Abstract：
The purpose of this systematic review and meta-analysis was to determine the most effective and least morbid surgical technique for relieving retroglossal airway obstruction in infants with Robin sequence (RS). The study adhered to PRISMA guidelines and included 25 studies (24 cohorts and one case series) that investigated interventions for airway improvement, including conservative measures, tongue-lip adhesion (TLA), mandibular distraction osteogenesis (MDO), and tracheostomy. The primary outcome variable was complication rate, while predictor variable was the use of interventions for airway improvement. Results showed that conservative measures were the preferred initial management strategy in most studies, while TLA was recommended for infants with mild obstruction, and MDO or tracheostomy was reserved for severe cases. Only complications could be analysed via meta-analysis due to data heterogeneity, revealing that tracheostomy had a summary odds ratio of 5.39 in favour of TLA, while MDO had a ratio of 2.8 over TLA, and the complication rates were similar between MDO and tracheostomy. If conservative measures fail, the study recommends mandibular distraction as the preferable technique for stable airway improvement. If the infant is unsuitable for distraction, tongue-lip adhesion may serve as an alternative, while tracheostomy should be reserved for cases of severe multi-level obstruction. The authors propose that large-scale, multicentre trials comparing long-term outcomes are required to establish definitive guidelines.
摘要：
这项系统评价和荟萃分析的目的是确定缓解Robin序列（RS）婴儿舌后气道阻塞的最有效和最不病态的手术技术。该研究遵循PRISMA指南，包括25项研究（24个队列和一个病例系列），调查了气道改善的干预措施。包括保守的措施,舌唇粘连(TLA),下颌骨牵张成骨（MDO），气管造口术.主要结果变量是并发症发生率，而预测变量是使用干预措施改善气道。结果表明，在大多数研究中，保守措施是首选的初始管理策略，虽然TLA被推荐用于轻度梗阻的婴儿，MDO或气管造口术保留用于重症病例。由于数据异质性，只有并发症可以通过荟萃分析进行分析，揭示气管造口术的总比值比为5.39，有利于TLA，而MDO与TLA的比率为2.8，MDO和气管造口术的并发症发生率相似。如果保守措施失败，该研究推荐下颌牵张作为稳定气道改善的优选技术.如果婴儿不适合分心，舌唇粘连可以作为一种选择，而气管切开术应保留用于严重的多层梗阻病例。作者提出，大规模，需要比较长期结局的多中心试验,以建立明确的指南.
