PDF(Pubmed)
Abstract：
Background: We aimed to conduct a systematic review and meta-analysis to evaluate the fetoscopic tracheal occlusion in patients with isolated severe and left-sided diaphragmatic hernia. Methods: Cochrane Library, Embase, and PubMed (Medline) databases were searched from inception to February 2024 with no filters or language restrictions. We included studies evaluating the outcomes of fetoscopic intervention compared to expectant management among patients with severe congenital diaphragmatic hernia exclusively on the left side. A random-effects pairwise meta-analysis was performed using RStudio version 4.3.1. Results: In this study, we included 540 patients from three randomized trials and five cohorts. We found an increased likelihood of neonatal survival associated with fetoscopic tracheal occlusion (Odds Ratio, 5.07; 95% Confidence Intervals, 1.91 to 13.44; p < 0.01) across general and subgroup analyses. Nevertheless, there were higher rates of preterm birth (OR, 5.62; 95% CI, 3.47-9.11; p < 0.01) and preterm premature rupture of membranes (OR, 7.13; 95% CI, 3.76-13.54; p < 0.01) in fetal endoscopic tracheal occlusion group compared to the expectant management. Conclusions: Our systematic review and meta-analysis demonstrated the benefit of fetoscopic tracheal occlusion in improving neonatal and six-month postnatal survival in fetuses with severe left-sided CDH. Further studies are still necessary to evaluate the efficacy of tracheal occlusion for isolated right-sided CDH, as well as the optimal timing to perform the intervention.
摘要：
背景：我们旨在进行系统评价和荟萃分析，以评估重度和左侧膈疝患者的胎儿镜气管闭塞。方法：Cochrane图书馆，Embase,和PubMed（Medline）数据库从开始到2024年2月进行搜索，没有过滤器或语言限制。我们纳入了仅在左侧患有严重先天性膈疝的患者中评估胎儿镜干预与期待治疗的结果的研究。使用RStudio4.3.1版进行随机效应成对荟萃分析。结果:在这项研究中,我们纳入了来自3项随机试验和5个队列的540例患者.我们发现与胎儿镜下气管阻塞相关的新生儿存活的可能性增加(赔率比，5.07；95%置信区间，在一般和亚组分析中，1.91至13.44；p<0.01）。然而，早产率较高(OR，5.62；95%CI，3.47-9.11；p<0.01）和早产胎膜早破（OR，7.13；95％CI，3.76-13.54；p<0.01）在胎儿内镜下气管闭塞组与期待管理相比。结论：我们的系统评价和荟萃分析表明，在重度左侧CDH的胎儿中，胎儿镜下气管阻塞在改善新生儿和出生后六个月生存率方面具有益处。仍然需要进一步的研究来评估气管闭塞对孤立的右侧CDH的疗效。以及执行干预的最佳时机。
