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Resource Center

Find webinars, use cases, tutorials, videos more at resources.qt.io

Qt Quick Compiler

The Qt Quick Compiler is a development add-on for Qt Quick applications which allows you to compile QML source code into the final binary. When you use this add-on, the application's startup time is significantly improved and you no longer need to deploy .qml files together with the application.

Note: Since Qt version 5.11, the functionality of the Qt Quick Compiler has been integrated into the Qt Quick module itself. This separate add-on remains available in the earlier long term support releases of Qt.

Qt Quick enables rapid development cycles for your applications. This is accomplished by doing away with the traditional C++ compilation step. Instead, we load the .qml source code on demand at run-time. The popular Just-in-time (JIT) compilation technique is used to generate machine code on the fly, which speeds up the execution of JavaScript and QML binding expressions.

Unfortunately this approach has some disadvantages: On application startup, several .qml files need to be parsed and dynamically compiled before the user interface can become visible and interactive. This is rarely a problem during application development itself, however it is an unnecessary step for a finally released application, as the ability for the end user to modify the qml source code like a developer is usually not required. Conceptually, this is similar to how a release build of C++ code cannot be used with a debugger.

As .qml files are loaded at run-time, it is necessary to deploy them together with the released application. For proprietary applications that wish to hide the source code from the end user, this is an unacceptable restriction.

Lastly, some platform versions such as iOS or Windows RT do not permit the dynamic generation of machine code. As a fallback QML provides an interpreter to allow for the full use of QML, but it comes at the expense of a longer execution time.

Compiled Qt Quick is an elegant solution to these problems: .qml files as well as accompanying .js files can be translated into intermediate C++ source code. After compilation with a traditional compiler, the code is linked into the application binary. This entirely eliminates the need of deploying QML source code, it reduces the application startup time and allows for a much faster execution on platforms that do not permit Just-in-time compilation.

The Qt Quick Compiler package consists of the compiler as a command line tool as well as a build system integration.

The integration into the build system happens at the level of the Qt Resource System. In order to use the Qt Quick Compiler, your application needs to be prepared:

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In this guide we will be exploring the three properties that are applied to flex items, which enable us to control the size and flexibility of the items along the main axis — flex-grow , California Kicks Tenis Fem Womens Oxford Laceup Zaxy saxVf8yx
, and Ultraboost Parley lowtop trainers adidas by Stella McCartney yT3Ix
. Fully understanding how these properties work with growing and shrinking items is the real key to mastering flexbox.

Our three properties control the following aspects of a flex item's flexibility:

The properties are usually expressed as the shorthand property. The following code would set the property to , to and to .

If you have read the article Basic Concepts of Flexbox , then you will have already had an introduction to the properties. Here we will explore them in depth in order that you can fully understand what the browser is doing when you use them.

There are a few concepts worth digging into before looking at how the flex properties work to control ratios along the main axis. These relate to the size of flex items before any growing or shrinking takes place, and to the concept of free space.

Flex item sizing

In order to work out how much space there is available to lay out flex items, the browser needs to know how big the item is to start with. How is this worked out for items that don’t have a width or a height applied using an absolute length unit?

There is a concept in CSS of and — these keywords are Womens CoralPrint Silk Maxi Wrap Dress We are Leone 8uOnv5lph
, and can be used in place of a length unit .

In the live example below for instance I have two paragraph elements thatcontain a string of text. The first paragraph has a width of . In a browser that supports this keyword you should be able to see that the text has taken all of the soft wrapping opportunities available to it, becoming as small as it can be without overflowing. This then, is the size of that string. Essentially, the longest word in the string is dictating the size.

The second paragraph has a value of and so it does the opposite. It gets as big as it possibly can be, taking no soft-wrapping opportunities. It would overflow the box it is in if that container was too narrow.

If your browser does not yet support these keywords both paragraphs will be rendered as normal paragraphs in block flow; the below screenshots show the expected rendering.

Remember this behaviour and what effects and have as we explore and later in this article.

Positive and negative free space

To talk about these properties we need to understand the concept of positive and negative free space . When a flex container has positive free space, it has more space than is required to display the flex items inside the container. For example, if I have a 500 pixel-wide container, is , and I have three flex items each 100 pixels wide, then I have 200 pixels of positive free space, which could be distributed between the items if I wanted them to fill the container.

We have negative free space when the natural size of the items adds up to larger than the available space in the flex container. If I have a 500 pixel-wide container like the one above, but the three flex items are each 200 pixels wide, the total space I need will be 600 pixels, so I have 100 pixels of negative free space. This could be removed from the items in order to make them fit the container.

It is this distribution of positive free space and removal of negative free space that we need to understand in order to understand the flex properties.

In the following examples I am working with set to row, therefore the size of items will always come from their width. We will be calculating the positive and negative free space created by comparing the total width of all the items with the container width. You could equally try out each example with . The main axis would then be the column, and you would then need to compare the height of the items and that of the container they are in to work out the positive and negative free space.

The property specifies the initial size of the flex item before any space distribution happens. The initial value for this property is . If is set to then to work out the initial size of the item the browser first checks if the main size of the item has an absolute size set. This would be the case if you had given your item a width of 200 pixels. In that case would be the for this item.

If your item is instead auto-sized, then resolves to the size of its content. At this point your knowledge of and sizing becomes useful, as flexbox will take the size of the item as the . The following live example can help to demonstrate this.

In this example I have created a series of inflexible boxes, with both and set to . Here we can see how the first item — which has an explicit width of 150 pixels set as the main size — takes a of , whereas the other two items have no width and so are sized according to their content width.

In addition to the keyword, you can use the keyword as the . This will result in the being taken from the content size even if there is a width set on the item. This is a newer keyword and has less browser support, however you can always get the same effect by using as the flex-basis and ensuring that your item does not have a width set, in order that it will be auto-sized.

If you want flexbox to completely ignore the size of the item when doing space distribution then set to . This essentially tells flexbox that all the space is up for grabs, and to share it out in proportion. We will see examples of this as we move on to look at .

The property specifies the flex grow factor , which determines how much theflex itemwill grow relative to the rest of theflex itemsin the flex container when the positive free space is distributed.

If all of your items have the same factor then space will be distributed evenly between all of them. If this is the situation that you want then typically you would use as the value, however you could give them all a of , or , or if you like — it is a ratio. If the factor is the same for all, and there is positive free space in the flex container then it will be distributed equally to all.

Combining and

Things can get confusing in terms of how and interact. Let's consider the case of three flex items of differing content lengths and the following rules applied to them:

In this case the value is and the items don’t have a width set, and so are auto-sized. This means that flexbox is looking at the size of the items. After laying the items out we have some positive free space in the flex container, shown in this image as the hatched area:

We are working with a equal to the content size so the available space to distribute is subtracted from the total available space (the width of the flex container), and the leftover space is then shared out equally among each item. Our bigger item ends up bigger because it started from a bigger size, even though it has the same amount of spare space assigned to it as the others:

If what you actually want is three equally-sized items, even if they start out at different sizes, you should use this:

Here we are saying that the size of the item for the purposes of our space distribution calculation is — all the space is up for grabs and as all of the items have the same factor, they each get an equal amount of space distributed. The end result is three equal width, flexible items.

Try changing the factor from 1 to 0 in this live example to see the different behavior:

Giving items different flex-grow factors

Our understanding of how works with allows us to have further control over our individual item sizes by assigning items different factors. If we keep our at so all of the space can be distributed, we could assign each of the three flex items a different factor. In theexample below I am using the following values:

Working from a of this means that the available space is distributed as follows. We need to add up the flex grow factors, then divide the total amount of positive free space in the flex container by that number, which in this case is 4. We then share out the space according to the individual values — the first item gets one part, the second one part, the third two parts. This means that the third item is twice the size of the first and second items.

Remember that you can use any positive value here. It is the ratio between one item and the others that matters. You can use large numbers, or decimals — it is up to you. To test that out change the values assigned in the above example to , , and — you should see the same result.

The property specifies the flex shrink factor , which determines how much theflex itemwill shrink relative to the rest of theflex itemsin the flex container when negative free space is distributed.

This property deals with situations where the browser calculates the values of the flex items, and finds that they are too large to fit into the flex container. As long as has a positive value the items will shrink in order that they do not overflow the container.

So where deals with adding available space, manages taking away space to make boxes fit into their container without overflowing.

In the next live example I have three items in a flex container; I’ve given each a width of 200 pixels, and the container is 500 pixels wide. With set to the items are not allowed to shrink and so they overflow the box.

Change the value to and you will see each item shrink by the same amount, in order that all of the items now fit in the box. They have become smaller than their initial width in order to do so.

Combining and

You could say that works in pretty much the same way as . However there are two reasons why it isn’t the same.

While it is usually subtle, defined in the specification is one reason why isn’t quite the same for negative space as is for positive space:

The second reason is that flexbox prevents small items from shrinking to zero size during this removal of negative free space. The items will be floored at their size — the size that they become if they take advantage of any soft wrapping opportunities available to them.

You can see this flooring happen in the below example, where the is resolving to the size of the content. If you change the width on the flex container — increasing it to 700px for example — and then reduce the flex item width, you can see that the first two items will wrap, however they will never become smaller than that size. As the box gets smaller space is then just removed from the third item.

In practice the shrinking behaviour does tend to give you reasonable results. You don’t usually want your content to disappear completely or for boxes to get smaller than their minimum content, so the above rules make sense in terms of sensible behaviour for content that needs to be shrunk in order to fit into a container.

Giving items different factors

In the same way as , you can give flex-items different factors. This can help change the default behaviour if, for example, you want an item to shrink more or less rapidly than its siblings or not shrink at all.

In the following live example the first item has a factor of 1, the second (so it won’t shrink at all), and the third . The third item therefore shrinks more rapidly than the first. Play around with the different values — as for you can use decimals or larger numbers here. Choose whatever makes most sense to you.

“Note:Theflex shrink factoris multiplied by theflex base sizewhen distributing negative space. This distributes negative space in proportion to how much the item is able to shrink, so that e.g. a small item won’t shrink to zero before a larger item has been noticeably reduced.”

(95)
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with t 0 taken as the first time point of experimental observation for each condition.

We then define the following objective function:

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where the fitted wings are WT #2, ECM_AntCut and ECM_DistCut, and n labels successive time points. The parameter ζ xx / K was obtained from fitting to circular laser cut experiments (see ‘Materials and methods’, Analysis of circular laser ablations). We found that the fitting procedure returned small values of the parameters ζ x x H / K and K H / K which were therefore set to zero. The fit function was minimised for the remaining 8 parameters, and the optimal parameters are reported in regular fit jeans Red Armani Jeans 8prN8xpGB
.

A separate fit was performed for Dumpy wings, with the following objective function:

(98)

where the tissue parameters ζ ¯ / K , K ¯ / K and η ¯ / K have the value obtained from WT fits, and ζ x x H / K and K H / K were set to zero as in WT fits. The parameter ζ x x Dp / K was obtained from fitting to circular laser cut experiments (see ‘Materials and methods’, Analysis of circular laser ablations). The values of the remaining five fitted parameters are reported in Table 2 .

Les preuves disponibles concernant l'efficacité de l'(adéno-)amygdalectomie par rapport au traitement non chirurgical chez l'adulte ne sont pas suffisantes pour permettre des conclusions fermes.

L'effet de la chirurgie, tel que le démontrent les études incluses, est modeste. Beaucoup de participants du groupe non chirurgical guérissent spontanément (même si certains des sujets randomisés dans ce groupe finissent par être opérés). Le «bénéfice» potentiel de la chirurgie doit être pesé par rapport aux risques car l'(adéno-)amygdalectomie est associé à une morbidité faible mais significative, prenant la forme d'hémorragies primaires et secondaires; en outre, même avec une bonne analgésie, l'opération est particulièrement inconfortable pour les adultes.

Plain language summary

This review compared the clinical effectiveness and safety of surgery (removal of the tonsils - tonsillectomy, or adenotonsillectomy - removal of the tonsils and adenoid tissues) against non-surgical management in adults and children with frequent or chronic tonsillitis.

Surgical removal of the tonsils is a commonly performed operation in patients with chronic or recurrent infections of the tonsils (tonsillitis) or the other tissues at the back of the throat (pharyngitis). Sometimes, the adenoid tissues are also removed during the surgery. However, opinions vary greatly about whether or not the benefits of these operations outweigh the risks.

This review included evidence available up to 30 June 2014. Seven trials with low to moderate risk of bias were included: five in children (987 participants) and two in adults (156 participants). An eighth trial in 40 adults was at high risk of bias and did not provide any data for analysis.

Although some studies in children followed participants for two or three years, reliable information is only available for up to about one year after surgery due to the high number of participants missing follow-up after the first year. Some studies had recruited children who were more severely affected by tonsillitis than other studies (for example, they had tonsillitis more often and with more severe symptoms). Therefore, we grouped the children into 'severely affected' and 'less severely affected' subgroups.

Two studies in adults had a short duration of follow-up (five to six months following surgery).

We found that in general children affected by recurrent acute tonsillitis may have a small benefit from adeno-/tonsillectomy: this procedure will avoid 0.6 episodes of any type of sore throat in the first year after surgery compared to non-surgical treatment. The children who had surgery had three episodes of sore throat on average compared to 3.6 episodes experienced by the other children. One of the three episodes is the episode of pain caused by surgery.

When it comes to avoiding bad sore throats, children who have more severe or frequent tonsillitis may benefit more from surgery compared to less severely affected children. In less severely affected children the potential benefits of adeno-/tonsillectomy are more uncertain. There are no good quality data for the effects of surgery in the second or later years after surgery.

We did not find enough evidence to draw firm conclusions on the effectiveness of tonsillectomy in adults with chronic/recurrent acute tonsillitis. Evidence is only available for the short term and is of low quality. The data are also difficult to interpret as the studies do not take into account the days of pain that always follow the operation. Based on the two small trials, tonsillectomy seems to result in fewer days of sore throat in the first six months after surgery.

Two of the studies in children said that they could not find a difference in quality of life outcomes and one study could not find a difference in the amount of painkiller that children took to help with their sore throats.

Bleeding immediately after tonsillectomy or in the two weeks following surgery is an important complication. The studies did not provide good information to allow us to assess accurately the risk of these complications.

We judged the quality of the evidence to be moderate for the data on children (this means that further research is likely to have an important impact on how confident we are in the results and may change those results). Quality is affected by a large number of children who are 'lost to follow-up' after the first year of the study. In addition, some children who are assigned to the 'no surgery' group end up having surgery.

The quality of evidence for tonsillectomy in adults in adults is low.

As always, any potential benefits of surgery should be carefully weighed against the possible harms as the procedure is associated with a small but significant degree of morbidity in the form of bleeding (either during or after the surgery). In addition, even with good pain relief medication, the surgery is particularly uncomfortable for adults.

Резюме на простом языке

Этот обзор сравнил клиническую эффективность и безопасность хирургического вмешательства (удаление миндалин - тонзиллэктомия, или аденотонзиллэктомия - удаление миндалин и аденоидных тканей) с нехирургической тактикой ведения у взрослых и детей с частыми или хроническими тонзиллитами.

Хирургическое удаление миндалин является часто выполняемой операцией у пациентов с хроническими или рецидивирующими инфекциями миндалин (тонзиллит) или других тканей в задней части горла (фарингит). Иногда аденоидные ткани также удаляют во время операции. Однако мнения о том, перевешивает ли польза от этих операций существующие риски, значительно различаются.

Этот обзор включил доступные доказательные данные до 30 июня 2014 года. Были включены семь испытаний с риском смещения от низкого до умеренного: пять испытаний у детей (987 участников) и два испытания у взрослых (156 участников). Восьмое испытание у 40 взрослых имело высокий риск смещения и не предоставило никаких данных для анализа.

Хотя в некоторых исследованиях у детей участники исследования наблюдались в течение двух или трех лет, надежная информация доступна только за период около одного года после операции в связи с большим числом участников (детей), пропускающих последующее наблюдение после первого года (после операции). Некоторые исследования включили детей, у которых были более тяжелые формы тонзиллита, чем в других исследованиях (например, у них тонзиллит встречался чаще или с более тяжелыми симптомами). Поэтому мы распределили детей в подгруппы "тяжело пострадавших" и "менее тяжело пострадавших".

В двух исследованиях у взрослых была короткая продолжительность наблюдения (5-6 месяцев после операции).

Мы обнаружили, что в целом, дети, страдающие рецидивирующим тонзиллитом могут иметь небольшую пользу от адено-/тонзиллэктомии: эта процедура позволит избежать 0,6 эпизодов боли в горле любого типа в течение первого года после операции по сравнению с нехирургическим лечением. У детей, которые перенесли операцию, было три эпизода боли в горле, в среднем, по сравнению с 3,6 эпизодами, перенесенными другими детьми. Один из трех эпизодов является эпизодом боли, вызванной хирургическим вмешательством.

Для того, чтобы избежать сильных болей в горле, у детей с более тяжелыми или частыми эпизодами тонзиллита может быть больше пользы от хирургического вмешательства по сравнению с детьми с менее тяжелыми формами тонзиллита. У детей с менее тяжелыми формами заболевания потенциальная польза от адено-/тонзиллэктомии является более неопределенной. Нет хороших качественных данных для определения эффектов хирургического вмешательства во втором и последующем годах после операции.

Мы не нашли достаточных доказательств, чтобы сделать окончательные выводы об эффективности тонзиллэктомии у взрослых с хроническим/рецидивирующим тонзиллитом. Доказательства доступны только на короткий срок и имеют низкое качество. Эти данные также трудно интерпретировать, так как исследования не учитывают дни боли, которая следует после операции. Основываясь на двух небольших испытаниях, тонзиллэктомия, кажется приводит к меньшему числу дней боли в горле в первые шесть месяцев после операции.

Два исследования у детей говорили, что они не могли найти различий в исходах качества жизни, и одно исследование не могло найти различий в числе обезболивающих средств, которые дети принимали для облегчения их болей в горле.

Кровотечение сразу после тонзиллэктомии или в течение двух недель после операции является важным осложнением. Эти исследования не предоставили полезную информацию, чтобы позволить нам точно оценить риск этих осложнений.

Мы заключили, что качество доказательств было умеренным для данных по детям (это означает, что дальнейшие исследования вероятно будут иметь важное влияние на нашу уверенность в результатах и ​​могут изменить те результаты). На качество оказало влияние большое число детей, которые "потерялись для наблюдения" после первого года исследования. Кроме того, некоторые дети, которые были распределены в "нехирургическую" группу, в конечном итоге, были подвергнуты хирургическому вмешательству.

Качество доказательств для тонзиллэктомии у взрослых является низким.

Как обычно, любые потенциальные преимущества хирургического вмешательства следует тщательно взвесить против возможного вреда, так как процедура связана с небольшим, но существенным уровнем заболеваемости в виде кровотечений (как во время, так и после операции). Кроме того, даже при хорошем обезболивании, хирургическое вмешательство особенно не комфортно для взрослых.

Перевод: Торобеков Шамилбек Женишбекович. Редактирование: Юдина Екатерина Викторовна. Координация проекта по переводу на русский язык: Казанский федеральный университет. По вопросам, связанным с этим переводом, пожалуйста, свяжитесь с нами по адресу: [email protected]

Résumé simplifié

Cette revue compare l'efficacité clinique et l'innocuité de la chirurgie (ablation des amygdales [amygdalectomie] ou des amygdales et des végétations adénoïdes [adéno-amygdalectomie]) et du traitement non chirurgical chez des adultes et des enfants souffrant d'amygdalites fréquentes ou chroniques.

L'ablation chirurgicale des amygdales est une opération fréquemment réalisée chez les patients atteints d'infections chroniques ou récidivantes des amygdales (amygdalite) ou des autres tissus de l'arrière de la gorge (pharyngite). Cette ablation est parfois étendue aux tissus adénoïdes (végétations). Les avis sont cependant très partagés quant à savoir si les bénéfices de ces opérations l'emportent sur les risques.

Cette revue porte sur les données disponibles à la date du 30 juin 2014. Sept essais comportant un risque faible à modéré de biais y ont été inclus: cinq menés sur des enfants (987 participants) et deux sur des adultes (156 participants). Une huitième étude, portant sur 40 adultes, comportait un risque élevé de biais et n'a pas fourni de données pour l'analyse.

Bien que certaines études chez les enfants comportent un suivi sur deux ou trois ans, il n'existe d'informations fiables que jusqu'à environ un an après l'opération car un grand nombre de participants est perdu de vue après la première année. Certaines études recrutaient des enfants qui ont étaient plus sévèrement affectés par les amygdalites que dans d'autres études (amygdalites plus fréquentes, par exemple, et symptômes plus sévères). Par conséquent, nous avons regroupé les enfants en sous-groupes «sévèrement touchés» et «moins sévèrement touchés».

Deux études chez l'adulte avaient une courte durée de suivi (de cinq à six mois après l'opération).

Nous avons constaté qu'en règle générale, les enfants affectés par des amygdalites aiguës récurrentes tiraient un petit bénéfice d'une (adéno-)amygdalectomie: cette intervention permet d'éviter 0,6 épisode de tous types de maux de gorge dans la première année après l'opération par rapport à un traitement non chirurgical. Les enfants opérés ont eu en moyenne trois épisodes de maux de gorge, contre 3,6 épisodes pour les autres enfants. L'un de ces trois épisodes est lié à la douleur postopératoire.

Si le but est d'éviter les maux de gorge sévères, les enfants ayant des amygdalites plus sévères ou fréquentes peuvent bénéficier davantage de la chirurgie que les enfants moins sévèrement touchés. Chez les enfants moins sévèrement touchés, les avantages potentiels de l'(adéno-)amygdalectomie sont plus incertains. Il n'existe pas de données de bonne qualité sur les effets de la chirurgie au cours de la deuxième année postopératoire et des années suivantes.

Nous n'avons pas trouvé de preuves suffisantes pour tirer des conclusions définitives sur l'efficacité de l'amygdalectomie chez les adultes souffrant d'une amygdalite aiguë chronique ou récidivante. Il n'existe de preuves que sur le court terme, et elles sont de qualité médiocre. Les données sont également difficiles à interpréter parce que les études ne prennent pas en compte les jours de douleur qui suivent toujours l'opération. Sur la base des deux petits essais, l'amygdalectomie semble entraîner moins de jours de maux de gorge dans les six premiers mois après l'opération.

Dans deux des études menées sur des enfants, les investigateurs n'ont pas trouvé de différence entre les résultats de qualité de vie, et une étude n'a pas trouvé de différence dans la quantité de médicaments antalgiques pris par les enfants pour soulager leurs maux de gorge.

Les saignements immédiatement après l'amygdalectomie ou dans le deux semaines suivant l'opération sont une complication importante. Les études ne donnent pas de bonnes informations pour évaluer avec précision ce risque de complication.

Nous avons jugé que la qualité de la preuve était modérée pour les données obtenues chez les enfants (ce qui signifie que davantage de recherches pourraient modifier sensiblement la confiance que l'on peut avoir dans les résultats et changer ces résultats). La qualité est affectée par le grand nombre d'enfants «perdus de vue» après la première année de l'étude. En outre, certains enfants affectés au groupe «sans chirurgie» finissent par être opérés.

La qualité des preuves concernant l'amygdalectomie chez l'adulte est faible.

Comme toujours, les avantages potentiels de la chirurgie doivent être soigneusement pesés par rapport aux préjudices possibles, puisque ce geste est associé à un risque faible mais significatif de saignements (pendant ou après l'opération). En outre, il s'agit d'une opération particulièrement inconfortable pour les adultes, même avec une bonne analgésie médicamenteuse.

Traduction réalisée par le Centre Cochrane Français

Laienverständliche Zusammenfassung

Dieser Review vergleicht die klinische Wirksamkeit und Sicherheit eines chirurgischen Eingriffs (Tonsillektomie - Entfernung der Gaumenmandeln - oder Adenotonsillektomie -Entfernung der Gaumen- und Rachenmandeln) mit nicht-chirurgischer Handhabung in Erwachsenen und Kindern mit häufiger oder chronischer Mandelentzündung (Tonsillitis).

Chirurgische Mandelentfernung ist eine häufig durchgeführte Operation bei Patienten mit chronischer oder wiederkehrender Entzündung der Mandeln (Tonsillitis) oder des Rachens (Pharyngitis oder Rachenkatarrh). Manchmal werden während der Operation die Rachenmandeln ebenfalls entfernt. Es existieren allerdings stark unterschiedliche Meinungen ob die Vorteile oder die Risiken dieser Operationen überwiegen.

Dieser Review schließt Evidenz ein, die bis zum 30. Juni 2014 identifiziert wurde. Sieben Studien mit niedrigem bis moderatem Risiko für Bias wurden eingeschlossen: fünf mit Kindern (987 Teilnehmer) und zwei mit Erwachsenen (156 Teilnehmer). Eine achte Studie mit 40 Erwachsenen mit hohem Risiko für Bias enthielt keine Daten für Analysen.

Obwohl manche Studien mit Kindern die Teilnehmer zwei oder drei Jahre lang verfolgten, ist verlässliche Information nur bis etwa ein Jahr nach der Operation erhältlich. Der Grund liegt in der großen Anzahl von Teilnehmern, welche an den Folgeuntersuchungen nicht teilnahmen. Manche Studien verwendeten Kinder mit schwererer Mandelentzündung als andere Studien (beispielsweise solche, die häufiger Mandelentzündung oder ernsthaftere Symptome hatten). Wir gruppierten daher Kinder in "ernsthaft Betroffene" und "weniger ernsthaft Betroffene" Subgruppen.

In zwei Studien mit Erwachsenen waren die Nachfolgeuntersuchungen innerhalb einer kurzen Zeitspanne (fünf bis sechs Monate nach der Operation).

Generell scheinen Kinder mit rezidivierender akuter Mandelentzündung durch Adeno-/Tonsillektomie einen leichten Vorteil zu haben: Diese Behandlung reduziert jede Art von Halsschmerzen um 0,6 Vorfälle im ersten Jahr nach der Operation, verglichen mit nicht-chirurgischer Behandlung. Kinder, an denen ein chirurgischer Eingriff vorgenommen wurde, hatten durchschnittlich drei Episoden von Halsschmerzen verglichen mit 3,6 Episoden bei den anderen Kindern. Eine Episode dieser drei Episoden bezieht sich auf den Schmerz, der durch die Operation hervorgerufen wurde.

Hinsichtlich des Vermeidens von starken Halsschmerzen scheinen Kinder mit schwerer oder häufiger Mandelentzündung von einem chirurgischen Eingriff mehr Nutzen zu ziehen als weniger ernsthaft betroffene Kinder. Für weniger ernsthaft betroffenen Kindern ist der potentielle Nutzen einer Adeno-/Tonsillektomie eher unsicher. Für die Wirkung chirurgischer Eingriffe im zweiten Jahr oder in späteren Jahren existieren keine Daten mit guter Qualität.

Wir haben nicht genügend Evidenz für solide Rückschlüsse gefunden bezüglich der Wirksamkeit einer Mandelentfernung bei Erwachsenen mit chronischer/rezidivierender akuter Mandelentzündung. Evidenz gibt es nur für kurze Zeitspannen, und diese ist von niedriger Qualität. Überdies sind die Daten schwer zu interpretieren, da die Studien nicht die Anzahl der Tage mit Schmerzen, die üblicherweise einer Operation folgen, anführten. Auf der Grundlage zweier kleiner Studien scheint die Entfernung von Mandeln zu weniger Tagen mit Halsschmerzen innerhalb der ersten sechs Monate nach der Operation zu führen.

Zwei Studien mit Kindern gaben an, dass kein Unterschied in der Lebensqualität festgestellt werden konnte und eine Studie konnte keinen Unterschied in der Anzahl der Schmerzmittel, die Kinder zur Linderung ihrer Halsschmerzen nahmen entdecken.

Blutungen unmittelbar nach der Mandelentfernung oder innerhalb von zwei Wochen nach der Operation sind eine wichtige Komplikation. Die Studien lieferten keine guten Informationen, die uns gestatteten, das Risiko dieser Komplikationen genau festzustellen.

Wir beurteilen die Qualität der Evidenz als moderat bezüglich der Daten für Kinder (das bedeutet, dass weitere Forschung einen wichtigen Einfluss darauf hat, wie sicher wir sind, dass die Ergebnisse korrekt sind und ob sich diese ändern). Die Qualität ist beeinträchtigt durch die große Anzahl von Kindern, die an den Nachfolgeuntersuchungen nach dem ersten Jahr nicht teilnahmen. Außerdem wurden einige Kinder aus der "nicht-Operation" - Gruppe trotzdem operiert.

Die Qualität der Evidenz bezüglich Tonsillektomie bei Erwachsenen ist niedrig.

Wie immer sollten die potentiellen Nutzen sorgfältig gegen mögliche Schäden gewogen werden, da der Eingriff zu einem kleinen aber signifikanten Anteil von Morbidität in der Form von Blutungen führt (entweder während oder nach der Operation). Außerdem ist die Operation bei Erwachsenen besonders unangenehm, auch bei Einnahme von schmerzstillenden Mitteln.

L. Hamminger, freigegen durch Cochrane Schweiz.

Ringkasan bahasa mudah

Kajian ini membandingkan keberkesanan klinikal dan keselamatan pembedahan (pembuangan tonsil - tonsilektomi, atau adenotonsilektomi - pembuangan tonsil dan tisu adenoid) dengan rawatan secara bukan pembedahan dalam kalangan pesakit dewasa dan kanak-kanak dengan radang tonsil berulang atau kronik.

Pembedahan pembuangan tonsil ini merupakan pembedahan yang biasa dilakukan ke atas pesakit yang mengalami jangkitan yang berulang atau kronik pada tonsil (tonsilitis) atau tisu-tisu lain di belakang kerongkong (faringitis). Kadang-kadang, tisu adenoid juga dibuang semasa pembedahan. Walau bagaimanapun, terdapat perbezaan pendapat yang ketara tentang sama ada manfaat pembedahan ini melebihi risikonya.

Ulasan ini mengambilkira bukti-bukti sedia ada sehingga 30 Jun 2014. Tujuh kajian dengan risiko kecenderungan yang rendah ke sederhana dinilai: lima melibatkan kanak-kanak (987 peserta) dan dua melibatkan orang dewasa (156 peserta). Kajian kelapan dalam kalangan 40 orang dewasa berisiko bias yang tinggi dan tidak menyediakan sebarang data untuk analisa.

Walaupun sesetengah kajian yang melibatkan kanak-kanak membuat susulan selama dua atau tiga tahun, maklumat yang boleh diambilkira hanyalah kira-kira setahun selepas pembedahan kerana bilangan peserta yang tidak datang rawatan susulan selepas tahun pertama adalah tinggi. Beberapa kajian telah memasukkan kanak-kanak yang terjejas lebih teruk oleh radang tonsilit daripada kajian-kajian lain (contohnya, mereka mempunyai radang tonsil yang lebih kerap dan gejala-gejala yang lebih teruk). Oleh yang demikian, pengulas membahagikan kanak-kanak ke dalam subkumpulan 'teruk terjejas' dan 'kurang teruk terjejas'.

Dua kajian dalam kalangan orang dewasa mempunyai tempoh rawatan susulan yang pendek (lima hingga enam bulan selepas pembedahan).

Kami mendapati pada umumnya kanak-kanak yang terjejas dengan radang tonsil akut yang berulang mungkin mendapat manfaat yang kecil dari adeno-/ tonsilektomi: prosedur ini akan menghindarkan sebanyak 0.6 episod sebarang jenis sakit tekak pada tahun pertama selepas pembedahan berbanding rawatan bukan pembedahan. Kanak-kanak yang menjalani pembedahan mempunyai purata tiga episod sakit tekak berbanding 3.6 episod yang dialami oleh kanak-kanak lain. Salah satu daripada tiga episod itu ialah ialah episod sakit yang disebabkan oleh pembedahan.

Berkenaan menghindari sakit tekak yang teruk, kanak-kanak yang mengalami radang tonsil yang lebih teruk atau kerap boleh mendapat manfaat lebih daripada pembedahan berbanding kanak-kanak kurang teruk terjejas. Bagi kanak-kanak yang kurang teruk terjejas, kelebihan menjalani adeno-/tonsilektomi adalah tidak jelas. Tiada terdapat data berkualiti bagi kesan pembedahan pada tahun-tahun kedua atau terkemudian selepas pembedahan.

Pengulas tidak mendapati cukup bukti untuk membuat kesimpulan yang kukuh mengenai keberkesanan tonsilektomi bagi pesakit dewasa dengan radang tonsil akut yang berulang/kronik. Bukti hanya tersedia untuk jangka masa pendek dan berkualiti rendah. Data juga turut sukar untuk ditafsirkan kerana kajian ini tidak mengambil kira bilangan hari kesakitan yang selalu dirasai selepas pembedahan. Berdasarkan dua kajian kecil, tonsilektomi seakan memberi hasil jumlah bilangan hari sakit tekak yang lebih sedikit dalam tempoh 6 bulan selepas pembedahan.

Dua kajian yang melibatkan kanak-kanak menyatakan bahawa mereka tidak dapat menemui perbezaan dari segi hasil kualiti kehidupan dan satu kajian tidak dapat mencari perbezaan jumlah ubat penahan sakit yang digunakan oleh kanak-kanak untuk membantu dengan sakit tekak mereka.

Pendarahan sejurus selepas tonsilektomi atau dalam dua minggu selepasnya adalah komplikasi yang penting. Kajian ini tidak menyediakan maklumat yang baik untuk membolehkan pengulas menilai dengan tepat risiko komplikasi ini.

Kami mendapati kualiti bukti adalah sederhana untuk data pada kanak-kanak (ini bermakna bahawa penyelidikan selanjutnya mungkin mempunyai kesan penting ke atas keyakinan pengulas dalam keputusan itu dan boleh mengubah keputusan tersebut). Kualiti terkesan oleh sebilangan besar kanak-kanak yang 'hilang ketiika rawatan susulan' selepas tahun pertama kajian. Di samping itu, sesetengah kanak-kanak yang dikategorikan dalam Kumpulan 'tanpa pembedahan' akhirnya menjalani pembedahan juga.

Kualiti bukti tonsilektomi dalam pesakit dewasa adalah rendah.

Seperti biasa, mana-mana potensi manfaat pembedahan harus dinilai dengan berhati-hati berbanding kemudaratan yang mungkin kerana prosedur ini dikaitkan dengan morbiditi yang kecil tetapi signifikan dalam bentuk pendarahan (sama ada semasa atau selepas pembedahan). Di samping itu, walaupun dengan ubat melegakan kesakitan yang baik, pembedahan ini adalah amat tidak selesa bagi orang dewasa.

Diterjemahkan oleh Irfan Mohamad (Universiti Sains Malaysia). Disunting oleh Ahmad Filza Ismail (Universiti Sains Malaysia). Untuk sebarang pertanyaan berkaitan terjemahan ini sila hubungi [email protected]

This is an update of a Cochrane review first published in The Cochrane Library in Issue 3, 1999 ( Burton 1999 ) and previously updated in 2009 ( Burton 2009 ).

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