Ping Wei-Dong, Zhao Qi-Ming, Sun Hua-Feng, Lu Hai-Shan, Li Fei
Department of Plastic and Reconstructive Surgery, Zhejiang Hospital.
Department of Plastic and Reconstructive Surgery, 903th Hospital of PLA, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2019 Apr;98(16):e15202. doi: 10.1097/MD.0000000000015202.
Nasal surgeries (such as Functional Endoscopic Sinus Surgery, Rhinoplasty, and Septorhinoplasty) are popular procedures. But perioperative bleeding, eyelid edema, and periorbital ecchymosis remain problems. Tranexamic acid (TXA) is an antifibrinolytic, and it was used to reduce the perioperative bleeding. However, there is no enough evidence judging its safety and efficiency. Therefore, a meta-analysis is conducted by us to evaluate the role of TXA in patients undergoing nasal surgeries.
A search of the literature was performed until June 2018; the PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched for related articles using search strategy. Two authors independently assessed the methodological quality of the included studies and extracted data. Surgical information and postoperative outcomes were analyzed. Only randomized controlled trial (RCT) articles were included, and subgroup analysis was established to deal with heterogeneity. RevMan 5.3 software was selected to conduct the meta-analysis.
Eleven RCTs were included in our meta-analysis. There were significant differences in blood loss (P < .001), surgical field quality (P < .001), edema rating of upper (P < .001) and lower (P < .001) eyelid, ecchymosis rating of upper (P < .001) and lower eyelid (P < .001) when comparing the TXA group to the placebo group. However, the difference in operation time (P = .57) was not significant between the two groups.
Perioperative TXA could reduce the blood loss and improve the quality of surgery field during nasal surgery, and it was helpful for reducing the edema and ecchymosis after nasal surgeries, but it has little influence in reducing the operation time.
鼻科手术（如功能性鼻内镜鼻窦手术、隆鼻术和鼻整形术）是常见的手术。但围手术期出血、眼睑水肿和眶周瘀斑仍是问题。氨甲环酸（TXA）是一种抗纤维蛋白溶解剂，用于减少围手术期出血。然而，尚无足够证据判断其安全性和有效性。因此，我们进行了一项荟萃分析，以评估TXA在接受鼻科手术患者中的作用。
检索文献至2018年6月；使用检索策略在PubMed、Embase、Cochrane对照试验中央注册库和谷歌学术数据库中搜索相关文章。两位作者独立评估纳入研究的方法学质量并提取数据。分析手术信息和术后结果。仅纳入随机对照试验（RCT）文章，并进行亚组分析以处理异质性。选择RevMan 5.3软件进行荟萃分析。
我们的荟萃分析纳入了11项RCT。将TXA组与安慰剂组相比，在失血量（P<0.001）、手术视野质量（P<0.001）、上睑（P<0.001）和下睑（P<0.001）水肿分级、上睑（P<0.001）和下睑（P<0.001）瘀斑分级方面存在显著差异。然而，两组之间的手术时间差异（P = 0.57）不显著。
围手术期使用TXA可减少鼻科手术中的失血量并改善手术视野质量，有助于减少鼻科手术后的水肿和瘀斑，但对缩短手术时间影响不大。
