Titulaer Kai, Schlattmann Peter, Guntinas-Lichius Orlando
Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
Department of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, Jena, Germany.
Front Surg. 2022 Jul 22;9:956338. doi: 10.3389/fsurg.2022.956338. eCollection 2022.
To determine the decannulation rate (DR) and revision surgery rate after surgery for bilateral vocal fold paralysis (BVFP).
Five databases (MEDLINE, PubMed, Embase, Web of Science, Scopus) were searched for the period 1908-2020.
The systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were pooled using a random-mixed-effects model. Randomized controlled trials and non-randomized studies (case-control, cohort, and case series) were included to assess DR and revision surgery rate after different surgical techniques for treatment of BVFP.
The search yielded 857 publications, of which 102 with 2802 patients were included. DR after different types of surgery was: arytenoid abduction (DR 0.93, 95%-confidence interval [CI], 0.86-0.97), endolaryngeal arytenoidectomy (DR 0.92, 95%-CI, 0.86-0.96), external arytenoidectomy (DR 0.94; 95%-CI, 0.71-0.99), external arytenoidectomy and lateralisation (DR 0.87; 95%-CI, 0.73-0.94), laterofixation (DR 0.95; 95%-CI, 0.91-0.97), posterior cordectomy (DR 0.97, 95%-CI, 0.94-0.99), posterior cordectomy and arytenoidectomy (DR 0.98, 95%-CI, 0.93-0.99), posterior cordectomy and subtotal arytenoidectomy (DR 0.98, 95%-CI, 0.88-1.00), posterior cordotomy (DR 0.96, 95%-CI, 0.84-0.99), reinnervation (0.69, 95%-CI, 0.12-0.97), subtotal arytenoidectomy (DR 1.00, 95%-CI, 0.00-1.00) and transverse cordotomy (DR 1.0, 95%-CI, 0.00-1.00). No significant difference between subgroups for DR could be found (Q = 15.67, df = 11, = 0.1540). The between-study heterogeneity was low (2 = 2.2627; = 1.5042; I = 0.0%). Studies were at high risk of bias.
BLVP is a rare disease and the study quality is insufficient. The existing studies suggest a publication bias and the literature review revealed that there is a lack of prospective controlled studies. There is a lack of standardized measures that takes into account both speech quality and respiratory function and allows adequate comparison of surgical methods.
确定双侧声带麻痹（BVFP）手术后的拔管率（DR）和翻修手术率。
检索了五个数据库（MEDLINE、PubMed、Embase、Web of Science、Scopus）在1908年至2020年期间的文献。
系统文献综述遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。使用随机混合效应模型汇总数据。纳入随机对照试验和非随机研究（病例对照、队列和病例系列），以评估不同手术技术治疗BVFP后的DR和翻修手术率。
检索共得到857篇出版物，其中102篇纳入了2802例患者。不同类型手术后的DR分别为：杓状软骨外展术（DR 0.93，95%置信区间[CI]，0.86 - 0.97）、喉内杓状软骨切除术（DR 0.92，95%CI，0.86 - 0.96）、杓状软骨外侧切除术（DR 0.94；95%CI，0.71 - 0.99）、杓状软骨外侧切除术及侧方固定术（DR 0.87；95%CI，0.73 - 0.94）、侧方固定术（DR 0.95；95%CI，0.91 - 0.97）、后索切除术（DR 0.97，95%CI，0.94 - 0.99）、后索切除术及杓状软骨切除术（DR 0.98，95%CI，0.93 - 0.99）、后索切除术及次全杓状软骨切除术（DR 0.98，95%CI，0.88 - 1.00）、后索切开术（DR 0.96，95%CI，0.84 - 0.99）、神经再支配术（0.69，95%CI，0.12 - 0.97）、次全杓状软骨切除术（DR 1.00，95%CI，0.00 - 1.00）和横断索切开术（DR 1.0，95%CI，0.00 - 1.00）。各亚组间DR无显著差异（Q = 15.67，自由度df = 11，P = 0.1540）。研究间异质性较低（I² = 2.2627；τ² = 1.5042；I² = 0.0%）。研究存在较高的偏倚风险。
BVFP是一种罕见疾病，研究质量不足。现有研究提示存在发表偏倚，文献综述显示缺乏前瞻性对照研究。缺乏同时考虑语音质量和呼吸功能并能充分比较手术方法的标准化措施。
