Gyawali Bigyan Raj, Dutta Heempali, Devkota Anuj, Gyawali Nitin, Chhantyal Sangit, Mishra Amit Kumar, Kharel Sanjeev, Balakrishnan Karthik, Sidell Douglas
Department of ENT and Head Neck Surgery Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital Kathmandu Nepal.
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital Kathmandu Nepal.
Laryngoscope Investig Otolaryngol. 2025 Jul 16;10(4):e70203. doi: 10.1002/lio2.70203. eCollection 2025 Aug.
This systematic review and meta-analysis compare the outcomes of primary laryngotracheal reconstruction (LTR) and partial cricotracheal resection (PCTR) in managing moderate-grade pediatric subglottic stenosis (severe Grade II and Grade III). While both surgical approaches are widely used, no clear consensus exists on the superior technique.
A systematic literature search was conducted across PubMed, Embase, and Scopus following PRISMA guidelines. Studies reporting outcomes of LTR and PCTR in pediatric patients (< 18 years) with severe Grade II (> 60%) or Grade III subglottic stenosis were included. The primary outcome was successful extubation or decannulation. Statistical analysis, including pooled prevalence estimates and heterogeneity assessment, was performed using STATA software.
A total of 24 studies were included, comprising 193 patients in the LTR group and 88 in the PCTR group. Successful decannulation was achieved in 83.93% of LTR cases and 96.59% of PCTR cases. However, the difference was not statistically significant ( = 0.47). Failed decannulation in both groups was associated with factors such as neurological disorders, severe airway scarring, and coexisting airway anomalies. PCTR demonstrated slightly better functional outcomes in voice and swallowing, whereas LTR was associated with a higher risk of restenosis and revision surgeries.
Both LTR and PCTR are viable options for moderate-grade pediatric subglottic stenosis, with comparable decannulation success rates. PCTR may offer advantages in functional outcomes, but further research with standardized reporting is necessary to establish an optimal surgical approach.
II.
本系统评价和荟萃分析比较了一期喉气管重建术（LTR）和部分环状气管切除术（PCTR）治疗中度小儿声门下狭窄（重度II级和III级）的疗效。虽然这两种手术方法都被广泛应用，但对于哪种技术更优尚无明确共识。
按照PRISMA指南，在PubMed、Embase和Scopus数据库中进行了系统的文献检索。纳入报告18岁以下患有重度II级（>60%）或III级声门下狭窄的小儿患者LTR和PCTR疗效的研究。主要结局是成功拔管或脱管。使用STATA软件进行统计分析，包括合并患病率估计和异质性评估。
共纳入24项研究，LTR组193例患者，PCTR组88例患者。LTR病例中83.93%成功脱管，PCTR病例中96.59%成功脱管。然而，差异无统计学意义（=0.47）。两组脱管失败均与神经功能障碍、严重气道瘢痕形成和并存气道异常等因素有关。PCTR在语音和吞咽功能结局方面表现略优，而LTR再狭窄和翻修手术风险较高。
LTR和PCTR都是治疗中度小儿声门下狭窄的可行选择，脱管成功率相当。PCTR在功能结局方面可能具有优势，但需要进一步开展标准化报告的研究以确定最佳手术方法。
II级。
