Ryan Lindsey, Segarra Daniel, Tabor Mark, Parasher Arjun
Department of Otolaryngology- Head and Neck Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd., MDC 73, Tampa, FL 33612, USA.
University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd, Tampa, FL 33612, USA.
World J Otorhinolaryngol Head Neck Surg. 2020 Nov 16;6(4):220-229. doi: 10.1016/j.wjorl.2020.07.010. eCollection 2020 Dec.
To review and evaluate outcomes of patients with aspirin-exacerbated respiratory disease (AERD) following endoscopic sinus surgery and subsequent aspirin desensitization.
Electronic searches of OVID MEDLINE (1948 to September 10, 2019), EMBASE (1980 to September 10, 2019), and PubMed were performed on September 10, 2019. A systematic review of the literature was performed using the 2009 PRISMA guidelines. Studies with both preoperative and postoperative data for patients with AERD who underwent sinus surgery and aspirin desensitization were considered appropriate for inclusion. Publications were written in English and included patients aged 18 years or older.
Six studies met inclusion criteria for this systematic review. The primary outcome measure was change in symptom profile measured by patient-reported quality of life scores. The results demonstrate statistically significant improvement in symptoms following endoscopic sinus surgery, with sustained improvement following aspirin desensitization. Revision surgery rates were significantly lower in patients maintained on aspirin therapy.
This review suggests that surgery followed by aspirin desensitization results in improvement in both subjective and objective outcome measures. The adjunctive use of aspirin desensitization allows for long-term stability in symptom scores. Recurrence of polyps and worsening symptoms requiring revision surgery occurs when aspirin maintenance therapy is interrupted.
回顾和评估阿司匹林加重性呼吸道疾病（AERD）患者在内镜鼻窦手术后及随后阿司匹林脱敏治疗的效果。
于2019年9月10日对OVID MEDLINE（1948年至2019年9月10日）、EMBASE（1980年至2019年9月10日）和PubMed进行电子检索。使用2009年PRISMA指南对文献进行系统评价。纳入那些有接受鼻窦手术和阿司匹林脱敏治疗的AERD患者术前和术后数据的研究。出版物为英文撰写，纳入年龄18岁及以上的患者。
六项研究符合本系统评价的纳入标准。主要结局指标是通过患者报告的生活质量评分衡量的症状变化情况。结果表明，内镜鼻窦手术后症状有统计学意义上的显著改善，阿司匹林脱敏治疗后症状持续改善。持续接受阿司匹林治疗的患者翻修手术率显著更低。
本综述表明，手术联合阿司匹林脱敏治疗可使主观和客观结局指标均得到改善。阿司匹林脱敏治疗的辅助使用可使症状评分长期稳定。中断阿司匹林维持治疗时会出现息肉复发和症状恶化需要翻修手术的情况。
