PDF(Pubmed)
Abstract：
OBJECTIVE: Previous studies have shown a higher recurrence rate and longer operative times for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) compared to open repair (OR). An updated meta-analysis was conducted to re-evaluate the surgical outcomes of TR.
METHODS: A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588).
RESULTS: Fourteen studies were selected for quantitative analysis, including a total of 709 patients (TR: 308 cases, OR: 401 cases). The recurrence rate was higher [Odds ratio: 4.03, 95% CI (2.21, 7.36), p < 0.001] and operative times (minutes) were longer [Mean Difference (MD): 43.96, 95% CI (24.70, 63.22), p < 0.001] for TR compared to OR. A significant reduction in the occurrence of postoperative bowel obstruction was observed in TR (5.0%) compared to OR (14.8%) [Odds ratio: 0.42, 95% CI (0.20, 0.89), p = 0.02].
CONCLUSIONS: TR remains associated with higher recurrence rates and longer operative times. However, the reduced risk of postoperative bowel obstruction suggests potential long-term benefits. This study emphasizes the importance of meticulous patient selection for TR to mitigate detrimental effects on patients with severe disease.
METHODS: A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588).
RESULTS: Fourteen studies were selected for quantitative analysis, including a total of 709 patients (TR: 308 cases, OR: 401 cases). The recurrence rate was higher [Odds ratio: 4.03, 95% CI (2.21, 7.36), p < 0.001] and operative times (minutes) were longer [Mean Difference (MD): 43.96, 95% CI (24.70, 63.22), p < 0.001] for TR compared to OR. A significant reduction in the occurrence of postoperative bowel obstruction was observed in TR (5.0%) compared to OR (14.8%) [Odds ratio: 0.42, 95% CI (0.20, 0.89), p = 0.02].
CONCLUSIONS: TR remains associated with higher recurrence rates and longer operative times. However, the reduced risk of postoperative bowel obstruction suggests potential long-term benefits. This study emphasizes the importance of meticulous patient selection for TR to mitigate detrimental effects on patients with severe disease.
摘要：
目的：先前的研究表明，与开放修补术（OR）相比，胸腔镜（TR）先天性膈疝（CDH）的复发率更高，手术时间更长。进行了更新的荟萃分析以重新评估TR的手术结果。
方法：根据PRISMA声明（PROSPERO：CRD42020166588），对新生儿的TR和OR进行了全面的文献检索。
结果：选择了14项研究进行定量分析，包括总共709例患者(TR：308例，或：401例）。复发率较高[赔率:4.03,95%CI(2.21,7.36),p<0.001]和手术时间（分钟）更长[平均差（MD）：43.96，95％CI（24.70，63.22），与OR相比，TR的p<0.001。与OR（14.8％）相比，TR（5.0％）观察到术后肠梗阻的发生率显着降低[赔率：0.42，95％CI（0.20，0.89），p=0.02]。
结论：TR仍然与较高的复发率和较长的手术时间相关。然而,术后肠梗阻风险降低提示潜在的长期益处.这项研究强调了精心选择TR患者以减轻对严重疾病患者的不利影响的重要性。
方法：根据PRISMA声明（PROSPERO：CRD42020166588），对新生儿的TR和OR进行了全面的文献检索。
结果：选择了14项研究进行定量分析，包括总共709例患者(TR：308例，或：401例）。复发率较高[赔率:4.03,95%CI(2.21,7.36),p<0.001]和手术时间（分钟）更长[平均差（MD）：43.96，95％CI（24.70，63.22），与OR相比，TR的p<0.001。与OR（14.8％）相比，TR（5.0％）观察到术后肠梗阻的发生率显着降低[赔率：0.42，95％CI（0.20，0.89），p=0.02]。
结论：TR仍然与较高的复发率和较长的手术时间相关。然而,术后肠梗阻风险降低提示潜在的长期益处.这项研究强调了精心选择TR患者以减轻对严重疾病患者的不利影响的重要性。
