Department of Otolaryngology, Head & Neck Surgery, Gosford Hospital, NSW Health-Central Coast Local Health District, Gosford, New South Wales, Australia.
School of Medicine and Public Health-Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia.
Laryngoscope. 2021 Aug;131(8):1704-1714. doi: 10.1002/lary.29350. Epub 2021 Jan 4.
To evaluate the efficacy of absorbable steroid-impregnated nasal packing on postoperative outcomes following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS).
A systematic review of the literature was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twelve databases (including Journals@Ovid, Embase®, Medline®, EBM Reviews and Joanna Briggs Institute EBP Database) were searched using relevant keywords and expanded with corresponding MeSH/Emtree terms. Results were narrowed to English articles assessing the efficacy of absorbable packing impregnated with steroids post-production placed at time of surgery under general anesthetic, with hollow-lumen devices and devices inserted in-office excluded.
Eight studies met criteria and were included in this review. Five evaluated the efficacy of the intervention in only CRS with nasal polyposis (CRSwNP) patients, two included all subtypes of CRS, and one included only CRS without nasal polyposis (CRSsNP). Of the eight studies, four studied the efficacy of Nasopore®, three studied bioabsorbable gels, and one studied bioabsorbable calcium alginate. Four studies applied triamcinolone as the operative steroid, with the other studies utilizing betamethasone, budesonide, mometasone, and dexamethasone. Seven studies demonstrated statistically significant improvements in endoscopic outcomes using validated scoring scales, albeit at differing timepoints. The one study which included only CRSsNP patients failed to find a significant difference.
Steroid-impregnated nasal packing appears to have positive effects on postoperative endoscopic outcomes in CRSwNP patients undergoing FESS. Additional research is needed to evaluate the efficacy of these interventions in more recently defined subtypes of CRS, and whether these interventions differ in their efficacy in eosinophilic and non-eosinophilic CRS. Laryngoscope, 131:1704-1714, 2021.
评估可吸收类固醇浸渍鼻填塞在慢性鼻-鼻窦炎（CRS）患者功能性内镜鼻窦手术后（FESS）的术后结局中的疗效。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对文献进行系统回顾。使用相关关键词和对应的 MeSH/Emtree 术语扩展了 12 个数据库（包括 Journals@Ovid、Embase®、Medline®、EBM Reviews 和 Joanna Briggs 研究所 EBP 数据库）进行搜索。结果缩小到评估在全身麻醉下手术时放置的类固醇浸渍可吸收填塞的有效性的英文文章，排除中空腔装置和在诊室插入的装置。
符合标准并纳入本综述的有 8 项研究。其中 5 项研究仅评估了该干预措施在伴有鼻息肉（CRSwNP）患者的 CRS 中的疗效，2 项研究包括所有 CRS 亚型，1 项研究仅包括无鼻息肉（CRSsNP）的 CRS。在这 8 项研究中，4 项研究了 Nasopore®的疗效，3 项研究了生物可吸收凝胶，1 项研究了生物可吸收的海藻酸钙。有 4 项研究应用曲安奈德作为手术类固醇，而其他研究则使用倍他米松、布地奈德、莫米松和地塞米松。7 项研究使用经过验证的评分量表显示术后内镜结果有统计学意义的改善，但时间点不同。唯一一项仅纳入 CRSsNP 患者的研究未发现差异有统计学意义。
在接受 FESS 的 CRSwNP 患者中，类固醇浸渍鼻填塞似乎对术后内镜结果有积极影响。需要进一步研究评估这些干预措施在最近定义的 CRS 亚型中的疗效，以及这些干预措施在嗜酸性粒细胞和非嗜酸性粒细胞 CRS 中的疗效是否存在差异。喉科学，131：1704-1714，2021。
