Swords C, Patel A, Smith M E, Williams R J, Kuhn I, Hopkins C
Department of Otolaryngology,Addenbrooke's Hospital,Cambridge,UK.
Institute of Naval Medicine,Gosport,UK.
J Laryngol Otol. 2017 Dec;131(12):1108-1130. doi: 10.1017/S0022215117002079.
There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of surgical artery ligation compared to direct treatments (nasal packing, cautery), and that of embolisation compared to direct treatments and surgery.
A systematic review of the literature was performed using a standardised published methodology and custom database search strategy.
Thirty-seven studies were identified relating to surgery, and 34 articles relating to interventional radiology. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery ligation. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates (73-100 per cent and 75-92 per cent, respectively), although embolisation was associated with more serious adverse effects (risk of stroke, 1.1-1.5 per cent). No articles directly compared the two techniques.
Trials comparing endoscopic sphenopalatine artery ligation to embolisation are required to better evaluate the clinical and economic effects of intervention in epistaxis.
在鼻出血的治疗中，手术和介入放射技术的使用存在差异。本综述评估了手术动脉结扎与直接治疗（鼻腔填塞、烧灼）相比的有效性，以及栓塞与直接治疗和手术相比的有效性。
使用标准化的已发表方法和自定义数据库搜索策略对文献进行系统综述。
确定了37项与手术相关的研究和34篇与介入放射学相关的文章。对于难治性鼻出血患者，与其他形式的手术动脉结扎相比，内镜下蝶腭动脉结扎的不良反应情况和成功率最为有利。内镜下蝶腭动脉结扎和栓塞的成功率相似（分别为73%-100%和75%-92%），尽管栓塞与更严重的不良反应相关（中风风险为1.1%-1.5%）。没有文章直接比较这两种技术。
需要进行比较内镜下蝶腭动脉结扎与栓塞的试验，以更好地评估鼻出血干预的临床和经济效果。
