内镜下扩张期间辅助局部丝裂霉素C治疗儿童腐蚀性食管狭窄：随机对照试验的系统评价与荟萃分析

文献信息

中文摘要

目的： 腐蚀性食管狭窄是导致儿童吞咽困难并需要反复扩张的主要原因。我们评估了辅助局部丝裂霉素C（MMC）是否能改善吞咽困难缓解并减少儿童的扩张次数。
方法： 我们检索了PubMed、Embase和Cochrane CENTRAL（自建库至2026年5月17日），纳入比较扩张联合局部MMC与单纯扩张治疗儿童腐蚀性食管狭窄的随机对照试验。使用RoB 2评估偏倚风险，使用GRADE评估证据确定性。进行了随机效应荟萃分析；唯一符合标准的成人随机对照试验以叙述性方式报告。
结果： 共合并三项儿童随机对照试验（221例患者；110例MMC，111例对照）。MMC与更高的吞咽困难缓解几率相关（OR 7.82；95% CI 4.17-14.65；I²=0%），并且扩张次数更少（MD -3.01；95% CI -3.30至-2.73；k=2；I²=0%）。在110例合并的MMC暴露中，或包括非合并对照证据的128例中，未发生可归因于MMC的不良事件。敏感性分析中效应稳健（OR 6.86；95% CI 3.34-14.10）。
结论： 在儿童腐蚀性食管狭窄中，辅助局部MMC可改善吞咽困难缓解并减少扩张负担。仍需要随访时间更长的多中心随机对照试验。
PROSPERO注册： CRD420261351544。

英文摘要

PURPOSE: Caustic esophageal stricture is a major cause of pediatric dysphagia requiring repeated dilation. We assessed whether adjunctive topical mitomycin C (MMC) improves dysphagia resolution and reduces dilation sessions in children.
METHODS: We searched PubMed, Embase, and Cochrane CENTRAL (inception through May 17, 2026) for randomized controlled trials comparing dilation plus topical MMC with dilation alone in children with caustic esophageal stricture. Risk of bias was assessed with RoB 2 and certainty with GRADE. Random-effects meta-analyses were performed; the single eligible adult RCT was reported narratively.
RESULTS: Three pediatric RCTs (221 patients; 110 MMC, 111 control) were pooled. MMC was associated with higher odds of dysphagia resolution (OR 7.82; 95% CI 4.17-14.65; I²=0%), and fewer dilation sessions (MD - 3.01; 95% CI - 3.30 to - 2.73; k = 2; I²=0%). No MMC-attributable adverse events occurred across 110 pooled MMC exposures, or 128 including non-pooled controlled evidence. Effects were robust in sensitivity analysis (OR 6.86; 95% CI 3.34-14.10).
CONCLUSION: In pediatric caustic esophageal stricture, adjunctive topical MMC improves dysphagia resolution and reduces dilation burden. Multicentre RCTs with longer follow-up remain needed.
PROSPERO REGISTRATION: CRD420261351544.