The Effectiveness Of Stents In Preventing Restenosis After Congenital Choanal Atresia:A Meta Analysis

Background:Postoperative restenosis in Congenital choanal atresia is the most important complication.At present,stents are used to prevent postoperative restenosis,but it is controversial whether stents can effectively prevent postoperative restenosis.Some people think that the postoperative indwelling stent can support and maintain the size of the newly built nostril,thus playing a key role in preventing restenosis,while others think that the use of stent will increase the difficulty of nursing.At the same time,it will also cause chronic mucosal inflammation,ulcers,aggravate granulation and scar production,leading to the occurrence of restenosis.Objective:The purpose of this study is to systematically review the literature on transnasal endoscopic bilateral congenital choanal atresia,and to analyze the effectiveness and safety of stents,so as to provide evidence-based basis for the use of stents after congenital choanal atresia.Methods:Pubmed,Embase,the Cochrane Library,China Biomedical Literature Database(CBM),China knowledge Network(CNKI)and Wanfang Database was used to search all articles about transnasal endoscopic bilateral congenital posterior nostril atresia with or without stents.The search deadline is December 4,2020.There is no limit to whether or not to set up a control group.If the control group is set up,the experimental group and the control group use stents and do not use stents respectively.The literature was screened strictly by establishing inclusion and exclusion criteria,and the quality of the final included non-randomized controlled trials was evaluated by MINORS Scale,and the JADAD Scale was used to evaluate the quality of the final included randomized controlled trials.and extract the basic information of the literature and the data needed in this study.STATA15.0 was used for meta analysis,and Q test(I~2value)was used to evaluate the heterogeneity of the study.If P>0.1,when I2≤50%,the fixed effect model is adopted,and on the contrary,the random effect model is adopted.In the single-arm study,the double-arcsine method was used for the combination,and the effect dose was the incidence rate,and the combined effect dose in the two-arm study was relative risk(relativerisk,RR).All the above were statistically significant(P<0.05).The publication bias of the study was expressed by funnel chart,and the stability of the results was determined by sensitivity analysis.Results:Finally,a total of 14 articles,2 randomized controlled trial,3 retrospective cohort studies,and 9 single-arm clinical studies were included(7 in the stent group and 2 in the non-stent group).A total of 276 patients with bilateral posterior nostril atresia were included,of which 174 cases used stents and 102 cases did not use stents.The results of the Meta analysis showed:Results of the Meta-analysis showed that:(1)Dual-arm trial:5 studies were included with a total of 122 patients,including 56 patients in the stent group and 66 patients in the non-stent group.The results showed that the success rate of stent surgery was not statistically significant between the two groups[RR=0.96(95%CI:0.76,1.20),P=0.700].(2)Single arm test:A total of 12 studies were included in the stent group,with a sample size of 174;A total of 7 studies with a sample size of 102 were included in the non-stent group.The combined effect size was 65%(95%CI:51%,77%)with the stent combination and 78%(95%CI:58%,93%)with the non-stent combination.The results of subgroup analysis showed that there was no statistical difference in the success rate between the two groups(P>0.05).Complications associated with stent implantation:granulation tissue formation,stent dislodgement or blockage,stents fell out,columellar tear,alar pressure ulcer,soft palate perforation.Conclusion:1.Complications related to stent use include:granulation tissue formation,stent dislodgement or blockage,stents fell out,columellar tear,alar pressure ulcer,soft palate perforation and so on.2.Mechanical stent expansion has no obvious advantage in preventing restenosis after congenital choanal atresia,so mechanical stent should be used carefully after congenital choanal atresia.3.For the prevention of restenosis after congenital choanal atresia surgery,more attention should be paid to the operation itself,or the further development and application of new materials such as the carboxymethyl cellulose gel-sodium salt and steroid-eluting stent.