■确定双侧声带麻痹(BVFP)手术后的拔管率(DR)和翻修手术率。
■五个数据库(MEDLINE,PubMed,Embase,WebofScience,Scopus)在1908-2020年期间进行了搜索。
■系统文献综述遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目。使用随机混合效应模型汇集数据。随机对照试验和非随机研究(病例对照,队列,和病例系列)被纳入其中,以评估不同手术技术治疗BVFP后的DR和翻修手术率。
■搜索产生了857种出版物,其中包括102例2802例患者。不同类型手术后的DR为:arytenoid外展(DR0.93,95%-置信区间[CI],0.86-0.97),喉内软骨切除术(DR0.92,95%-CI,0.86-0.96),外软骨样切除术(DR0.94;95%-CI,0.71-0.99),外软骨样切除术和侧化(DR0.87;95%-CI,0.73-0.94),颈固定(DR0.95;95%-CI,0.91-0.97),后路皮质切除术(DR0.97,95%-CI,0.94-0.99),后路皮质切除术和软骨切除术(DR0.98,95%-CI,0.93-0.99),后路皮质切除术和次全肌腱切除术(DR0.98,95%-CI,0.88-1.00),后路脊髓切开术(DR0.96,95%-CI,0.84-0.99),神经支配(0.69,95%-CI,0.12-0.97),次全肌腱切除术(DR1.00,95%-CI,0.00-1.00)和横行下颌关节切开术(DR1.0,95%-CI,0.00-1.00)。在DR亚组之间没有发现显着差异(Q=15.67,df=11,p=0.1540)。研究之间的异质性较低(τ2=2.2627;τ=1.5042;I2=0.0%)。研究存在高偏倚风险。
■BLVP是一种罕见疾病,研究质量不足。现有研究表明存在发表偏倚,文献综述表明缺乏前瞻性对照研究。缺乏考虑语音质量和呼吸功能并允许对手术方法进行充分比较的标准化措施。
UNASSIGNED: To determine the
decannulation rate (DR) and revision surgery rate after surgery for bilateral vocal fold paralysis (BVFP).
UNASSIGNED: Five databases (MEDLINE, PubMed, Embase, Web of Science, Scopus) were searched for the period 1908-2020.
UNASSIGNED: The systematic literature
review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were pooled using a random-mixed-effects model. Randomized controlled trials and non-randomized studies (case-control, cohort, and case series) were included to assess DR and revision surgery rate after different surgical techniques for treatment of BVFP.
UNASSIGNED: The search yielded 857 publications, of which 102 with 2802 patients were included. DR after different types of surgery was: arytenoid abduction (DR 0.93, 95%-confidence interval [CI], 0.86-0.97), endolaryngeal arytenoidectomy (DR 0.92, 95%-CI, 0.86-0.96), external arytenoidectomy (DR 0.94; 95%-CI, 0.71-0.99), external arytenoidectomy and lateralisation (DR 0.87; 95%-CI, 0.73-0.94), laterofixation (DR 0.95; 95%-CI, 0.91-0.97), posterior cordectomy (DR 0.97, 95%-CI, 0.94-0.99), posterior cordectomy and arytenoidectomy (DR 0.98, 95%-CI, 0.93-0.99), posterior cordectomy and subtotal arytenoidectomy (DR 0.98, 95%-CI, 0.88-1.00), posterior cordotomy (DR 0.96, 95%-CI, 0.84-0.99), reinnervation (0.69, 95%-CI, 0.12-0.97), subtotal arytenoidectomy (DR 1.00, 95%-CI, 0.00-1.00) and transverse cordotomy (DR 1.0, 95%-CI, 0.00-1.00). No significant difference between subgroups for DR could be found (Q = 15.67, df = 11, p = 0.1540). The between-study heterogeneity was low (τ2 = 2.2627; τ = 1.5042; I2 = 0.0%). Studies were at high risk of bias.
UNASSIGNED: BLVP is a rare disease and the study quality is insufficient. The existing studies suggest a publication bias and the literature
review revealed that there is a lack of prospective controlled studies. There is a lack of standardized measures that takes into account both speech quality and respiratory function and allows adequate comparison of surgical methods.