成人获得性腭咽闭合不全的管理：系统综述与荟萃分析
Management of Acquired Velopharyngeal Insufficiency in Adults: A Systematic Review and Meta-Analysis.
文献信息
| PMID | 42878437 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Dhruv Shreedhar Kothari |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA. |
| 期刊 | The Laryngoscope |
| SCI 分区 | Q2 |
| IF | 2.3 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 评估成人非裂隙性获得性腭咽闭合不全（VPI）的治疗结局，并综合现有干预措施的疗效与安全性。
数据来源： 检索PubMed/MEDLINE、Embase、Web of Science和Cochrane Library中2005年1月至2025年10月发表的研究。
综述方法： 纳入评估成人（≥18岁）VPI干预措施并报告言语和/或吞咽结局的研究。两名评价者独立筛选研究、提取数据并评估质量。采用随机效应荟萃分析，使用logit转换后的合并比例确定言语和吞咽改善率。
结果： 共筛选1167条记录，11项研究符合纳入标准，代表107名成人和163次干预。VPI最常发生于头颈癌治疗后（45%）或神经系统疾病（47%）。63.5%为轻度至中度VPI。注射咽成形术（IP）是最常用的干预措施（82.2%），其次是腭提升假体（7.4%）和手术重建（5.5%）。荟萃分析显示，所有干预措施中言语和吞咽改善率分别为88%（95% CI：78%-94%）和78%（95% CI：49%-93%）；在IP患者中分别为88%（95% CI：73%-95%）和71%（95% CI：34%-92%）。IP有效且不良事件发生率低，为5.2%。
结论： 成人获得性VPI高度可治，大多数患者在各种干预措施下言语和吞咽均有改善。然而，证据仍受样本量小和结局报告异质性限制。需要采用标准化诊断标准和统一结局指标的前瞻性和比较性研究，以更好地确定该成人人群的最佳治疗选择。
证据等级： 不适用。
英文摘要
OBJECTIVE: To evaluate treatment outcomes for non-cleft, acquired velopharyngeal insufficiency (VPI) in adults and synthesize the efficacy and safety of available interventions.
DATA SOURCES: PubMed/MEDLINE, Embase, Web of Science, and Cochrane Library were searched for studies published from January 2005 to October 2025.
REVIEW METHODS: Studies were included if they evaluated interventions with speech and/or swallow outcomes in adults (≥ 18 years) with VPI. Two reviewers independently screened studies, extracted data, and assessed quality. Random-effects meta-analysis using logit-transformed pooled proportions determined rates of speech and swallowing improvement.
RESULTS: Of 1167 records screened, 11 studies met inclusion criteria, representing 107 adults and 163 interventions. VPI most occurred after head and neck cancer treatment (45%) or neurologic disease (47%). 63.5% had small to moderate VPI. Injection pharyngoplasty (IP) was the most frequently used intervention (82.2%), followed by palatal lift prosthesis (7.4%) and surgical reconstruction (5.5%). Meta-analysis demonstrated improved speech and swallow in 88% (95% CI: 78%-94%) and 78% (95% CI: 49%-93%) across all interventions, and in 88% (95% CI: 73%-95%) and 71% (95% CI: 34%-92%) in IP patients, respectively. IP is effective and has a low 5.2% adverse events rate.
CONCLUSION: Acquired VPI in adults is highly treatable, with most patients experiencing improvement in speech and swallowing across interventions. However, evidence remains limited by small sample sizes and heterogeneous outcome reporting. Prospective and comparative studies using standardized diagnostic criteria and uniform outcome measures are required to better define optimal treatment selection for this adult population.
LEVEL OF EVIDENCE: N/A.