等离子扁桃体部分切除术与全切术治疗儿童阻塞性睡眠呼吸暂停综合征的Meta分析

Plasma partial and total tonsillectomy for the treatment of pediatric obstructive sleep apnea syndrome:a Meta analysis

目的通过Meta分析评价等离子扁桃体部分切除术与等离子扁桃体全切术治疗儿童阻塞性睡眠呼吸暂停综合征(POSAS)的疗效。方法计算机检索PubMed、中国知网数据库、维普数据库、中国生物医学文献数据库、万方数据库、Web of Science、Springerlink、Cochrane Library中关于等离子扁桃体部分切除术与等离子扁桃体全切术治疗POSAS的随机对照试验(RCT)或病例对照研究(从建库至2022年6月)。应用RevMan 5.3软件对符合标准的文献进行Meta分析。结果共纳入文献26篇,其中英文文献5篇,中文文献21篇。Meta分析结果显示观察组(等离子扁桃体部分切除组)与对照组(等离子扁桃体全切除组)的有效率、术后睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO_(2))、白膜脱落时间比较,差异均无统计学意义(均P>0.05);而观察组的手术时间短于对照组,术中出血量少于对照组,差异均有统计学意义(均P<0.05)。观察组术后第1天、第3天疼痛评分及术后出血率均低于对照组,差异均有统计学意义(均P<0.05)。结论等离子扁桃体部分切除术治疗POSAS安全有效,且与等离子扁桃体全切术相比,具有手术时间短,术中出血量少,术后疼痛程度低,术后出血风险低的优势,但仍需同质、多中心、大样本的RCTs来提供更准确的结论以指导临床实践。

Objective To evaluate the efficacy of plasma partial tonsillectomy and plasma total tonsillectomy in the treatment of pediatric obstructive sleep apnea syndrome(POSAS)through Meta analysis.Methods Randomized controlled trials(RCTs)or case-control studies(from the establishment of database to June 2022)on the treatment of POSAS by plasma partial tonsillectomy and plasma total tonsillectomy were searched in PubMed,China National Knowledge Network database,CPVIP database,Chinese Biomedical literature database,Wanfang database,Web of Science,Springerlink and Cochrane Library.RevMan 5.3 software was used to conduct a Meta analysis of literature that meets the standards.Results A total of 26 references were included,including 5 in English and 21 in Chinese.The results of Meta analysis showed that there were no statistically significant differences between the observation group(plasma partial tonsillectomy group)and the control group(plasma total tonsillectomy group)in the effective rate,postoperative sleep apnea-hypopnea index(AHI),lowest of oxygen saturation(LSaO_(2))and white membrane shedding time(all P>0.05).However,the observation group had shorter operation time and less intraoperative bleeding volume compared to the control group,with statistically significant differences(all P<0.05).The pain scores on the 1st and 3rd day after operation and postoperative bleeding rate of the observation group were lower than those of the control group,and the differences were statistically significant(all P<0.05).Conclusion Plasma partial tonsillectomy is safe and effective in the treatment of POSAS,and operation time,intraoperative bleeding volume,postoperative pain and risk of postoperative bleeding are obviously shorter or less than those of plasma total tonsillectomy.However,homogenous,multi-center,large-sample RCTs are still needed to provide more accurate conclusions to guide clinical practice.