Vuncannon Jackson R, Wise Sarah K
Emory University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Atlanta, GA.
Curr Opin Otolaryngol Head Neck Surg. 2023 Feb 1;31(1):33-38. doi: 10.1097/MOO.0000000000000855. Epub 2022 Nov 14.
Bleeding during endoscopic endonasal procedures can quickly obscure critical anatomic landmarks. This increases both the difficulty of the surgical procedure and the risk of complications faced by the patient. As the indications for surgical management of sinonasal pathology grow, it is important to review techniques to minimize bleeding and facilitate safe surgery.
Evidence continues to accumulate for best practices in the surgical management of sinonasal disease. Recently, international guidelines have attempted to summarize this body of evidence, lending further support to several interventions which have been advocated as methods to decrease bleeding during endoscopic endonasal surgery. Additional studies have specifically investigated the safety of certain commonly employed techniques. The utility of preoperative corticosteroid therapy and the use of total intravenous anesthetic techniques in increasingly validated. Further evidence supports the safety of reverse Trendelenburg positioning for surgical management of inflammatory disease.
Recent wide scale systematic review of the literature regarding perioperative and intraoperative management of hemostasis has reinforced the utility of certain interventions, while others remain ambiguous.
鼻内镜手术中的出血会迅速模糊关键的解剖标志。这既增加了手术难度，也增加了患者面临的并发症风险。随着鼻窦疾病手术治疗适应证的增加，回顾减少出血并促进安全手术的技术非常重要。
鼻窦疾病手术管理的最佳实践证据不断积累。最近，国际指南试图总结这一证据体系，进一步支持了几种被倡导为减少鼻内镜手术出血方法的干预措施。其他研究专门调查了某些常用技术的安全性。术前皮质类固醇治疗的效用以及全静脉麻醉技术的使用越来越得到验证。更多证据支持在炎症性疾病手术管理中采用头高脚低位的安全性。
最近对围手术期和术中止血管理的文献进行的大规模系统综述强化了某些干预措施的效用，而其他措施仍不明确。
