Mcleod R W J, Price A, Williams R J, Smith M E, Smith M, Owens D
ENT Department,University Hospital of Wales,Cardiff,UK.
Institute of Naval Medicine,Gosport,UK.
J Laryngol Otol. 2017 Dec;131(12):1056-1064. doi: 10.1017/S0022215117002043.
Cauterisation techniques are commonly used and widely accepted for the management of epistaxis. This review assesses which methods of intranasal cautery should be endorsed as optimum treatment on the basis of benefits, risks, patient tolerance and economic assessment.
A systematic review of the literature was performed using a standardised methodology and search strategy.
Eight studies were identified: seven prospective controlled trials and one randomised controlled trial. Pooling of data was possible from 3 studies, yielding a total of 830 patients. Significantly lower re-bleed rates were identified (p < 0.01) using electrocautery (14.5 per cent) when compared to chemical cautery (35.1 per cent). No evidence suggested that electrocautery was associated with more adverse events or discomfort. Limited evidence supported the use of a vasoconstrictor agent and operating microscope during the procedure. The included studies had considerable heterogeneity in terms of design and outcome measures.
Consistent evidence suggests that electrocautery has higher success rates than chemical cautery, and is not associated with increased complications or patient discomfort. Lower quality evidence suggests that electrocautery reduces costs and duration of hospital stay.
烧灼技术常用于鼻出血的治疗且被广泛接受。本综述基于益处、风险、患者耐受性和经济评估，评估哪种鼻内烧灼方法应被认可为最佳治疗方法。
采用标准化方法和检索策略对文献进行系统综述。
共纳入8项研究：7项前瞻性对照试验和1项随机对照试验。3项研究的数据可合并，共计830例患者。与化学烧灼（35.1%）相比，使用电烧灼时再出血率显著降低（p < 0.01）（14.5%）。没有证据表明电烧灼会导致更多不良事件或不适。有限的证据支持在手术过程中使用血管收缩剂和手术显微镜。纳入的研究在设计和结局指标方面存在相当大的异质性。
一致的证据表明，电烧灼的成功率高于化学烧灼，且不会增加并发症或患者不适。质量较低的证据表明，电烧灼可降低成本和缩短住院时间。
