Provinciatto Henrique, Barbalho Maria Esther, Araujo Júnior Edward, Cruz-Martínez Rogelio, Agrawal Pankaj, Tonni Gabriele, Ruano Rodrigo
Department of Medicine, Barao de Maua University Center, Ribeirao Preto 14090-062, SP, Brazil.
Department of Medicine, Potiguar University, Natal 59056-000, RN, Brazil.
J Clin Med. 2024 Jun 18;13(12):3572. doi: 10.3390/jcm13123572.
We aimed to conduct a systematic review and meta-analysis to evaluate the fetoscopic tracheal occlusion in patients with isolated severe and left-sided diaphragmatic hernia. Cochrane Library, Embase, and PubMed (Medline) databases were searched from inception to February 2024 with no filters or language restrictions. We included studies evaluating the outcomes of fetoscopic intervention compared to expectant management among patients with severe congenital diaphragmatic hernia exclusively on the left side. A random-effects pairwise meta-analysis was performed using RStudio version 4.3.1. In this study, we included 540 patients from three randomized trials and five cohorts. We found an increased likelihood of neonatal survival associated with fetoscopic tracheal occlusion (Odds Ratio, 5.07; 95% Confidence Intervals, 1.91 to 13.44; < 0.01) across general and subgroup analyses. Nevertheless, there were higher rates of preterm birth (OR, 5.62; 95% CI, 3.47-9.11; < 0.01) and preterm premature rupture of membranes (OR, 7.13; 95% CI, 3.76-13.54; < 0.01) in fetal endoscopic tracheal occlusion group compared to the expectant management. Our systematic review and meta-analysis demonstrated the benefit of fetoscopic tracheal occlusion in improving neonatal and six-month postnatal survival in fetuses with severe left-sided CDH. Further studies are still necessary to evaluate the efficacy of tracheal occlusion for isolated right-sided CDH, as well as the optimal timing to perform the intervention.
我们旨在进行一项系统评价和荟萃分析，以评估在孤立性严重左侧膈疝患者中进行胎儿镜气管封堵术的效果。检索了Cochrane图书馆、Embase和PubMed（Medline）数据库，检索时间从建库至2024年2月，无筛选条件和语言限制。我们纳入了评估单纯左侧严重先天性膈疝患者中胎儿镜干预与期待治疗相比的结局的研究。使用RStudio 4.3.1版本进行随机效应成对荟萃分析。在本研究中，我们纳入了来自三项随机试验和五个队列的540例患者。我们发现在总体和亚组分析中，胎儿镜气管封堵术与新生儿存活可能性增加相关（优势比，5.07；95%置信区间，1.91至13.44；P<0.01）。然而，与期待治疗相比，胎儿内镜气管封堵术组的早产率（优势比，5.62；95%置信区间，3.47 - 9.11；P<0.01）和胎膜早破早产率（优势比，7.13；95%置信区间，3.76 - 13.54；P<0.01）更高。我们的系统评价和荟萃分析表明，胎儿镜气管封堵术在改善严重左侧先天性膈疝胎儿的新生儿和出生后六个月存活率方面具有益处。仍有必要进一步研究评估气管封堵术对孤立性右侧先天性膈疝的疗效，以及进行干预的最佳时机。
