这项系统评价的目的是建立不同的嘴唇手术修复对鼻对称性的影响。PubMed,Scopus,Embase,科克伦中部,Ovid数据库搜索最初只针对英语文章,在单侧完全性唇裂伴或不伴牙槽裂和腭裂(UCCLAP)的患者中,年龄小于1岁并接受唇裂修复,并根据截至2020年12月31日的最早数据发布。主要结果变量是鼻对称性,报告的并发症是次要变量。提供了定性合成。共获得19,828条记录,并选择了17篇文章进行最终审查。使用Cochrane偏差风险2(RoB-2)工具对纳入的随机对照试验(RCT)(N-1)的偏差风险进行评估,ROBINS-I工具用于非随机研究(n=14)。建议的分级,评估,发展,和评估(GRADE)用于评估证据体的质量。大多数纳入的研究将三角修复与旋转推进(RA)技术进行了比较,和首选RA或其修改。就鼻部对称性而言,Fisher修复被证明优于RA技术。RA和直线修复都不优于彼此。Delaire技术可能优于改良的RA。此外,同时进行唇鼻修复的结果令人满意.这篇系统的综述检查了过多的技术,关于手术类型的研究之间的异质性非常高,鼻对称性评估方法,和随访时间的长短,从而产生低质量的证据;因此,结果应谨慎解释。未来的研究需要具有更大样本量和适当随访时间的RCT,手术最好由一位有经验的外科医生完成。
The aim of this systematic review was to establish the effect of different surgical repairs for the lip on nasal symmetry. PubMed, Scopus, Embase, Cochrane CENTRAL, and Ovid databases search was performed initially for only English-language articles, in patients with unilateral complete cleft lip with or without cleft alveolus and palate (UCCLAP) who were younger than 1 year of age and undergoing cleft lip repair, and are published from the earliest data available up to December 31, 2020. The primary outcome variable was nasal symmetry, with reported complications being secondary variables. A qualitative synthesis was provided. A total of 19,828 records were obtained, and 17 articles were selected for final review. Assessment of the risk of bias of the included randomized controlled trials (RCTs) (N-1) was done with the Cochrane Risk of Bias 2 (RoB-2) tool, and the ROBINS-I tool was used for non-randomized studies (n = 14). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to evaluate the quality of the body of evidence. The majority of the included studies compared the triangular repair with the rotation advancement (RA) techniques, and preferred RA or its modifications. In terms of the nasal symmetry, the Fisher repair proved to be superior to the RA technique. Neither RA nor straight line repair was superior to one another. The Delaire technique may be preferred over the modified RA. Also, satisfactory outcomes were observed with simultaneous lip-nose repair. This systematic review examined a plethora of techniques, and the heterogeneity between studies was very high regarding type of surgery, method of nasal symmetry assessment, and length of follow-up, thus producing low-quality evidence; therefore, results should be interpreted with caution. Future research requires RCTs with larger sample sizes and appropriate length of follow-up, and surgeries preferably performed by a single experienced surgeon.