建立扁桃体腺样体不同手术方式对儿童阻塞性睡眠呼吸暂停低通气综合征疗效的系统评价体系

A systemic review system to evaluate the effects of different tonsil and adenoid surgical methods on children with obstructive sleep apnea-hypopnea syndrome

目的探讨建立比较分析不同的扁桃体腺样体手术方式对儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)疗效的系统评价体系。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库和维普数据库中关于扁桃体腺样体不同手术方式治疗儿童OSAHS的随机对照试验,时限为从建库到2016年7月。对纳入研究的质量进行严格评价与提取资料,对符合标准的文献进行系统评价,统计学处理分析应用Rev Man 5.0软件。结果共纳入7篇随机对照试验。结果显示观察组与对照组的治愈率、有效率、术后低通气指数(AHI)及最低血氧饱和度(LSa O2)的比较,其差异均无统计学意义(P>0.05);而观察组的手术时间及术中出血量均少于对照组,两者间差异均有统计学意义(P<0.05)。只有1篇对比了腺样体切除伴扁桃体部分及全切术术前及术后6个月时体液免疫及细胞免疫指标的改变,无法进行Meta分析,故未能提供循证医学证据。结论目前不同术式对患儿免疫功能的影响及治疗效果的研究较少,而且术后观察时间不一致,但这些可查询到的研究均表明腺样体切除伴部分扁桃体切除术不会对儿童的体液及细胞免疫功能造成不良影响。8岁以下且扁桃体仅单纯增生肥大的OSAHS患儿,部分扁桃体切除+腺样体切除术既可改善通气障碍,又能保留扁桃体的免疫功能及减少手术时间和术中出血量,是治疗该类患者的理想方法。

Objective To establish a systematic review system to compare the therapeutic effects of different tonsil and adenoid surgical procedures on childrens obstructive sleep apnea-hypopnea syndrome （OSAHS）.Methods CNKI, Wanfang Data,CBM and VIP were searched for randomized controlled trials on the therapeutic effects of different tonsil and adenoid surgical procedures on childrens OSAHS from the date of establishment of the databases to July of 2016. The extracted data were analyzed by Revman 5.0.Results A total 7 studies were included.Meta-analysis showed the differences between the case group and control group in curative ratio,effective rate,AHI and LSaO2 werent significant （P 〉0.05）,but the differences in the operation time and intraoperative blood loss were significant （P 〈0.05）.Only one paper compared humoral and cellular immunity index before and 6 months after partial and total tonsillectomy with adenoidectomy,which could not be included in the meta-analysis.Conclusion Few researches on the effects of differ-ent surgical procedures on childrens immunity have been found,and control tests could not be carried out because of different observing time after surgery.The results from the present study indicate that partial tonsillectomy plus adenoid-ectomy does not impact on the humoral and cellular immunity of children.It is an ideal method for patients below eight with simple hypertrophy of tonsil and adenoid,which can not only improve ventilation disorder,but also retain the ton-sil immune function and reduce the operation time and intraoperative blood loss.