Marvin Kastley, Coulter Michael, Johnson Christopher, Friesen Tzyynong, Morris Kimberly, Brigger Matthew T
Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Camp Lejeune, North Carolina, USA.
Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Camp Pendleton, California, USA.
Otolaryngol Head Neck Surg. 2023 Apr;168(4):602-610. doi: 10.1177/01945998221084891. Epub 2023 Feb 5.
To assess dysphagia outcomes following surgical management of unilateral vocal fold immobility in children.
Ovid Medline, Embase, Web of Science, and CENTRAL databases.
A systematic review of the medical literature was performed following the PRISMA guidelines. An a priori protocol was defined to identify all articles that presented quantifiable outcome data in children aged <18 years who underwent surgical treatment to improve glottal competence for dysphagia. Two authors independently determined references meeting the inclusion criteria, extracted data, and assigned levels of evidence. Data were pooled via a random effects model where possible. The quality of studies was graded with the MINORS criteria.
An overall 398 publications were screened, with 9 meeting inclusion criteria. A total of 115 patients were included. Of these, 75% had preoperative swallowing symptoms. Surgical intervention for dysphagia included 61 injection laryngoplasties, 11 medialization laryngoplasties, and 10 reinnervations (ansa cervicalis to recurrent laryngeal nerve). The articles consistently reported success in improving dysphagia symptoms, and limited meta-analysis demonstrated a mean improvement after surgical intervention in 79% (95% CI, 67%-91%) of children. The reported rate of minor and major complications was 15% (95% CI, 1%-29%). The MINORS scores ranged from 5 to 12.
Surgical management of unilateral vocal fold immobility in properly selected children can be an effective treatment for dysphagia when symptoms are present. Selection of surgical modalities relies on patient- and surgeon-related factors, and the rate of success is high across different interventions in treating these complex children.
评估儿童单侧声带麻痹手术治疗后的吞咽困难结果。
Ovid Medline、Embase、Web of Science和CENTRAL数据库。
按照PRISMA指南对医学文献进行系统综述。定义了一个先验方案，以识别所有在18岁以下接受手术治疗以改善吞咽困难声门功能的儿童中呈现可量化结果数据的文章。两位作者独立确定符合纳入标准的参考文献，提取数据，并确定证据水平。如有可能，通过随机效应模型汇总数据。研究质量采用MINORS标准进行分级。
共筛选了398篇出版物，其中9篇符合纳入标准。共纳入115例患者。其中，75%术前有吞咽症状。吞咽困难的手术干预包括61例注射喉成形术、11例喉内移术和10例神经再支配术（颈袢至喉返神经）。文章一致报道手术成功改善了吞咽困难症状，有限的荟萃分析表明，手术干预后79%（95%CI，67%-91%）的儿童有平均改善。报告的轻微和严重并发症发生率为15%（95%CI，1%-29%）。MINORS评分范围为5至12分。
对于适当选择的有症状儿童，单侧声带麻痹的手术治疗可能是治疗吞咽困难的有效方法。手术方式的选择取决于患者和外科医生相关因素，在治疗这些复杂儿童时，不同干预措施的成功率都很高。
