儿童先天性会厌谷囊肿：系统综述与Meta分析

文献信息

中文摘要

目的： 综合关于儿童先天性会厌谷囊肿（CVCs）的表现、评估和手术结局的当代证据。
数据来源： 遵循系统综述和Meta分析首选报告项目（PRISMA）指南，检索了PubMed、MEDLINE、Embase和Scopus从1992年至2024年的文献。
综述方法： 符合条件的研究描述了18岁以下患者的CVCs，并具有可提取的人口统计学、表现、影像学、管理或结局数据。两名评价者独立筛选和提取数据；分歧由第三名评价者裁决。使用Freeman-Tukey变换的随机效应比例Meta分析生成了表现、影像学和手术的合并估计值。通过混合效应Meta回归比较造袋术与非造袋术，检查了复发和重复切除。按发表时期（1994-2008年 vs 2009-2024年）对时间实践模式进行了描述性总结。
结果： 54项研究共362名儿童符合纳入标准。诊断时的平均年龄为3.3个月；54%为男性。喘鸣占主导地位（236/362，65.2%），柔性纤维喉镜检查在287/362例（79.3%）中进行。造袋术是最常见的干预措施（288/362，79.6%），而非造袋术技术用于72/362例（19.9%）。Meta回归显示，非造袋术与造袋术相比，预测复发率显著更高（10.13% vs 2.78%；P = .008），而预测重复切除率在两组之间无显著差异（6.33% vs 2.08%；P = .062）。
结论： CVC通常表现为婴儿早期喘鸣和喂养困难。柔性喉镜检查是诊断的核心，内镜下造袋术提供了持久的缓解，与非造袋术技术相比，复发风险显著降低。

英文摘要

OBJECTIVE: To synthesize contemporary evidence on the presentation, evaluation, and surgical outcomes of congenital vallecular cysts (CVCs) in children.
DATA SOURCES: PubMed, MEDLINE, Embase, and Scopus were searched from 1992 to 2024 following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
REVIEW METHODS: Eligible studies described CVCs in patients <18 years with extractable data on demographics, presentation, imaging, management, or outcomes. Two reviewers independently screened and extracted data; discrepancies were adjudicated by a third. Random-effects proportional meta-analyses using Freeman-Tukey transformation generated pooled estimates for presentation, imaging, and procedures. Recurrence and repeat excision were examined with mixed-effects meta-regression comparing marsupialization versus non-marsupialization. Temporal practice patterns were summarized descriptively by publication period (1994-2008 vs 2009-2024).
RESULTS: Fifty-four studies encompassing 362 children met inclusion criteria. Mean age at diagnosis was 3.3 months; 54% were male. Stridor predominated (236/362, 65.2%), and flexible fiberoptic laryngoscopy was performed in 287/362 cases (79.3%). Marsupialization was the most common intervention (288/362, 79.6%), whereas non-marsupialization techniques were used in 72/362 cases (19.9%). Meta-regression showed significantly higher predicted recurrence with non-marsupialization versus marsupialization (10.13% vs 2.78%; P = .008), while predicted repeat excision did not differ significantly between groups (6.33% vs 2.08%; P = .062).
CONCLUSION: CVC typically presents in early infancy with stridor and feeding difficulty. Flexible laryngoscopy is central to diagnosis, and endoscopic marsupialization provides durable resolution with significantly lower recurrence risk compared to non-marsupialization techniques.