Abstract：
OBJECTIVE: To evaluate pre- and post-operative resonance, surgical technique, revision rate, and revision indication among syndromic and non-syndromic children with velopharyngeal insufficiency (VPI).
METHODS: A systematic review was conducted through July 2022. Children surgically treated for VPI were included. A meta-analysis of single means, proportions, comparison of proportions, and mean differences with 95 % confidence interval [CI] was conducted.
RESULTS: Twenty-three articles (n = 1437) were included in the analysis. The most common surgery was Sphincter Pharyngoplasty (SP), 62.6 % [31.3-88.9] for syndromic and 76.3 % [37.5-98.9] for non-syndromic children. Among all surgical techniques, for syndromic and non-syndromic children, 54.8 % [30.9-77.5] and 73.9 % [61.3-84.6] obtained normal resonance post-operatively, respectively. Syndromic patients obtained normal resonance post-operatively in 83.3 % [57.7-96.6] of Combined Furlow Palatoplasty and Sphincter Pharyngoplasty (CPSP), 72.6 % [54.5-87.5] of Pharyngeal Flap (PF), and 45.1 % [13.2-79.8] of Sphincter Pharyngoplasty (SP) surgeries. Non-syndromic patients obtained normal resonance post-operatively in 79.2 % [66.4-88.8] of PF and 75.2 % [61.8-86.5] of SP surgeries. The revision rate for syndromic and non-syndromic patients was 19.9 % [15.0-25.6] and 11.3 % [5.8-18.3], respectively. The difference was statistically significant, 8.6 % [2.9-15.0, p = 0.003]. Syndromic patients who underwent PF were least likely to undergo revision surgery as compared to SP and CPSP, 7.7 % [2.3-17.9] vs. 23.7 % [15.5-33.1] and 15.3 % [2.8-40.7], respectively.
CONCLUSIONS: Syndromic children had higher revision rates and were significantly less likely to obtain normal resonance following primary surgery than non-syndromic patients. Among syndromic children, PF and CPSP have been shown to improve resonance and reduce revision rates more so than SP alone.
METHODS: A systematic review was conducted through July 2022. Children surgically treated for VPI were included. A meta-analysis of single means, proportions, comparison of proportions, and mean differences with 95 % confidence interval [CI] was conducted.
RESULTS: Twenty-three articles (n = 1437) were included in the analysis. The most common surgery was Sphincter Pharyngoplasty (SP), 62.6 % [31.3-88.9] for syndromic and 76.3 % [37.5-98.9] for non-syndromic children. Among all surgical techniques, for syndromic and non-syndromic children, 54.8 % [30.9-77.5] and 73.9 % [61.3-84.6] obtained normal resonance post-operatively, respectively. Syndromic patients obtained normal resonance post-operatively in 83.3 % [57.7-96.6] of Combined Furlow Palatoplasty and Sphincter Pharyngoplasty (CPSP), 72.6 % [54.5-87.5] of Pharyngeal Flap (PF), and 45.1 % [13.2-79.8] of Sphincter Pharyngoplasty (SP) surgeries. Non-syndromic patients obtained normal resonance post-operatively in 79.2 % [66.4-88.8] of PF and 75.2 % [61.8-86.5] of SP surgeries. The revision rate for syndromic and non-syndromic patients was 19.9 % [15.0-25.6] and 11.3 % [5.8-18.3], respectively. The difference was statistically significant, 8.6 % [2.9-15.0, p = 0.003]. Syndromic patients who underwent PF were least likely to undergo revision surgery as compared to SP and CPSP, 7.7 % [2.3-17.9] vs. 23.7 % [15.5-33.1] and 15.3 % [2.8-40.7], respectively.
CONCLUSIONS: Syndromic children had higher revision rates and were significantly less likely to obtain normal resonance following primary surgery than non-syndromic patients. Among syndromic children, PF and CPSP have been shown to improve resonance and reduce revision rates more so than SP alone.
摘要：
目的：评估术前和术后共振，外科技术,修订率，和修正指征的综合征和非综合征患儿与咽喉功能不全（VPI）。
方法：到2022年7月进行了系统评价。包括接受VPI手术治疗的儿童。单一手段的荟萃分析，比例,比例比较，并进行了95%置信区间[CI]的平均差异。
结果：分析中包括23篇文章（n=1437）。最常见的手术是括约肌成形术（SP），62.6%[31.3-88.9]为综合征儿童，76.3%[37.5-98.9]为非综合征儿童。在所有的手术技术中,对于综合征和非综合征儿童，54.8%[30.9-77.5]和73.9%[61.3-84.6]术后获得正常共振，分别。综合患者在术后83.3%[57.7-96.6]中获得正常共振，72.6%[54.5-87.5]的咽部瓣(PF),和45.1%[13.2-79.8]的括约肌成形术(SP)手术。非综合征患者在PF手术的79.2％[66.4-88.8]和SP手术的75.2％[61.8-86.5]中获得了正常的共振。综合征和非综合征患者的修订率为19.9%[15.0-25.6]和11.3%[5.8-18.3],分别。差异有统计学意义,8.6%[2.9-15.0,p=0.003]。与SP和CPSP相比，接受PF的综合征患者最不可能接受翻修手术。7.7%[2.3-17.9]vs.23.7%[15.5-33.1]和15.3%[2.8-40.7]，分别。
结论：与非综合征患者相比，综合征患儿在初次手术后具有更高的翻修率，并且获得正常共振的可能性明显更低。在综合征儿童中，PF和CPSP已被证明比单独的SP更能改善共振并降低翻修率。
方法：到2022年7月进行了系统评价。包括接受VPI手术治疗的儿童。单一手段的荟萃分析，比例,比例比较，并进行了95%置信区间[CI]的平均差异。
结果：分析中包括23篇文章（n=1437）。最常见的手术是括约肌成形术（SP），62.6%[31.3-88.9]为综合征儿童，76.3%[37.5-98.9]为非综合征儿童。在所有的手术技术中,对于综合征和非综合征儿童，54.8%[30.9-77.5]和73.9%[61.3-84.6]术后获得正常共振，分别。综合患者在术后83.3%[57.7-96.6]中获得正常共振，72.6%[54.5-87.5]的咽部瓣(PF),和45.1%[13.2-79.8]的括约肌成形术(SP)手术。非综合征患者在PF手术的79.2％[66.4-88.8]和SP手术的75.2％[61.8-86.5]中获得了正常的共振。综合征和非综合征患者的修订率为19.9%[15.0-25.6]和11.3%[5.8-18.3],分别。差异有统计学意义,8.6%[2.9-15.0,p=0.003]。与SP和CPSP相比，接受PF的综合征患者最不可能接受翻修手术。7.7%[2.3-17.9]vs.23.7%[15.5-33.1]和15.3%[2.8-40.7]，分别。
结论：与非综合征患者相比，综合征患儿在初次手术后具有更高的翻修率，并且获得正常共振的可能性明显更低。在综合征儿童中，PF和CPSP已被证明比单独的SP更能改善共振并降低翻修率。
