EFFECTS OF TONSIL-ADENOID SURGERY ON THROAT INFECTION

这项研究旨在测试扁桃体切除术的疗效，以及 扁桃体切除加腺样体切除(T&A)在减少黄斑变性发生中的作用 既往有咽喉感染史儿童的咽喉感染事件 符合当前推荐和引用的标准的体验 扁桃体切除术。有指定最低和最高历史的儿童 复发性咽喉感染从儿童医院招募 门诊病人和由社区医生转介或带来的病人 是父母直接给的。经过评估，儿童被发现有资格获得 这项研究被随机分配到以下三个处理组之一： 扁桃体切除、T&A或非手术对照。所有科目的考试地址为 每隔六周，也用于干预呼吸或相关 生病了。电话每两周打一次，询问特定的 一组症状和事件。主要的终点是频率 和咽喉感染的严重程度，但其他衡量标准 还将对发病率进行分析。 到目前为止，已对1367名儿童进行了评估，141名儿童接受了 随机分配到三个治疗组中的一个。初步数据 显示扁桃体摘除和T&A的结果没有差异，但显示 对外科手术有利的结果在统计学上有显著差异 治疗(扁桃体切除术或T&A)胜过非手术治疗 第一年随访，第二年倾向于手术 后续年份。然而，外科手术之间的差异大小 而对照受试者似乎比我们之前的试验中涉及更多 受严重影响的儿童。特别是，控制对象已经发展起来 很少有剧集被评为中度或重度；几乎所有的剧集 一直都很温和。因此，手术对这些受试者的益处可能会下降。 没有证明风险和成本是合理的。如果这些结果继续下去 更多的受试者在更长的时间内，有可能 结论(1)腺样体切除术不应作为扁桃体切除术的一种 例行公事，以及(2)目前普遍接受标准 复发性咽喉扁桃体切除术的适应证探讨 感染不够严格，应该修改或在 最不严格的资格。 科目招生至1986年8月，后续工作至8月， 1989年似乎是必要的，以取得足够确凿的结果 对临床医生有说服力，并影响既定的标准 练习一下。

This study is designed to test the efficacy of tonsillectomy, and of tonsillectomy with adenoidectomy (T&A), in reducing the occurrence of episodes of throat infection in children with previous throat-infection experiences that conform to currently recommended and invoked criteria for tonsillectomy. Children with specified minimum and maximum histories of recurrent throat infection are recruited from among Children's Hospital outpatients and patients referred by community physicians or brought directly by parents. After evaluation, children found to be eligible for the study are offered random assignment to one of three treatment groups: tonsillectomy, T&A, or nonsurgical control. All subjects are examined at six-week intervals, and also for intervening respiratory or related illness. Telephone calls are made bi-weekly to inquire about a specified group of symptoms and events. The principal end-points are the frequency and severity of episodes of throat infection, but other measures of morbidity also will be analyzed. To date 1367 children have been evaluated, and 141 children have been randomly assigned to one of the three treatment groups. Preliminary data show no differences in outcome between tonsillectomy and T&A, but show statistically significant differences in outcome favoring surgical treatment (tonsillectomy or T&A) over nonsurgical treatment during the first follow-up year, and trends favoring surgery during the second follow-up year. However, the magnitude of the differences between surgical and control subjects appears less than in our earlier trial involving more severely affected children. In particular, control subjects have developed few episodes rated as moderate or severe; virtually all of their episodes have been mild. Thus the benefit of surgery in these subjects may fall short of justifying the risks and costs. If these results continue with larger numbers of subjects over longer periods, it may be possible to conclude (1) that adenoidectomy should not be added to tonsillectomy as a matter of routine, and (2) that current, generally accepted standards regarding indications for tonsillectomy on the basis of recurrent throat infection are not sufficiently stringent, and should be modified or at least sharply qualified. Enrollment of subjects through August 1986 and follow-up through August, 1989 appears necessary to achieve results sufficiently conclusive to be persuasive to clinicians and to influence well-established standards of practice.