Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Otolaryngol Head Neck Surg. 2023 Aug;169(2):227-233. doi: 10.1002/ohn.279. Epub 2023 Feb 7.
To examine and compare the outcomes of various surgical interventions for congenital laryngeal webs in terms of avoidance of tracheostomy, rate of decannulation, web recurrence, revision surgery, and mortality in children.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted on December 10, 2021, using a comprehensive search in PubMed, Web of Science, Cochrane library, and Embase with no date restriction.
Articles on surgical intervention for congenital laryngeal webs in pediatric (<18 years) patients were included in the analysis. Articles including acquired laryngeal webs, no surgical intervention, or exclusively adult population were excluded.
9027 articles were reviewed, 24 articles met the inclusion criteria and 126 patients were included. In patients with Grades I and II webs, there was no significant difference in rates of tracheostomy or decannulation, between endoscopic (100%) versus open approach (100%). For Grades III and IV webs, 96% of patients who received open surgery were decannulated or avoided tracheostomy compared to 84% of those managed endoscopically (p = 0.081). There were significantly lower rates of revision surgery in the open group compared to the endoscopic group (77.8% vs 30.9%, p = 0.008).
This study showed no difference in rates of tracheostomy, decannulation, web recurrence, revision, or mortality between endoscopic and open approaches for the treatment of Grades I and II webs. For Grades III and IV, open surgical techniques achieved a lower revision rate. Results should be interpreted in light of associated increased morbidity with open procedures.
研究并比较各种手术干预先天性喉蹼的结果，主要比较避免气管切开术、拔管率、蹼复发、再次手术率和死亡率，以评估这些结果在儿童患者中的差异。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，于 2021 年 12 月 10 日进行了系统评价，使用了 PubMed、Web of Science、Cochrane 图书馆和 Embase 的全面检索，无日期限制。
分析中纳入了关于儿童（<18 岁）患者先天性喉蹼手术干预的文章。排除了后天性喉蹼、无手术干预或仅为成人的文章。
共审查了 9027 篇文章，24 篇文章符合纳入标准，共纳入 126 例患者。在 I 级和 II 级蹼的患者中，内镜（100%）与开放手术（100%）的气管切开术或拔管率无显著差异。对于 III 级和 IV 级蹼，接受开放手术的患者中，96%的患者可以拔管或避免气管切开术，而接受内镜治疗的患者中这一比例为 84%（p=0.081）。开放组的再次手术率明显低于内镜组（77.8%比 30.9%，p=0.008）。
本研究表明，内镜和开放方法治疗 I 级和 II 级蹼在气管切开术、拔管、蹼复发、再次手术或死亡率方面无差异。对于 III 级和 IV 级，开放手术技术的再次手术率较低。结果应结合开放手术相关的发病率增加来解释。
