支架和非支架内窥镜技术在双侧后肛门闭锁修复中的应用：系统回顾和荟萃分析

IF 1.3 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology Pub Date : 2025-07-18 DOI:10.1016/j.ijporl.2025.112494

Raisa Chowdhury , Deema Almutawa , Nasser K. Almutairi , Ostap Orishchak , Hamad Almhanedi , Marc A. Tewfik , Sam J. Daniel

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引用次数: 0

摘要

背景：双侧后鼻孔闭锁是一种罕见的先天性后鼻孔阻塞，可导致新生儿和婴儿严重的呼吸窘迫和喂养困难。虽然内窥镜手术修复是标准的护理，但由于潜在的并发症，术后鼻支架的使用仍然存在争议。本系统综述和荟萃分析比较了双侧后肛门闭锁的内镜下支架入路与非支架入路的结果，以评估儿童临床决策的有效性和安全性。方法遵循PRISMA指南，对PubMed、Cochrane Library、CINAHL、Scopus和Web of Science进行全面的图书馆员辅助检索，检索截止到2024年12月。在儿科或新生儿人群中比较支架和非支架内窥镜修复的研究包括在内。两名评论者独立进行数据提取和质量评估，随机试验使用ROB 2，观察性研究使用纽卡斯尔-渥太华量表。结果9项研究共纳入336例再狭窄患者和295例肉芽组织分析患者。大多数患者为新生儿或幼龄婴儿（年龄范围：3-28天）。支架手术的再狭窄发生率显著高于支架手术(RR 2.21, 95% CI 1.53-3.18, p <；0.01)和肉芽组织形成(RR 1.95, 95% CI 1.31-2.90, p <；0.01)。在手术成功率（RR 0.63, p = 0.05）、出血（RR 0.26, p = 0.14）、息肉形成（RR 1.25, p = 0.79）方面无显著差异。异质性和发表偏倚较低。结论内镜下双侧后肛门闭锁修补术后支架置入增加了再狭窄和肉芽形成的风险，在手术成功率和减少并发症方面没有明显的好处。常规支架植入术在新生儿和婴儿中可能是不合理的。

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Stented and non-stented endoscopic techniques in bilateral choanal atresia repair: A systematic review and meta-analysis

Background

Bilateral choanal atresia is a rare congenital obstruction of the posterior nasal apertures that causes severe respiratory distress and feeding difficulties in neonates and infants. While endoscopic surgical repair is the standard of care, the use of postoperative nasal stents remains controversial due to potential complications.

Objectives

This systematic review and meta-analysis compared outcomes of stented versus non-stented endoscopic approaches in bilateral choanal atresia to evaluate efficacy and safety for pediatric clinical decision-making.

Methods

Following PRISMA guidelines, a comprehensive librarian-assisted search was conducted across PubMed, Cochrane Library, CINAHL, Scopus, and Web of Science up to December 2024. Studies comparing stented and non-stented endoscopic repairs in pediatric or neonatal populations were included. Two reviewers independently performed data extraction and quality assessment using ROB 2 for randomized trials and the Newcastle-Ottawa Scale for observational studies.

Results

Nine studies involving 336 patients for restenosis and 295 for granulation tissue analysis were included. Most patients were neonates or young infants (age range: 3–28 days). Stented procedures had significantly higher rates of restenosis (RR 2.21, 95 % CI 1.53–3.18, p < 0.01) and granulation tissue formation (RR 1.95, 95 % CI 1.31–2.90, p < 0.01). No significant differences were found in surgical success (RR 0.63, p = 0.05), bleeding (RR 0.26, p = 0.14), or polyp formation (RR 1.25, p = 0.79). Heterogeneity and publication bias were low.

Conclusions

Stenting after endoscopic repair of bilateral choanal atresia increases restenosis and granulation risks without clear benefit in surgical success or complication reduction. Routine stenting may not be warranted in neonates and infants.

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来源期刊

International journal of pediatric otorhinolaryngology 医学-耳鼻喉科学

CiteScore

3.20

自引率

6.70%

发文量

276

审稿时长

62 days

期刊介绍： The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.