中度小儿声门下狭窄的喉气管重建和部分环气管切除的疗效比较：系统回顾和meta分析

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology Pub Date : 2025-07-16 DOI:10.1002/lio2.70203

Bigyan Raj Gyawali, Heempali Dutta, Anuj Devkota, Nitin Gyawali, Sangit Chhantyal, Amit Kumar Mishra, Sanjeev Kharel, Karthik Balakrishnan, Douglas Sidell

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引用次数: 0

摘要

目的：本系统综述和meta分析比较了原发性喉气管重建术（LTR）和环气管部分切除术（PCTR）治疗中度小儿声门下狭窄（严重II级和III级）的疗效。虽然这两种手术方法都被广泛使用，但对于哪种技术更优还没有明确的共识。方法根据PRISMA指南，在PubMed、Embase和Scopus中进行系统的文献检索。研究报告了严重II级（60%）或III级声门下狭窄的儿科患者（18岁）LTR和PCTR的结果。主要结果是成功拔管或脱管。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。结果共纳入24项研究，其中LTR组193例，PCTR组88例。LTR和PCTR分别为83.93%和96.59%。但差异无统计学意义（p = 0.47）。两组患者脱管失败均与神经系统疾病、严重气道瘢痕和共存气道异常等因素相关。PCTR在语音和吞咽方面表现出稍好的功能结果，而LTR与再狭窄和翻修手术的高风险相关。结论LTR和PCTR都是治疗中度儿童声门下狭窄的可行选择，其去管成功率相当。PCTR可能在功能预后方面具有优势，但需要进一步的标准化报告研究来确定最佳的手术方法。证据级别II

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Comparison of Outcomes Between Primary Laryngotracheal Reconstruction and Partial Cricotracheal Resection in Moderate Grade Pediatric Subglottic Stenosis: A Systematic Review and Meta-Analysis

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Comparison of Outcomes Between Primary Laryngotracheal Reconstruction and Partial Cricotracheal Resection in Moderate Grade Pediatric Subglottic Stenosis: A Systematic Review and Meta-Analysis

Objective

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.

Methods

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.

Results

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 (p = 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.

Conclusion

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.