced and albuginea off time [MD=1.84, 95%CI （0.24, 3.44）, P=0.02] was prolonged in coblation assisted tonsillectomy. However, there was no significant difference between the two groups in average pain time （P〉0.05）. CONCLUSION Coblation assisted tonsillectomy is more safe and effective with minimal invasion and quick recovery. But due to the poor quality and small sample of the included trials, more well-designed randomized controlled trails should be performed.