Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD.
Int Forum Allergy Rhinol. 2013 Oct;3(10):814-22. doi: 10.1002/alr.21190. Epub 2013 Jul 9.
The objective of this work was to systematically review literature on the effectiveness of surgical management for chronic rhinosinusitis (CRS) in cystic fibrosis (CF) patients.
We performed a literature search encompassing the last 25 years in PubMed, Embase, and Cochrane CENTRAL. Inclusion criteria included English language papers containing original data, more than 6 subjects, and measurable clinical outcomes. Data was systematically collected on study design, patient demographics, clinical characteristics and outcomes, and level-of-evidence. Two investigators independently reviewed all manuscripts. A quality assessment of the included studies was performed.
The initial search yielded 416 abstracts, of which 24 articles met inclusion criteria, detailing 680 adult and pediatric CF patients who underwent surgical therapy. Surgical treatment included primarily endoscopic sinus surgery (ESS) (22/24). Outcome measures included sinonasal symptoms (14/24), endoscopic findings (8/24), pulmonary function testing (8/24), recurrence or revision surgery (5/24), hospitalization (4/24), need for antibiotic therapy (2/24), radiographic findings (2/24), and pulmonary exacerbations (1/24). The level-of-evidence was predominantly Level 4 (21/24); there were no Level 1 evidence studies. Most studies found improvement in symptom measures and endoscopic findings but no improvement in lower airway function after surgical therapy. Postoperative measures of the other outcomes were inconclusive or inconsistent.
For adult and pediatric CF sinusitis, ESS yielded clinical improvement as measured primarily by sinonasal symptoms and endoscopic findings. It is unclear if surgical intervention modifies lower airway disease. Future prospective studies with predetermined, objective, and validated outcome measures are needed to determine the effectiveness of surgical intervention for CF-related CRS. Overall evidence Grade B/C.
本研究旨在系统回顾有关囊性纤维化（CF）患者慢性鼻-鼻窦炎（CRS）手术治疗效果的文献。
我们在 PubMed、Embase 和 Cochrane CENTRAL 数据库中进行了一项涵盖过去 25 年的文献检索。纳入标准包括包含原始数据、超过 6 例患者且具有可测量临床结局的英文文献。系统收集研究设计、患者人口统计学、临床特征和结局以及证据水平等数据。两名研究者独立审查所有文献。对纳入研究进行质量评估。
最初的检索得到了 416 篇摘要，其中 24 篇文章符合纳入标准，详细描述了 680 例接受手术治疗的成年和儿童 CF 患者。手术治疗主要包括内镜鼻窦手术（ESS）（22/24）。结局指标包括鼻-鼻窦症状（14/24）、内镜检查结果（8/24）、肺功能检测（8/24）、复发或再次手术（5/24）、住院（4/24）、抗生素治疗需求（2/24）、影像学表现（2/24）和肺部恶化（1/24）。证据水平主要为 4 级（21/24）；没有 1 级证据研究。大多数研究发现手术治疗后症状和内镜检查结果改善，但对下呼吸道功能无改善。其他结局的术后测量结果不确定或不一致。
对于成人和儿童 CF 鼻窦炎，ESS 可改善临床结局，主要通过鼻-鼻窦症状和内镜检查结果来衡量。手术干预是否能改善下呼吸道疾病尚不清楚。需要前瞻性研究，采用预定的、客观的和经过验证的结局指标，以确定手术干预对 CF 相关 CRS 的有效性。总体证据等级为 B/C。
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