背景:良性喉气管狭窄可通过微创内镜介入治疗得到广泛应用,如激光切口或切除疤痕,和扩张。然而,各种内镜治疗与高复发率显著相关.当地辅助措施,包括吸入类固醇,注射类固醇,和局部局部应用丝裂霉素C,进行了研究,以提高成功率。
目的:比较良性喉气管狭窄患者有无局部辅助的内镜治疗的疗效,并分析其临床结果,复发,和并发症。
方法:在荟萃分析中,数据库,包括PubMed,EMBASE,OVID,和WebofScience检索了比较喉气管狭窄患者辅助治疗和非辅助治疗结果的论文。重复的出版物,reviews,评论或信件,会议摘要,病例报告被排除.随机效应模型用于评估合并风险估计。
结果:八项研究(1204例)涉及两项前瞻性随机对照研究,两项前瞻性队列研究,4项回顾性队列研究最终纳入荟萃分析.确定了三种辅料的交付模式,包括腔内注射类固醇(n=2),吸入类固醇(n=2),和局部应用丝裂霉素C(n=4)。在接受类固醇注射或吸入类固醇的内镜治疗的患者中,发现复发率的风险估计降低。与单纯内镜干预相比(P<0.05)。此外,接受辅助治疗的患者复发风险估计较低,与仅接受内镜手术的患者相比(P<0.05),基于前瞻性队列研究的亚组,声门下,Mayer-I-II度的棉花量表,狭窄长度<3cm。合并风险估计的高度异质性可能是由于辅助药物的因素,患者的临床特征,和方法论。没有发现并发症发生率的明显差异。
结论:局部应用类固醇进行微创干预似乎可以降低喉气管狭窄的复发率。各种附件可用,包括类固醇和丝裂霉素C,似乎是安全的,并且与附件特异性并发症发生率的低风险估计相关.需要高质量的多中心随机对照研究,有足够的时间进行后续行动以及主观和客观结果指标,为了正确评估疗效,安全,和辅助药物的成本效益。
BACKGROUND: Benign laryngotracheal stenosis is widely managed with minimally invasive endoscopic interventions, such as laser incision or excision scar, and dilation. However, various endoscopic treatments are significantly associated with a high recurrence rate. Local auxiliary measures, including inhalation of steroids, injection of steroids, and local topical application of mitomycin C, have been studied in order to increase the success rate.
OBJECTIVE: To compare the efficacy of endoscopic treatments with and without local adjuncts in patients with benign laryngotracheal stenosis, and analyze their clinical outcomes, recurrence, and complications.
METHODS: In the meta-analysis, databases including PubMed, EMBASE, OVID, and Web of Science were searched for papers comparing the outcomes of adjunct therapy with non-adjunct therapy in patients with laryngotracheal stenosis. The duplicate publications, reviews, comments or letters, conference abstracts, and case reports were excluded. The random effect model was used for assessing the pooled risk estimates.
RESULTS: Eight studies (1204 cases) referring to two prospective randomized controlled studies, two prospective cohort studies, and four retrospective cohort studies were ultimately included in the meta-analysis. Three delivery modes of adjuncts were identified, including intralesion steroid injection (n = 2), inhaled steroid (n = 2), and topical application of mitomycin C (n = 4). The decreased risk estimates of recurrence rate were detected in patients receiving endoscopic treatments with steroid injection or inhaled steroid, compared with endoscopic interventions alone (P < 0.05). Additionally, patients undergoing adjunct therapies had lower risk estimates of recurrence, compared to those receiving endoscopic procedures alone (P < 0.05), based on the subgroup of prospective cohort studies, subglottis, Mayer-Cotton scale of I-II degree, and stenosis length of < 3 cm. The high heterogeneity of the pooling risk estimates perhaps was due to factors of auxiliary drug, clinical characteristics of patients, and methodology. No discernible difference in the incidence of complication was identified.
CONCLUSIONS: Local application of steroids to minimally invasive interventions appear to reduce the recurrence rate of laryngotracheal stenosis. Various adjuncts available, including steroids and mitomycin C, appear to be safe and associated with a low risk estimate of adjuncts-specific complication rate. High quality multi-center randomized controlled studies are needed, with sufficient periods for follow-up and subjective and objective outcome indicators, to properly evaluate the efficacy, safety, and cost-effectiveness of adjuvant drugs.