手术技术对扁桃体切除术后出血的影响——一项基于登记处的队列研究

文献信息

中文摘要

目的： 目的是评估手术技术对扁桃体切除术后出血（PTH）风险的影响。
方法： 这是一项2017年至2025年间基于登记处的队列研究，覆盖研究期间挪威所有扁桃体切除术（不包括扁桃体部分切除术）。主要暴露变量为手术技术，分为三组：冷法（剥离和止血均采用非热技术）、冷+热法（止血采用热技术）和热法（剥离和止血均采用热技术）。采用logistic回归分析手术技术对PTH风险的影响，并校正混杂因素。同时计算绝对风险和需伤害人数。
结果： 共纳入25,953例患者（女性16,318例[62.9%]，年龄中位数[IQR]为20[13]岁）。1,946例患者（7.5%）报告PTH。3,348例患者（12.9%）采用冷法手术技术，16,284例患者（62.7%）采用冷+热联合技术，6,321例患者（24.4%）采用热法技术。与纯冷法技术相比，使用部分或完全热法技术与PTH显著相关（冷+热法：OR 2.4，95% CI 1.9-3.1；热法：OR 3.4，95% CI 2.5-4.6）。与冷法技术相比，PTH风险的绝对增加为4.5%（冷+热法）和7.5%（热法），相应的需伤害人数分别为22和13。热法技术导致的风险增加在青少年和成人中比儿童更为明显。
结论： 这项基于人群的队列研究证实，手术技术与PTH相关，与冷法技术相比，使用部分或完全热法技术时PTH风险显著更高。基于累积证据，或许有必要提出是否应推荐扁桃体切除术采用冷法手术技术，尤其是在青少年和成人中。
证据等级： 3。

英文摘要

OBJECTIVE: The objective was to estimate the impact of surgical technique on the risk of post-tonsillectomy hemorrhage (PTH).
METHODS: This was a registry-based cohort study between 2017 and 2025, covering all tonsillectomies (excluding tonsillotomies) in Norway during the study period. The primary exposure variable was surgical technique, divided into three groups: cold (non-thermal technique for both dissection and hemostasis), cold + warm (thermal technique for hemostasis), and warm (thermal technique for both dissection and hemostasis). The effect of surgical technique on risk of PTH was analyzed using logistic regression, adjusting for confounding factors. Absolute risks and numbers needed to harm were also calculated.
RESULTS: A total of 25,953 patients were included (16,318 females [62.9%], median [IQR] age 20 [13] years). PTH was reported in 1946 patients (7.5%). Cold surgical technique was used in 3348 patients (12.9%), combined cold + warm technique was used in 16,284 patients (62.7%), and warm technique was used in 6321 patients (24.4%). Use of partly or fully warm technique was significantly associated with PTH compared to a purely cold technique (cold + warm: OR 2.4, 95% CI 1.9-3.1; warm: OR 3.4, 95% CI 2.5-4.6). The absolute increase in risk of PTH was 4.5% (cold + warm) and 7.5% (warm) compared to the cold technique, with corresponding numbers needed to harm of 22 and 13. The increased risk with warm technique was more pronounced for adolescents and adults compared to children.
CONCLUSION: This population-based cohort study confirms that surgical technique is associated with PTH, with a significantly higher risk of PTH when using partially or fully warm technique compared to cold technique. Based on the cumulative evidence, it may be appropriate to raise the question whether one should recommend that tonsillectomies be performed with cold surgical technique, especially in adolescents and adults.
LEVEL OF EVIDENCE: 3.