PDF(Pubmed)
Abstract：
Pharyngocutaneous fistula (PCF) is a major complication after total laryngectomy, with significant morbidity and mortality. Whether mechanical stapler closure of the pharynx reduces fistula rates compared to hand-sewn techniques remains unclear. We conducted an updated systematic review and meta-analysis to clarify this question. Five databases were systematically searched from inception through November 2023 for studies comparing stapler versus suture closure for fistula outcomes after laryngectomy. Odds ratios (OR) were pooled using random-effects models and fixed-effects models. Subgroup and sensitivity analyses were performed. Risk of bias was appraised using NHLBI tools. Nine studies with 803 patients were included. Mechanical closure significantly reduced fistula incidence versus suture closure (OR = 0.57, 95% CI 0.34-0.95, p = 0.03). Subgroup analysis found that stapling\'s protective effect varied by patient age, country/region, linear stapler size and female percentage. Stapling reduced fistula odds by 80% in the Turkey subgroup (OR = 0.20, 95% CI 0.09-0.50) but showed no benefit in other regions. Patients <60 years showed an 84% fistula reduction with stapling (OR = 0.17, 95% CI 0.06-0.45), whereas older subgroups did not. Linear stapler size of 60 mm significantly reduced fistula occurrence while 75 mm did not. There was no evidence that low female percentage mitigated stapling benefits. Mechanical stapler closure after total laryngectomy meaningfully reduces the likelihood of postoperative PCF formation compared to hand-sewn closure, especially for patients younger than 60 years old. The absolute risk reduction supports its utility to prevent this complication.
摘要：
咽部瘘（PCF）是全喉切除术后的主要并发症，具有显著的发病率和死亡率。与手工缝制技术相比，机械吻合器咽部闭合是否可以降低瘘管发生率尚不清楚。我们进行了最新的系统评价和荟萃分析来澄清这个问题。从开始到2023年11月，系统地搜索了五个数据库，以比较吻合器与缝合闭合器对喉切除术后瘘管结局的研究。使用随机效应模型和固定效应模型合并赔率(OR)。进行亚组和敏感性分析。使用NHLBI工具评估偏倚风险。包括803例患者的9项研究。与缝合闭合相比，机械闭合可显著降低瘘管发生率（OR=0.57，95％CI0.34-0.95，p=0.03）。亚组分析发现，钉合的保护作用因患者年龄而异，国家/地区,线性订书机尺寸和女性百分比。钉扎术在土耳其亚组中降低了80％的瘘几率（OR=0.20，95％CI0.09-0.50），但在其他地区没有获益。<60岁的患者吻合后瘘管减少84％（OR=0.17，95％CI0.06-0.45），而老年亚组没有。尺寸为60mm的线性吻合器显着减少了瘘管的发生，而75mm则没有。没有证据表明低女性百分比会减轻钉书钉的益处。与手工缝合闭合相比，全喉切除术后机械缝合器闭合显著降低了术后PCF形成的可能性，尤其是60岁以下的患者。绝对风险降低支持其防止这种并发症的效用。
