Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA.
Int Forum Allergy Rhinol. 2011 Nov-Dec;1(6):417-30. doi: 10.1002/alr.20072. Epub 2011 Oct 29.
Early postoperative care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several postoperative care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early postoperative care following ESS.
A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early postoperative care strategy; and clearly defined primary clinical end-point.
This review identified and evaluated the literature on 7 early postoperative care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents.
Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early postoperative care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in postoperative management. These evidence-based recommendations should not necessarily be applied to all postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate care.
内镜鼻窦手术（ESS）后的早期术后护理被认为可以最大限度地减少可避免的并发症并优化长期结果。已经提出了几种术后护理策略，但从未对证据进行过正式的综合评估。本文的目的是提供一种基于证据的 ESS 后早期术后护理方法。
对文献进行系统评价，并遵循临床实践指南手册、指南标准化会议（COGS）和评估指南和研究评估（AGREE）工具建议。研究纳入标准为：成人人群>18 岁；根据已发表的诊断标准患有慢性鼻-鼻窦炎（CRS）；ESS 是在药物治疗失败后进行的；主要研究目的是评估 ESS 早期术后护理策略；并明确界定主要临床终点。
本综述确定并评估了 ESS 后 7 种早期术后护理策略的文献：盐水冲洗、窦腔清创术、全身类固醇、局部类固醇、口服抗生素、局部减充血剂和载药间隔物/支架。
根据现有证据，推荐在 ESS 后早期使用鼻腔盐水冲洗、窦腔清创术和标准局部鼻腔类固醇喷雾作为护理干预措施。术后抗生素、全身类固醇、非标准局部鼻腔类固醇溶液和/或载药间隔物/支架是术后管理的选择。这些基于证据的建议不一定适用于所有术后患者，临床判断以及证据对于确定最合适的护理至关重要。
