1 Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Voice and Swallowing Center, Loma Linda, California, USA.
2 School of Nursing, Loma Linda University, Loma Linda, California, USA.
Otolaryngol Head Neck Surg. 2019 Sep;161(3):388-400. doi: 10.1177/0194599819839991. Epub 2019 Apr 23.
To determine adverse events after endoscopic flexible vs endoscopic rigid cricopharyngeal myotomy for treatment of Zenker's diverticulum (ZD).
Systematic review of MEDLINE, Web of Science, CINAHL, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials for all years according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additional studies were identified from review citations and a by hand search of manuscripts referencing ZD.
A structured literature search was conducted to identify studies for this systematic review. Methodological Index for Non-randomized Studies (MINORS) criteria were applied to assess study quality. For inclusion, each study had to provide data for at least 10 adult patients who had undergone endoscopic ZD repair reporting clear association with the postprocedure course in each case. Data extracted included all reported adverse events, recurrences, follow-up, and operative times.
In total, 115 studies were included. All but 8 were retrospective case series. Sixty-one reported series of patients after rigid endoscopic stapler repair, 31 after rigid laser repair, and 13 with other rigid endoscopic instruments. Twenty-nine flexible endoscopic studies were included. Mortality, infection, and perforation were not significantly more likely in either the rigid or the flexible group, but bleeding and recurrence were more likely after flexible endoscopic techniques (20% vs <10% and 4% vs 0%, respectively). Dental injury and vocal fold palsy were reported rarely in the rigid endoscopic groups.
Adverse events are rare after endoscopic Zenker's repair. The flexible approach minimizes exposure limitations and can be completed in some patients without general anesthesia. Transoral rigid approaches result in fewer revision surgeries compared with flexible diverticulotomy.
比较内镜下软性与硬性环咽肌切开术治疗Zenker 憩室（ZD）的不良事件。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 MEDLINE、Web of Science、CINAHL、Clinicaltrials.gov 和 Cochrane 对照试验中心注册库所有年份进行系统评价的文献检索。从综述引文和手动搜索引用 ZD 的手稿中确定了其他研究。
进行了结构化文献检索，以确定这项系统评价的研究。非随机研究方法学指数（MINORS）标准用于评估研究质量。纳入标准为，每个研究必须提供至少 10 例接受内镜 ZD 修复的成年患者的数据，并且在每个病例中都明确与术后过程相关。提取的数据包括所有报告的不良事件、复发、随访和手术时间。
共纳入 115 项研究。除 8 项外，其余均为回顾性病例系列研究。61 项报告了硬性内镜吻合器修复后的系列患者，31 项报告了硬性激光修复后的系列患者，13 项报告了其他硬性内镜器械修复后的系列患者。纳入了 29 项软性内镜研究。死亡率、感染和穿孔在硬性或软性组中均不太可能发生，但软性内镜技术后出血和复发的可能性更高（分别为 20%比<10%和 4%比 0%）。硬性内镜组报告的牙齿损伤和声带麻痹很少见。
内镜 Zenker 修复后不良事件罕见。软性方法最大限度地减少了暴露限制，并且可以在一些患者中无需全身麻醉即可完成。与软性憩室切开术相比，经口硬性方法导致的再次手术较少。
