Yip Jonathan, Yao Christopher M, Lee John M
Department of Otolaryngology-Head and Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada.
Am J Rhinol Allergy. 2014 Nov-Dec;28(6):493-501. doi: 10.2500/ajra.2014.28.4103.
Endoscopic sinus surgery is an important modality to the armamentarium of the otolaryngologist managing chronic rhinosinusitis (CRS). Within the spectrum of CRS, there exists a subset of patients who are recalcitrant to conventional treatment strategies, including those with aspirin-exacerbated respiratory disease (AERD). Although surgery is frequently undertaken in this group, there has been no general consensus on the efficacy or optimal extent of surgery.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of published studies was conducted. Inclusion criteria included original publications of adult patients with AERD undergoing surgery, cohorts of greater than five subjects, a minimum follow-up of 3 months, and measurable clinical outcomes. An electronic search was performed using OVID MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science.
Sixteen studies met the criteria for analysis. For our primary objective, sinus surgery appeared to improve patient-reported quality of life (QoL) and symptom profile in AERD. Overall, most studies reported a decrease in radiographic grading, endoscopy scores, and asthma severity. Compared with aspirin-tolerant asthmatic patients, AERD patients may have worse objective measures of disease severity both pre- and postoperatively; however, patient-reported QoL and symptom improvement may be similar after sinus surgery. Finally, this review showed that patients with AERD required revision surgeries sooner and more frequently compared with other subtypes of CRS. We also discussed the role of maximal surgical techniques and additional benefit of postoperative adjunctive therapies in the management of this disease entity.
The state of the art in the management of AERD patients suggests that surgery does play an important role in helping establish symptomatic control. In the future, more rigorous studies evaluating the comprehensiveness of surgery and postoperative adjuncts are required to understand their impact on long-term patient outcomes.
鼻内镜鼻窦手术是耳鼻喉科医生治疗慢性鼻-鼻窦炎（CRS）的重要手段。在CRS范围内，有一部分患者对传统治疗策略反应不佳，包括那些患有阿司匹林加重性呼吸系统疾病（AERD）的患者。尽管该组患者经常接受手术治疗，但对于手术的疗效或最佳范围尚无普遍共识。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对已发表的研究进行系统评价。纳入标准包括关于成年AERD患者接受手术的原始出版物、样本量大于5例的队列研究、至少3个月的随访以及可测量的临床结局。使用OVID MEDLINE、EMBASE、Cochrane对照试验中央注册库和Web of Science进行电子检索。
16项研究符合分析标准。对于我们的主要目标，鼻窦手术似乎改善了AERD患者报告的生活质量（QoL）和症状表现。总体而言，大多数研究报告影像学分级、内镜评分和哮喘严重程度有所降低。与阿司匹林耐受的哮喘患者相比，AERD患者术前和术后疾病严重程度的客观指标可能更差；然而，鼻窦手术后患者报告的QoL和症状改善可能相似。最后，本综述表明，与其他CRS亚型相比，AERD患者需要更早且更频繁地进行翻修手术。我们还讨论了最大手术技术的作用以及术后辅助治疗在该疾病实体管理中的额外益处。
AERD患者的治疗现状表明，手术在帮助实现症状控制方面确实起着重要作用。未来，需要更严格的研究来评估手术和术后辅助治疗的全面性，以了解它们对患者长期结局的影响。
