Cedin Antonio C, Atallah Alvaro N, Andriolo Régis B, Cruz Oswaldo L, Pignatari Shirley N
ENT, Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil.
Cochrane Database Syst Rev. 2012 Feb 15;2012(2):CD008993. doi: 10.1002/14651858.CD008993.pub2.
Congenital choanal atresia is a rare abnormality characterized by unilateral or bilateral lack of patency of the posterior end of the nasal cavity. With an incidence of 1:5000 to 1:8000 births, it is twice as prevalent in females as it is in males. Surgical procedures aim to provide adequate functional choanal patency and a low rate of restenosis, avoid harm to any structure in development, enable shorter surgery and hospitalization times, and minimize morbidity and mortality.
To evaluate the effectiveness and safety of the available surgical techniques for the treatment of congenital choanal atresia in patients with unilateral and bilateral atresia.
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the search was 31 January 2011.
We planned to include parallel randomized or quasi-randomized controlled trials testing surgical approaches for the treatment of congenital atresia (irrespective of gender and age) that evaluated normal/adequate respiratory function (self reported or preserved nasal airway) and restenosis as the main primary outcomes. We did not consider reoperation and non-congenital atresia (e.g. traumatic, iatrogenic atresias) for inclusion.
Three review authors independently assessed the titles and abstracts of the identified articles to determine potential relevance. For dichotomous and continuous variables, we planned to calculate risk ratios (relative risks; RR) and mean differences (MD) with 95% confidence intervals (CI), respectively. We planned to use the random-effects model since we were expecting substantial clinical and methodological heterogeneity.
No randomized controlled trials were identified. From the 120 reports retrieved using our search strategy, 46 primary studies had the potential to be included since they had tested surgical approaches for choanal atresia. However, we excluded all of them during the final selection process because their study designs did not meet our inclusion criteria.
AUTHORS' CONCLUSIONS: There is no definitive evidence, based on randomized controlled trials, to demonstrate the potential advantages and disadvantages of any specific surgical technique for patients with choanal atresia. Specialists should unify their efforts in multicenter randomized controlled trials that test the effectiveness and safety of different surgical techniques in patients with choanal atresia.
先天性后鼻孔闭锁是一种罕见的异常情况，其特征为鼻腔后端单侧或双侧不通畅。发病率为1:5000至1:8000活产儿，女性发病率是男性的两倍。手术目的是提供足够的后鼻孔通畅功能和低再狭窄率，避免损害任何发育中的结构，缩短手术和住院时间，并将发病率和死亡率降至最低。
评估现有手术技术治疗单侧和双侧先天性后鼻孔闭锁患者的有效性和安全性。
我们检索了Cochrane耳、鼻和咽喉疾病组试验注册库；Cochrane对照试验中央注册库（CENTRAL）；PubMed；EMBASE；CINAHL；科学引文索引；BIOSIS预评文摘；剑桥科学文摘；国际标准随机对照试验编号及其他已发表和未发表试验的来源。检索日期为2011年1月31日。
我们计划纳入平行随机或半随机对照试验，这些试验测试治疗先天性闭锁（不论性别和年龄）的手术方法，以正常/足够的呼吸功能（自我报告或保留鼻气道）和再狭窄作为主要主要结局进行评估。我们不考虑再次手术和非先天性闭锁（如创伤性、医源性闭锁）纳入。
三位综述作者独立评估已识别文章的标题和摘要，以确定潜在相关性。对于二分变量和连续变量，我们计划分别计算风险比（相对风险；RR）和平均差（MD）及其95%置信区间（CI）。由于我们预计存在大量临床和方法学异质性，我们计划使用随机效应模型。
未识别到随机对照试验。在使用我们的检索策略检索到的120篇报告中，46项主要研究有可能被纳入，因为它们测试了后鼻孔闭锁的手术方法。然而，在最终选择过程中，我们将它们全部排除，因为它们的研究设计不符合我们的纳入标准。
基于随机对照试验，没有确凿证据证明任何特定手术技术对后鼻孔闭锁患者的潜在优缺点。专家们应共同努力开展多中心随机对照试验，以测试不同手术技术对后鼻孔闭锁患者的有效性和安全性。
