Abstract：
BACKGROUND: Bilateral choanal atresia requires prompt surgical intervention. Surgeons have historically used stents in the repair process, however their efficacy has come into question in recent years. We performed a systematic review to investigate, primarily, whether stents enjoy more favourable outcomes compared to stentless repair. We also explored the use of operative adjuncts, such as steroids, antibiotics, mitomycin C and KTP laser.
METHODS: We performed a search of the Medline and Embase databases using a search strategy developed with the assistance of an academic librarian. Only full peer reviewed articles were included. Abstracts, posters, case reports and proceedings of academic conferences were excluded.
RESULTS: We identified 48 unique articles for inclusion, composed of a meta-analysis, two randomised control trials and 45 case series. Pooled analysis of the two randomised control trials yielded no statistically significant difference in choanal patency between stented and stentless repair, but a statistically significant reduction in complications, specifically granulation tissue formation, was found in stentless repair. Data from case series were, overall, of mixed quality, making factors contributing to successful outcomes difficult to elucidate.
CONCLUSIONS: Overall, there is a lack of high quality evidence to support the use of either a stented or stentless approach to bilateral choanal atresia repair, however stentless repair may experience fewer complications. Operative techniques, such as the use of mucosal flaps, are worthy of future study. Authors call for future high quality randomised control trials to investigate this uncommon but important condition.
METHODS: We performed a search of the Medline and Embase databases using a search strategy developed with the assistance of an academic librarian. Only full peer reviewed articles were included. Abstracts, posters, case reports and proceedings of academic conferences were excluded.
RESULTS: We identified 48 unique articles for inclusion, composed of a meta-analysis, two randomised control trials and 45 case series. Pooled analysis of the two randomised control trials yielded no statistically significant difference in choanal patency between stented and stentless repair, but a statistically significant reduction in complications, specifically granulation tissue formation, was found in stentless repair. Data from case series were, overall, of mixed quality, making factors contributing to successful outcomes difficult to elucidate.
CONCLUSIONS: Overall, there is a lack of high quality evidence to support the use of either a stented or stentless approach to bilateral choanal atresia repair, however stentless repair may experience fewer complications. Operative techniques, such as the use of mucosal flaps, are worthy of future study. Authors call for future high quality randomised control trials to investigate this uncommon but important condition.
摘要：
背景：双侧后鼻孔闭锁需要及时的手术干预。历史上，外科医生在修复过程中使用支架，然而，它们的功效近年来受到质疑。我们进行了系统的回顾调查，主要是,与无支架修复相比，支架是否享有更有利的结果。我们还探讨了手术附件的使用，比如类固醇，抗生素,丝裂霉素C和KTP激光。
方法：我们使用在学术图书馆员的协助下开发的搜索策略对Medline和Embase数据库进行了搜索。仅包括完整的同行评审文章。摘要,海报,病例报告和学术会议记录被排除在外。
结果：我们确定了48篇独特的文章，由荟萃分析组成，两项随机对照试验和45例病例系列。两项随机对照试验的汇总分析显示，支架修复和无支架修复之间的后鼻孔通畅性差异无统计学意义。但是并发症的统计学显着减少，特别是肉芽组织的形成，在无支架修复中被发现。病例系列的数据是，总的来说,混合质量，使促成成功结果的因素难以阐明。
结论：总体而言，缺乏高质量的证据支持使用支架或无支架方法进行双侧后鼻孔闭锁修复，然而，无支架修复可能会经历较少的并发症。操作技术,例如使用粘膜瓣，值得今后研究。作者呼吁未来高质量的随机对照试验来研究这种罕见但重要的情况。
方法：我们使用在学术图书馆员的协助下开发的搜索策略对Medline和Embase数据库进行了搜索。仅包括完整的同行评审文章。摘要,海报,病例报告和学术会议记录被排除在外。
结果：我们确定了48篇独特的文章，由荟萃分析组成，两项随机对照试验和45例病例系列。两项随机对照试验的汇总分析显示，支架修复和无支架修复之间的后鼻孔通畅性差异无统计学意义。但是并发症的统计学显着减少，特别是肉芽组织的形成，在无支架修复中被发现。病例系列的数据是，总的来说,混合质量，使促成成功结果的因素难以阐明。
结论：总体而言，缺乏高质量的证据支持使用支架或无支架方法进行双侧后鼻孔闭锁修复，然而，无支架修复可能会经历较少的并发症。操作技术,例如使用粘膜瓣，值得今后研究。作者呼吁未来高质量的随机对照试验来研究这种罕见但重要的情况。
