腭裂患者手术结局和修复率：综合征型与非综合征型儿童的系统回顾和荟萃分析
Surgical outcomes and revision rates for velopharyngeal insufficiency (VPI) in syndromic and non-syndromic children: A systematic review and meta-analysis.
机构信息
Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, 135 Rutledge Avenue, Charleston, SC 29425, USA; SUNY Upstate Medical University, School of Medicine, 766 Irving Ave, Syracuse, NY 13210, USA.
Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, 135 Rutledge Avenue, Charleston, SC 29425, USA; University of Central Florida, School of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA.
出版信息
Am J Otolaryngol. 2024 Jul-Aug;45(4):104341. doi: 10.1016/j.amjoto.2024.104341. Epub 2024 May 1.
PURPOSE
To evaluate pre- and post-operative resonance, surgical technique, revision rate, and revision indication among syndromic and non-syndromic children with velopharyngeal insufficiency (VPI).
MATERIALS AND METHODS
A systematic review was conducted through July 2022. Children surgically treated for VPI were included. A meta-analysis of single means, proportions, comparison of proportions, and mean differences with 95 % confidence interval [CI] was conducted.
RESULTS
Twenty-three articles (n = 1437) were included in the analysis. The most common surgery was Sphincter Pharyngoplasty (SP), 62.6 % [31.3-88.9] for syndromic and 76.3 % [37.5-98.9] for non-syndromic children. Among all surgical techniques, for syndromic and non-syndromic children, 54.8 % [30.9-77.5] and 73.9 % [61.3-84.6] obtained normal resonance post-operatively, respectively. Syndromic patients obtained normal resonance post-operatively in 83.3 % [57.7-96.6] of Combined Furlow Palatoplasty and Sphincter Pharyngoplasty (CPSP), 72.6 % [54.5-87.5] of Pharyngeal Flap (PF), and 45.1 % [13.2-79.8] of Sphincter Pharyngoplasty (SP) surgeries. Non-syndromic patients obtained normal resonance post-operatively in 79.2 % [66.4-88.8] of PF and 75.2 % [61.8-86.5] of SP surgeries. The revision rate for syndromic and non-syndromic patients was 19.9 % [15.0-25.6] and 11.3 % [5.8-18.3], respectively. The difference was statistically significant, 8.6 % [2.9-15.0, p = 0.003]. Syndromic patients who underwent PF were least likely to undergo revision surgery as compared to SP and CPSP, 7.7 % [2.3-17.9] vs. 23.7 % [15.5-33.1] and 15.3 % [2.8-40.7], respectively.
CONCLUSIONS
Syndromic children had higher revision rates and were significantly less likely to obtain normal resonance following primary surgery than non-syndromic patients. Among syndromic children, PF and CPSP have been shown to improve resonance and reduce revision rates more so than SP alone.
目的
评估综合征和非综合征性腭咽闭合不全（VPI）儿童的术前和术后共鸣、手术技术、翻修率和翻修指征。
材料和方法
通过 2022 年 7 月进行了系统评价。纳入了接受 VPI 手术治疗的儿童。对单均值、比例、比例比较和均值差异进行了 95%置信区间[CI]的荟萃分析。
结果
23 篇文章（n=1437）被纳入分析。最常见的手术是咽缩肌成形术（SP），综合征儿童为 62.6%[31.3-88.9]，非综合征儿童为 76.3%[37.5-98.9]。在所有手术技术中，综合征和非综合征儿童术后分别有 54.8%[30.9-77.5]和 73.9%[61.3-84.6]获得正常共鸣。综合征患者在联合 Furlow 咽后瓣成形术和咽缩肌成形术（CPSP）中术后获得正常共鸣的比例为 83.3%[57.7-96.6]，在咽瓣成形术中为 72.6%[54.5-87.5]，在咽缩肌成形术中为 45.1%[13.2-79.8]。非综合征患者在咽瓣成形术中术后获得正常共鸣的比例为 79.2%[66.4-88.8]，在咽缩肌成形术中为 75.2%[61.8-86.5]。综合征和非综合征患者的翻修率分别为 19.9%[15.0-25.6]和 11.3%[5.8-18.3]。差异具有统计学意义，8.6%[2.9-15.0，p=0.003]。与 SP 和 CPSP 相比，综合征患者行咽瓣成形术的翻修手术可能性最小，分别为 7.7%[2.3-17.9]、23.7%[15.5-33.1]和 15.3%[2.8-40.7]。
结论
综合征儿童的翻修率较高，与非综合征患者相比，初次手术后获得正常共鸣的可能性明显降低。在综合征儿童中，与单独使用 SP 相比，PF 和 CPSP 已被证明可以改善共鸣并降低翻修率。
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