儿童会厌固定术：适应证、技术、结局与并发症的范围综述

文献信息

中文摘要

目的： 梳理并综合关于会厌固定术治疗儿童喉软化症、会厌脱垂和阻塞性睡眠呼吸暂停（OSA）患者的证据，重点关注适应证、技术、结局、并发症及证据空白。
数据来源： 检索PubMed/MEDLINE、Scopus、Web of Science和Google Scholar，时间范围为1980年1月至2026年5月，纳入英文和法文研究，并辅以参考文献列表的手工检索。
综述方法： 本范围综述遵循PRISMA-ScR指南。综述方案在数据提取前已在OSF注册。符合条件的研究为因任何适应证接受会厌固定术的儿童患者（<18岁）的原始报告。两名评价者独立筛选记录并提取数据；结果以描述性方式综合。
结果： 24项研究（371例患者）符合纳入标准，发表于1987年至2026年间，包括来自10个国家的病例报告、病例系列和回顾性队列。手术方式包括内镜下CO2激光或电灼辅助的舌会厌固定术、经口缝线会厌固定术、经颈外固定术以及机器人辅助会厌固定术。适应证涵盖经典型III型喉软化症、并发于气管造口依赖性或综合征性气道疾病中的会厌脱垂，以及越来越多地涵盖药物诱导睡眠内镜（DISE）证实的难治性OSA患儿中的会厌阻塞。呼吸改善被一致报告，吞咽功能大多得以保留或改善，并发症和复发率较低，多数病例单次手术即成功。
结论： 据报道，会厌固定术在多种临床情境和技术下对儿童会厌脱垂安全有效。DISE已将其适应证扩展至睡眠状态依赖性会厌阻塞。证据仍受限于小型回顾性系列研究；需要采用标准化DISE方案、结局指标和更长随访时间的前瞻性研究。
证据等级： 不适用。

英文摘要

OBJECTIVE: To map and synthesize the evidence on epiglottopexy in pediatric patients with laryngomalacia, epiglottic prolapse, and obstructive sleep apnea (OSA) with attention to indications, techniques, outcomes, complications, and evidence gaps.
DATA SOURCES: PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched from January 1980 to May 2026 for English- and French-language studies, supplemented by hand-searching of reference lists.
REVIEW METHODS: This scoping review followed PRISMA-ScR guidelines. The review protocol was registered on OSF prior to data extraction. Eligible studies were original reports of pediatric patients (< 18 years) who underwent epiglottopexy for any indication. Two reviewers independently screened records and extracted data; findings were synthesized descriptively.
RESULTS: Twenty-four studies (371 patients) published between 1987 and 2026 met inclusion criteria, comprising case reports, case series, and retrospective cohorts from 10 countries. Surgical approaches included endoscopic CO2 laser or cautery-assisted glossoepiglottopexy, transoral suture-based epiglottopexy, transcervical external fixation, and robot-assisted epiglottopexy. Indications spanned classic Type III laryngomalacia, epiglottic prolapse complicating tracheostomy-dependent or syndromic airway disease, and increasingly, drug-induced sleep endoscopy (DISE)-confirmed epiglottic obstruction in children with refractory OSA. Respiratory improvement was consistently reported, swallowing function was largely preserved or improved, and complication and recurrence rates were low, with single-procedure success in most cases.
CONCLUSION: Epiglottopexy is reported to be safe and effective for pediatric epiglottic prolapse across diverse clinical contexts and techniques. DISE has expanded its indications to sleep-state-dependent epiglottic obstruction. Evidence remains limited by small, retrospective series; prospective studies with standardized DISE protocols, outcome measures, and longer follow-up are needed.
LEVEL OF EVIDENCE: N/A.