Giordano J, Darras J, Chevalier D, Mortuaire G
Service d'ORL et de chirurgie cervico-faciale, hôpital C. Huriez, CHRU de Lille, Place de Verdun, 59000 Lille, France.
Ann Otolaryngol Chir Cervicofac. 2009 Jun;126(3):120-4. doi: 10.1016/j.aorl.2009.03.005. Epub 2009 Apr 21.
Impairment of the surgical view by bleeding in endoscopic ethmoidectomy for chronic rhinosinusitis with nasal polyps (CRSwNP) contributes to the risk of skull base injuries. The aim of this study was to investigate the effect of a short course of a systemic corticoid treatment on bleeding and surgical field quality during endoscopic ethmoidectomy for CRSwNP.
A prospective study was conducted on 40 patients. Before surgery, 21 of them (group B) were treated with 1 mg/kg per day of prednisolone for seven days. They were compared with the 19 other patients (group A) on intraoperative blood loss and surgery duration.
The two groups shared identical clinical features (Lidholdt endoscopic grading). There was no statistical difference in terms of bleeding, although the Lund-Mackay CT score was higher in group B (19/24 vs. 21/24, p=0.05). The surgical procedure was shorter in group B (72 min vs. 85 min, p=0.05).
Preoperative treatment with systemic corticosteroids does not seem to reduce surgical blood loss. However, we noted a decrease in the procedure's duration. By reducing mucous inflammation, this treatment could improve the local conditions and help the surgeon in the mucous eradication.
在伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）的内镜筛窦切除术中，出血导致的手术视野受损会增加颅底损伤的风险。本研究旨在探讨短期全身性皮质类固醇治疗对CRSwNP内镜筛窦切除术期间出血及手术视野质量的影响。
对40例患者进行了一项前瞻性研究。术前，其中21例患者（B组）接受每天1mg/kg的泼尼松龙治疗，为期7天。将他们与其他19例患者（A组）在术中失血量和手术持续时间方面进行比较。
两组具有相同的临床特征（利德霍尔特内镜分级）。尽管B组的伦德-麦凯CT评分更高（19/24对21/24，p=0.05），但在出血方面没有统计学差异。B组的手术时间更短（72分钟对85分钟，p=0.05）。
术前全身性皮质类固醇治疗似乎不会减少手术失血量。然而，我们注意到手术持续时间有所缩短。通过减轻黏膜炎症，这种治疗可以改善局部状况并有助于外科医生清除黏液。
