Abstract：
Objectives: To compare the susceptibility and complication rates between flap and primary closures for tracheocutaneous fistula (TCF). Methods: We searched 4 online databases (Web of Science, Cochrane Library, PubMed, and Scopus) for relevant articles published from study inception until August 2022. Studies including at least 5 adult or child patients with persistent TCFs who underwent closure surgery via primary or flap repair were included. All included studies reported outcomes of surgical repairs such as successful closure rates and complications. In addition, we performed single-arm meta-analyses for each surgical method using the Open Meta-Analyst software to calculate the pooled event rate with a 95% confidence interval (CI); compared the 2 surgical procedures using the Review Manager software using the risk ratio with 95% CI; and assessed study quality based on the National Heart, Lung, and Blood Institute criteria. Results: Overall, 27 studies with 997 patients were included. No significant difference was observed between the closure success and major complication rates of surgical methods. The primary and flap closures had overall success rates of 0.979 and 0.98, respectively. The overall major complication rates in primary and flap closures were 0.034 and 0.021, respectively; and that of minor were 0.045 and 0.04, respectively. In primary closure, a significant decrease in the success rate with increasing age at the time of decannulation was observed. In addition, the risk of major complications increased with increasing time from decannulation to closure. Conclusions: Both the primary and flap repairs of TCF are effective based on closure success and complication rates; therefore, they are both acceptable therapeutic alternatives, and flap repair can be considered when other techniques have failed. However, further prospective randomized studies comparing these 2 procedures are needed to support our results.
摘要：
目的：比较皮瓣和初次闭合气管皮瘘（TCF）的敏感性和并发症发生率。方法：我们搜索了4个在线数据库(WebofScience，科克伦图书馆,PubMed,和Scopus）从研究开始到2022年8月发表的相关文章。包括至少5名患有持续性TCF的成人或儿童患者的研究，这些患者通过原发性或皮瓣修复进行了闭合手术。所有纳入的研究报告了手术修复的结果，如成功闭合率和并发症。此外,我们使用OpenMeta-Analyst软件对每种手术方法进行了单臂荟萃分析，以95%置信区间（CI）计算合并事件率；使用ReviewManager软件使用风险比与95%CI比较两种手术方法；并基于NationalHeart,肺，和血液研究所的标准。结果：总体而言，纳入了27项997名患者的研究。手术方法的闭合成功率和主要并发症发生率之间没有显着差异。初级和皮瓣闭合的总成功率分别为0.979和0.98。原发性和皮瓣闭合的总体主要并发症发生率分别为0.034和0.021；次要并发症发生率分别为0.045和0.04。在初级封闭中，观察到拔管时，成功率随着年龄的增加而显着降低。此外,主要并发症的风险随着从拔管到关闭的时间增加而增加.结论：基于闭合成功率和并发症发生率，TCF的初次和皮瓣修复均有效；因此，它们都是可以接受的治疗选择，当其他技术失败时，可以考虑襟翼修复。然而,需要进一步的前瞻性随机研究来比较这2项手术以支持我们的结果.
