| Objective:To evaluate the clinical efficacy of Thoracoscopic approach and Open approach,in the treatment of congenital esophageal atresia with tracheoesopha geal fistula by meta-analysis system.Method:Search CNKI,Wanfang,VIP,Medline,Cochrance,Pubmed,Embase and other related databases were searched from December 2001 to December 2021.Including collecting the comparative trials of Thoracoscopic approach and Open approach in the treatment of congenital esophageal atresia with tracheoesophageal fistula,and evaluating the quality by Revman5.4 software to compare the effect differences between the two surgical methods.Results :A total of thirteen articles were included,including seven articles in Chinese and six articles in English,with a total sample size of 1226 cases.The results showed that the baseline of gestational age : [SMD = 0.18,95% CI(-0.14,0.50),P = 0.27];Baseline of gender : [OR = 0.95,95% CI(0.69,1.30),P = 0.74];Baseline of birth weight : [SMD = 0.31,95% CI(0.00,0.62),P = 0.05];Baseline of children with other system malformations: [OR = 0.99,95% CI(0.70,1.39),P = 0.93];Baseline of Cross classification: [OR = 0.97,95% CI(0.56,1.68),P = 0.91];The baseline of the age of children after operation: [SMD = 0.06,95% CI(-0.53,0.65),P = 0.85];Operation time:[SMD = 0.73,95% CI(-0.01,1.47),P = 0.05];Blood loss during operation: [SMD=-0.35,95% CI(-1.41,0.71),P = 0.52];The use time of ventilator after operation:[SMD = 0.16,95% CI(-0.67,0.98),P = 0.71];Postoperative hospitalization time:[SMD =-0.23,95% CI(-0.91,0.45),P = 0.50];Postoperative anastomotic leakage occurred in children: [OR = 0.58,95% CI(0.32,1.07),P = 0.50];Postoperative anastomotic stenosis occurred in children: [OR = 1.61,95% CI(0.96,2.69),P = 0.07];Severe pneumonia occurred after operation: [OR = 0.67,95% CI(0.29,1.54),P =0.34];The number of patients cured after operation: [OR = 1,30,95% CI(0.64,2.64),P = 0.46] had no statistical significance.Operation time: [SMD = 0.60,95% CI(0.43,0.77),P < 0.00001];The first feeding time after operation: [SMD =-0.90,95%CI(-1.38,-0.42),P = 0.0002];Postoperative recurrence of tracheoesophageal fistula occurred in children: [OR = 2.05,95% CI(1.24,3.38),P = 0.005];Tracheal softening occurred after operation: [OR=2.52,95%CI(1.08,5.90),P = 0.03].The difference was statistically significant.Conclusion:This study shows that there is no significant difference between TR and OR in data baseline,such as baseline of gestational age,baseline of gender,baseline of birth weight,baseline with other system abnormalities,baseline of Cross typing baseline,and baseline of operation age,indicating that there is comparability between groups.There is no significant difference in outcome indicators such as operation time,blood loss during operation,postoperative ventilator use time,hospitalization time,anastomotic leakage after operation,anastomotic stenosis,and cure number,which indicates that thoracoscopic surgery has no obvious advantage in ventilator use time,hospitalization time,anastomotic leakage,anastomotic stenosis,and cure number after operation,but the first oral feeding time of thoracoscopic surgery group is earlier than that of traditional thoracotomy group,and the recurrence probability of tracheoesophageal fistula after operation is higher than that of thoracotomy group. |
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