低温等离子术与电刀凝切术对扁桃体切除患者临床疗效的Meta分析

The Clinical Efficacy of Coblation and Electrocautery in Tonsillectomy:A Meta-Analysis

目的:评价低温等离子术与电刀凝切术对扁桃体切除患者临床疗效的影响。方法:计算机检索PubMed、EMBASE、The Cochrane Library等电子数据库,查找自建库以来至2019年5月31日关于低温等离子消融术与电刀凝切术的随机对照试验(RCT)。由2位评价员独立筛选文献及提取资料,采用Version 5.1.0 of Cochrane Handbook for Systematic Reviews of Interventions手册中针对RCT的偏倚风险评估工具进行评价后,采用Cochrane协作网提供的RevMan 5.3软件进行Meta分析。结果:共纳入21项研究,包含1599例行扁桃体切除术患者。Meta分析结果显示:低温等离子组患者扁桃体手术切除时间(MD=1.95,95%CI=0.25~3.66,P=0.02)明显长于电刀凝切组;而术中平均出血量(MD=-6.99,95%CI=-13.67^-0.30,P=0.04)和术后第1天疼痛程度(MD=-0.99,95%CI=-1.88~0.11,P=0.03)均明显小于电刀凝切组;同时,两组患者原发性出血发生率(OR=1.40,95%CI=0.27~7.24,P=0.69)、继发性出血发生率(OR=0.78,95%CI=0.48~1.26,P=0.31)、术后恢复正常饮食时间(MD=-1.25,95%CI=-4.03~1.54,P=0.38)、术后恢复正常活动时间(MD=-0.61,95%CI=-2.62~1.41,P=0.55)、术后恶心呕吐发生率(OR=0.53,95%CI=0.16~1.79,P=0.31)和术后脱水发生率(OR=0.32,95%CI=0.08~1.24,P=0.10)差异无统计学意义。结论:当前证据显示,与电刀凝切术相比,低温等离子切除扁桃体可明显减少术中出血量,减轻术后第1天疼痛程度,但延长手术时间;二组术后出血发生率、术后第2~7天疼痛程度、术后恢复正常饮食和活动时间及术后并发症发生率无明显差异。鉴于受纳人研究文献文种和质量有限,上述结论尚需展开更多大样本、高质量的RCT予以验证。

Objective To systematically review the clinical efficacy of coblation and electrocautery in tonsillectomy.Methods Randomized controlled trials(RCTs)of coblation and electrocautery in tonsillectomy were searched and retrieved through online databases(PubMed,EMBASE,Cochrane Library and so on)from the establishment of the database to May 31,2019.Two investigators independently screened literatures,extracted data and evaluated RCT bias risk assessment tools using the Version 5.1.0 of Cochrane Handbook for Systematic Reviews of Interventions.Then,Meta-analysis was performed using RevMan 5.3 software provided by the Cochrane Collaboration.Results A total of 21 RCTs with 1599 tonsillectomy patients were included.The results of meta-analysis showed that the operation time(MD=1.95,95%CI 0.25 to 3.66,P=0.02)of patients in coblation tonsillectomy group was significantly longer than that in electrocautery tonsillectomy group.The mean intraoperative blood loss(MD=-6.99,95%CI-13.67 to-0.30,P=0.04)and postoperative pain on day 1(MD=-0.99,95%CI-1.88 to-0.11P=0.03)in coblation tonsillectomy group were all significantly lower than those in electrocautery tonsillectomy group.Meanwhile,there was no statistically significant differences of incidence rate of primary hemorrhage(OR=1.40,95%CI 0.27 to 7.24,P=0.69),secondary hemorrhage(OR=0.78,95%CI 0.48 to1.26,P=0.31),return to normal diet(days)(MD=-1.25,95%CI-4.03 to 1.54,P=0.38),return to normal activity(days)(MD=-0.61,95%CI-2.62 to 1.41,P=0.55),postoperative nausea and vomiting(OR=0.53,95%CI 0.16 to 1.79,P=0.31)or postoperative dehydration(OR=0.32,95%CI 0.08 to 1.24,P=0.10)between the two groups.Conclusion Current evidence shows that compared with electrocautery tonsillectomy,the coblation tonsillectomy group can significantly decrease intraoperative blood loss and alleviate postoperative pain degree on day 1,but prolong the operation time.There was no statistically significant differences of incidence rate of postoperative hemorrhage,postoperative pain on day 2-7,the time of postoperative recovery of normal diet and activity,and the incidence of postoperative complications between the two groups.In view of the limited literature and quality of the recipient research,more large sample and high-quality RCTs are needed to verify the above conclusions.