Yoon H Y, Lee H S, Kim I H, Hwang S H
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Otolaryngol. 2018 Apr;43(2):525-532. doi: 10.1111/coa.13015. Epub 2017 Nov 8.
Recently, topical steroid therapy delivery using high-volume sinonasal irrigations has been used more frequently, following endoscopic sinus surgery (ESS), to improve drug delivery into the paranasal sinuses.
The goal of this study was to perform a systematic review with meta-analysis of the efficacy of steroid nasal irrigation on post-operative management of Chronic rhinosinusitis (CRS) following ESS.
Five databases (PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database) from inception to March 2017 were independently reviewed by two researchers. Studies that scored CRS endoscopic findings and CRS-related quality of life (QOL) post-operatively before and after steroid nasal irrigation and that compared the effects of steroid nasal irrigation (treatment groups) with saline alone irrigation (control group) were included in the analysis.
Twelve studies (n = 360) met inclusion criteria. Steroid nasal irrigation significantly reduced the endoscopic score compared with pre-treatment values and also improved QOL. Adverse effects following steroid nasal irrigation such as increased intraocular pressure (IOP) and hypothalamus-pituitary-adrenal (HPA) axis disturbance were not significant. However, compared with saline alone irrigation, the additional effects of steroid irrigation were not significant in the view of the endoscopic score and disease-specific QOL.
Although steroid nasal irrigation would not induce adverse effects related to systemic steroid absorption, the beneficial effects of additional steroids in saline irrigation were ambiguous in regard to endoscopic score and CRS-related QOL improvement compared with saline alone irrigation. However, further clinical trials with robust research methodologies should be conducted to confirm the results of this study.
最近，在内镜鼻窦手术（ESS）后，使用大容量鼻窦冲洗进行局部类固醇治疗的方法越来越频繁地被采用，以提高药物向鼻窦的输送。
本研究的目的是对类固醇鼻腔冲洗在ESS后慢性鼻窦炎（CRS）术后管理中的疗效进行系统评价和荟萃分析。
两名研究人员独立检索了从建库至2017年3月的五个数据库（PubMed、SCOPUS、Embase、Web of Science和Cochrane数据库）。分析纳入了对类固醇鼻腔冲洗前后CRS内镜检查结果和CRS相关生活质量（QOL）进行评分，并将类固醇鼻腔冲洗（治疗组）与单纯盐水冲洗（对照组）的效果进行比较的研究。
12项研究（n = 360）符合纳入标准。与治疗前相比，类固醇鼻腔冲洗显著降低了内镜评分，同时也改善了生活质量。类固醇鼻腔冲洗后的不良反应，如眼压升高（IOP）和下丘脑-垂体-肾上腺（HPA）轴紊乱并不显著。然而，从内镜评分和疾病特异性生活质量来看，与单纯盐水冲洗相比，类固醇冲洗的额外效果并不显著。
虽然类固醇鼻腔冲洗不会引起与全身类固醇吸收相关的不良反应，但与单纯盐水冲洗相比，在盐水冲洗中添加类固醇在内镜评分和CRS相关生活质量改善方面的有益效果尚不明确。然而，应该进行更多具有可靠研究方法的临床试验来证实本研究的结果。
