Article record

胸主动脉手术术后声带活动障碍：发生率、解剖学及确认方式的系统综述与荟萃分析

Postoperative Vocal fold mobility impairment after thoracic aortic surgery: A systematic review and meta-analysis of incidence, anatomy, and ascertainment.

综述 Meta咽喉科IF 1.4Q3

文献信息

PMID	42958650
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Omar Farooq 查看其他 7 位作者 Eyad Jamileh；Fahad Muhammad；Alishba Nawaz；Zaheer Abbas；Georgia Layton；Mustafa Zakkar；Ibrahim Antoun
作者单位	Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, England, UK. 查看其他 8 条单位信息 School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.；Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Cumbria, UK.；School of Medicine and Dentistry, Barts and The London, Queen Mary University of London, London, UK.；Maidstone and Tunbridge Wells Hospital Trust, Maidstone, Kent, England, UK.；School of Medicine, University of Central Lancashire, School of Medicine, UK.；Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, England, UK.；Division of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, UK.；Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
期刊	Interdisciplinary cardiovascular and thoracic surgery
SCI 分区	Q3
IF	1.4
研究类型	综述 Meta · 临床
所属专科	咽喉科

中文摘要

目的： 胸主动脉手术术后声带活动障碍（VFMI）的报道不一致，因为手术解剖、结局定义和术后确认方式差异很大。我们评估了观察到的VFMI的变异、其与解剖暴露和确认方式的关系，以及其报道的临床后果。
方法： 检索PubMed、Embase和MEDLINE（Ovid）自建库至2026年7月，纳入报告开放或杂交胸主动脉手术后VFMI的成人研究。随机效应荟萃分析仅限于接受直接开放胸主动脉重建、由症状触发并经器械确认的队列。使用QUIPS和JBI指南评估偏倚风险，使用GRADE评估证据确定性。
结果： 共纳入39项观察性研究。11个由症状触发并经器械确认的队列（2,082例患者；263例事件）纳入主要合成分析。合并观察到的VFMI为14.9%（95% CI 9.4-21.5%），但异质性很大（I² 92.7%，95% CI 89.7-94.6%），95%预测区间为0.3-43.3%。研究水平的发生率范围为4.0%至38.8%。更大的解剖范围，尤其是远端弓或降主动脉暴露，始终与更高的观察到的VFMI相关，而特定的左锁骨下动脉邻近估计基于有限的观察性证据。VFMI还与肺部并发症、气道干预和住院时间延长相关。
结论： 单一合并发生率不能充分描述胸主动脉手术术后VFMI。观察到的风险随解剖暴露和确认策略而显著变化。证据支持对有症状患者进行有针对性的术后喉部评估，并强调需要在选定的高风险远端弓和降主动脉手术中评估常规筛查。

英文摘要

OBJECTIVES: Postoperative vocal fold mobility impairment (VFMI) after thoracic aortic surgery is reported inconsistently because operative anatomy, outcome definitions and postoperative ascertainment vary substantially. We evaluated variation in observed VFMI, its relationship with anatomical exposure and ascertainment, and its reported clinical consequences.
METHODS: PubMed, Embase and MEDLINE (Ovid) were searched from inception to July 2026 for adult studies reporting VFMI after open or hybrid thoracic aortic surgery. Random-effects meta-analysis was restricted to symptom-triggered, instrumentally confirmed cohorts undergoing direct open thoracic-aortic reconstruction. Risk of bias was assessed using QUIPS and JBI guidance, and certainty using GRADE.
RESULTS: Thirty-nine observational studies were included. Eleven symptom-triggered, instrumentally confirmed cohorts (2,082 patients; 263 events) contributed to the primary synthesis. Pooled observed VFMI was 14.9% (95% CI 9.4-21.5%), but heterogeneity was substantial (I² 92.7%, 95% CI 89.7-94.6%) and the 95% prediction interval was 0.3-43.3%. Study-level incidence ranged from 4.0% to 38.8%. Greater anatomical extent, particularly distal arch or descending exposure, was consistently associated with higher observed VFMI, whereas specific left-subclavian-proximate estimates were based on limited observational evidence. VFMI was also associated with pulmonary morbidity, airway intervention and prolonged hospitalisation.
CONCLUSION: A single pooled incidence does not adequately describe postoperative VFMI after thoracic aortic surgery. Observed risk varies markedly with anatomical exposure and ascertainment strategy. The evidence supports targeted postoperative laryngeal assessment in symptomatic patients and highlights the need to evaluate routine screening in selected high-risk distal arch and descending procedures.