Strychowsky Julie E, Kawai Kosuke, Moritz Ethan, Rahbar Reza, Adil Eelam A
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.
Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
Laryngoscope. 2016 Jan;126(1):218-27. doi: 10.1002/lary.25393. Epub 2015 May 25.
The use of nasal stents as a postoperative adjunct following repair of choanal atresia remains controversial. The study objective was to systematically review the literature regarding the efficacy and safety of stenting following transnasal endoscopic repair of bilateral choanal atresia.
Systematic review with meta-analysis.
A comprehensive search in PubMed, EMBASE, CINAHL, and the Cochrane Library was conducted. Inclusion criteria included articles written in the English language with five or more subjects and clear intervention data and outcomes. Two independent reviewers screened studies for eligibility, appraised the level of evidence, extracted data, and resolved discrepancies by consensus. Successful surgery was defined as the absence of restenosis.
Of 154 identified studies, 15 met inclusion criteria. Levels of evidence varied from level 3 to 4. Mean age at surgery ranged from 5 days to 25 months. Thirteen studies (n = 167 patients) included patients who were stented; the weighted pooled proportion of successful surgery was 65% (95% confidence interval [CI], 49-76%). Mean duration of stenting ranged from 48 hours to 16 weeks. Six studies (n = 42) evaluated patients who were not stented; the weighted pooled proportion of successful surgery was 64% (95% CI, 42-84%). Complications associated with stenting included alar injury, vestibular stenosis, columellar tear, and stent dislodgement or blockage.
Success rates for bilateral choanal atresia repair were similar with and without the use of nasal stents. The use of nasal stents may be associated with more complications. There is insufficient data to determine if mitomycin C is a useful therapeutic adjunct.
鼻支架作为后鼻孔闭锁修复术后的辅助手段，其应用仍存在争议。本研究的目的是系统回顾经鼻内镜修复双侧后鼻孔闭锁后支架置入术的疗效和安全性相关文献。
系统评价并进行荟萃分析。
全面检索了PubMed、EMBASE、CINAHL和Cochrane图书馆。纳入标准包括用英文撰写、有5名或更多受试者且有明确干预数据和结果的文章。两名独立评审员筛选研究的合格性，评估证据水平，提取数据，并通过共识解决分歧。成功手术定义为无再狭窄。
在154项已识别的研究中，15项符合纳入标准。证据水平从3级到4级不等。手术时的平均年龄为5天至25个月。13项研究（n = 167例患者）纳入了置入支架的患者；成功手术的加权合并比例为65%（95%置信区间[CI]，49 - 76%）。支架置入的平均持续时间为48小时至16周。6项研究（n = 42例）评估了未置入支架的患者；成功手术的加权合并比例为64%（95% CI，42 - 84%）。与支架置入相关的并发症包括鼻翼损伤、前庭狭窄、鼻小柱撕裂以及支架移位或堵塞。
双侧后鼻孔闭锁修复术使用鼻支架与否的成功率相似。使用鼻支架可能会伴随更多并发症。尚无足够数据确定丝裂霉素C是否为有用的治疗辅助手段。
