富血小板血浆用于扁桃体切除术后疼痛、出血和创面愈合：随机对照试验的系统评价与荟萃分析
Platelet-rich plasma for post-tonsillectomy pain, haemorrhage, and wound healing: a systematic review and meta-analysis of randomized controlled trials.
文献信息
| PMID | 42867652 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Mahmoud A Megahed |
| 作者单位 | Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 确定术中自体富血小板血浆（PRP）是否能减轻扁桃体切除术后的疼痛和出血并促进创面愈合，同时批判性评估影响临床转化和未来应用的局限性。
方法： 检索了5个数据库，截止至2026年7月3日，纳入比较PRP与无PRP、安慰剂或未处理对侧扁桃体窝的随机对照试验。使用RoB 2评估偏倚风险，使用GRADE评估证据确定性。对疼痛和愈合结局采用Hartung-Knapp校正的随机效应模型；对稀疏的出血结局采用Mantel-Haenszel固定效应模型并进行了敏感性分析。平行组和裂口设计试验分别进行分析。
结果： 共纳入12项随机试验，包括723例患者，其中11项提供了定量数据。PRP与术后第1天（POD 1）疼痛减轻相关（MD -1.21，95% CI -2.01至-0.40）以及POD 3疼痛减轻相关（MD -1.12，95% CI -2.10至-0.14），尽管效应存在异质性且为暂时性。原发性出血显示出有利的固定效应估计（RR 0.23，95% CI 0.07-0.80），但这仅基于12例事件，且随机效应敏感性分析未能证实。完全愈合在组间无显著差异（RR 1.34，95% CI 0.59-3.06）。
结论： PRP可能在扁桃体切除术后提供适度的早期镇痛效果，但当前证据并未显示止血或黏膜愈合有一致改善。未来研究应侧重于标准化的PRP表征、患者层面的比较试验，以及直接评估PRP与其他生物材料方法相比是否能改善组织再生。
英文摘要
PURPOSE: To determine whether intraoperative autologous platelet-rich plasma (PRP) reduces postoperative pain and haemorrhage and enhances wound healing after tonsillectomy, while critically evaluating the limitations that affect clinical translation and future applications.
METHODS: Five databases were searched through 3 July 2026 for randomized controlled trials comparing PRP with no PRP, placebo, or an untreated contralateral fossa. Risk of bias was assessed using RoB 2 and certainty using GRADE. Random-effects models with Hartung-Knapp adjustment were used for pain and healing outcomes; sparse haemorrhage outcomes were analysed using Mantel-Haenszel common-effect models with sensitivity analyses. Parallel-group and split-mouth trials were analysed separately.
RESULTS: Twelve randomized trials including 723 patients were included, with 11 contributing quantitative data. PRP was associated with reduced pain on postoperative day (POD) 1 (MD -1.21, 95% CI -2.01 to -0.40) and POD 3 (MD -1.12, 95% CI -2.10 to -0.14), although effects were heterogeneous and transient. Primary haemorrhage showed a favourable common-effect estimate (RR 0.23, 95% CI 0.07-0.80), but this was based on only 12 events and was not confirmed by random-effects sensitivity analysis. Complete healing did not significantly differ between groups (RR 1.34, 95% CI 0.59-3.06).
CONCLUSION: PRP may provide a modest early analgesic effect after tonsillectomy, but current evidence does not demonstrate a consistent improvement in haemostasis or mucosal healing. Future research should focus on standardized PRP characterization, patient-level comparative trials, and direct evaluation of whether PRP improves tissue regeneration compared with other biomaterial-based approaches.