Padia Reema, Sjogren Phayvanh, Smith Marshall, Muntz Harlan, Stoddard Gregory, Meier Jeremy
Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, USA.
Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, USA.
Int J Pediatr Otorhinolaryngol. 2018 May;108:168-174. doi: 10.1016/j.ijporl.2018.03.003. Epub 2018 Mar 8.
To compare operation-specific decannulation rates between single-stage (SSLTR) and double-stage laryngotracheal reconstruction (DSLTR) when controlling for grade of airway stenosis.
A systematic review and meta-analysis were performed using PubMed, EMBASE and Cochrane databases from 1970 to 2015 to examine primary SSLTR and DSLTR for subglottic stenosis in patients 18 years or younger. Primary outcome was decannulation or extubation after LTR. Failures included patients not decannulated or requiring additional open airway procedures prior to decannulation. Only studies providing outcomes delineated by airway stenosis grade were included. Non-English language studies and case reports were excluded.
There were 712 abstracts reviewed and 16 studies with 663 pooled patients included in the systematic review analysis. The metaanalysis included 5 studies. Overall, the operation-specific decannulation success was statistically significantly different between SSLTR [93.2% (N = 221)] and DSLTR [83.7% (N = 442)] (P<0.001). When controlling for stenosis severity, however, no difference was found in decannulation success between SS- or DSLTR except in the grade 3 group: Grade 1-100% (N = 6) vs. 100% (N = 6), (P = 1); Grade 2 - 84.9% (N = 106) vs. 83.3% (N = 138), (P = 0.72); Grade 3-80.2% (N = 101) vs. 69.7% (N = 238), (P = 0.03); Grade 4-33.3% (N = 6) vs. 50% (N = 58), (P = 0.67).
No difference in decannulation rates was seen between SSLTR and DSLTR when comparing similar grades of stenosis except in grade 3 stenosis. With worsening stenosis, the success rate declines with both methods. Prospective studies with standardized enrollment criteria and reported outcomes are needed to better understand the advantages and disadvantages of each approach.
在控制气道狭窄分级的情况下，比较单阶段喉气管重建术（SSLTR）和双阶段喉气管重建术（DSLTR）的特定手术脱管率。
使用1970年至2015年的PubMed、EMBASE和Cochrane数据库进行系统评价和荟萃分析，以研究18岁及以下患者声门下狭窄的原发性SSLTR和DSLTR。主要结局是喉气管重建术后脱管或拔管。失败包括未脱管或在脱管前需要额外气道开放手术的患者。仅纳入提供按气道狭窄分级划分结局的研究。排除非英语语言研究和病例报告。
共检索712篇摘要，16项研究纳入系统评价分析，共663例患者。荟萃分析纳入5项研究。总体而言，SSLTR[93.2%（N = 221）]和DSLTR[83.7%（N = 442）]的特定手术脱管成功率在统计学上有显著差异（P<0.001）。然而，在控制狭窄严重程度时，除3级组外，SSLTR或DSLTR的脱管成功率无差异：1级-100%（N = 6）对100%（N = 6），（P = 1）；2级-84.9%（N = 106）对83.3%（N = 138），（P = 0.72）；3级-80.2%（N = 101）对69.7%（N = 238），（P = 0.03）；4级-33.3%（N = 6）对50%（N = 58），（P = 0.67）。
除3级狭窄外，比较相似狭窄分级时，SSLTR和DSLTR的脱管率无差异。随着狭窄加重，两种方法的成功率均下降。需要采用标准化纳入标准并报告结局的前瞻性研究，以更好地了解每种方法的优缺点。
