de Gabory L, Serrano E, Lecanu J-B, Ebbo D, Coudert F, Hanau M, Escabasse V
Service d'ORL et chirurgie cervico-faciale, hôpital Pellegrin, centre Michelet, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
Service d'ORL et de chirurgie cervico-faciale, CHU de Toulouse, 31059 Toulouse cedex 9, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2015 Feb;132(1):35-40. doi: 10.1016/j.anorl.2014.09.001. Epub 2014 Dec 23.
The French Otorhinolaryngology Society (SFORL) set up a work group to draw up a consensus document on day-case surgery in four rhinologic procedures: endoscopic middle meatal antrostomy (French National Health Insurance (CCAM) code GBPE001), septoplasty (GAMA007), and reduction of nasal bone fracture using a direct approach (LAEA007) and using a closed technique (LAEP002).
Methodology followed the French Health Authority (HAS) "Methodological Bases for Drawing Up Professional Guidelines by Formalized Consensus" published in January 2006; the method chosen was the short version of the RAND/UCLA Appropriateness Method (without editorial group), as the work group topic was highly specialized, with few experts available.
Ahead of any day-case sinonasal surgery, it is recommended that patient eligibility criteria be respected and hemorrhagic risk assessed; preference should be given to short procedures involving little variation in surgery time and minimizing blood-loss, and associated procedures (e.g., septoplasty+turbinectomy) should be avoided. The patient and family should be informed of specific hemorrhagic, orbital and/or neuromeningeal risks, onset of which may preclude discharge home. Uni- or bilateral postoperative nasal packing is not a contraindication to day-case management.
All four procedures may be performed on a day-case basis. Eligibility criteria should be systematically respected, but hemorrhagic risk, which is very specific to the sinonasal organ, is to be assessed on a case-by-case basis, as it is a major issue in this kind of management for a non-negligible number of patients.
法国耳鼻咽喉科学会（SFORL）成立了一个工作组，以起草一份关于四种鼻科手术日间手术的共识文件，这四种手术分别是：内镜中鼻道上颌窦造口术（法国国家健康保险（CCAM）代码GBPE001）、鼻中隔成形术（GAMA007）、直接入路鼻骨骨折复位术（LAEA007）和闭合技术鼻骨骨折复位术（LAEP002）。
采用的方法遵循法国卫生当局（HAS）于2006年1月发布的“通过正式共识制定专业指南的方法基础”；由于工作组的主题专业性很强，可用专家较少，因此选择的方法是兰德/加州大学洛杉矶分校适宜性方法的简短版本（无编辑小组）。
在进行任何鼻窦日间手术之前，建议遵守患者入选标准并评估出血风险；应优先选择手术时间变化小且失血最少的简短手术，并应避免联合手术（如鼻中隔成形术+鼻甲切除术）。应告知患者及其家属特定的出血、眼眶和/或神经脑膜风险，这些风险的发生可能会妨碍患者出院回家。术后单侧或双侧鼻腔填塞并非日间手术管理的禁忌症。
所有这四种手术均可在日间进行。应系统地遵守入选标准，但鼻窦器官特有的出血风险应逐案评估，因为对于相当数量的患者而言，这是此类管理中的一个主要问题。
