Objective Our systematic review aims to compare recurrence rates and complications of biological versus synthetic patches for the repair of congenital diaphragmatic herniae.

Methods Studies from January 1, 1980 to April 25, 2020, with patients under the age of 16 years and with a minimum 6-month follow-up, were included from MEDLINE, Embase, and Cochrane databases. Funnel plots for recurrence rates were constructed for biological and synthetic patches. Subgroup analysis was performed for recurrence rate at the 1-year time-point and data were gathered on individual adverse events from relevant studies.

Results A total of 47 studies with 986 patients (226 biological, 760 synthetic) were included. Funnel plot analysis determined overall recurrence rates of 16.7% for synthetic and 30.3% for biological patches. Subgroup analysis of 493 and 146 patients with synthetic and biological patches, respectively, showed recurrence rates of 9.9 and 26%, respectively.

The most commonly used patch types—PTFE (polytetrafluoroethylene) and SIS (small intestinal submucosa)—had 11.5 and 33.3% recurrence, respectively. Adhesive bowel obstruction rates ranged from 4 to 29% in studies that systematically reported it for synthetic, and 7 to 35% for biological patches. Gastroesophageal reflux rates ranged from 25 to 48% in studies that systematically reported it for synthetic, and 21 to 42% for biological patches. Pectus deformity rates were reported as high as 80% for synthetic patches.

Conclusion Biological patches appear to have higher recurrence rates than synthetic patches, while skeletal deformities are associated more commonly with synthetic patches. Results of biological patches are mainly using SIS and this may overestimate complications of current superior biological patches.

目的 我们的系统评价旨在比较生物补片与合成补片修复先天性膈疝的复发率和并发症。

方法 从 MEDLINE、Embase 和 Cochrane 数据库中纳入了 1980 年 1 月 1 日至 2020 年 4 月 25 日对 16 岁以下患者进行的至少 6 个月随访的研究。为生物和合成斑块构建复发率的漏斗图。对 1 年时间点的复发率进行了亚组分析，并收集了相关研究中个别不良事件的数据。

结果 共纳入 47 项研究，共 986 名患者（226 名生物制品，760 名合成制品）。漏斗图分析确定合成贴片的总体复发率为 16.7%，生物贴片的总体复发率为 30.3%。分别对 493 名和 146 名使用合成和生物贴片的患者进行亚组分析，结果显示复发率分别为 9.9% 和 26%。

最常用的贴片类型——PTFE（聚四氟乙烯）和 SIS（小肠粘膜下层）——分别有 11.5% 和 33.3% 的复发率。在系统报告合成贴剂的研究中，粘连性肠梗阻的发生率为 4% 至 29%，而生物贴剂的发生率为 7% 至 35%。在系统报告合成贴片的研究中，胃食管反流率范围为 25% 至 48%，而生物贴片的范围为 21% 至 42%。据报道，合成贴片的胸肌畸形率高达 80%。

结论 生物补片似乎比合成补片具有更高的复发率，而骨骼畸形更常见于合成补片。生物补片的结果主要使用 SIS，这可能高估了当前高级生物补片的并发症。