Hwang Se Hwan, Kim Sung Won, Basurrah Mohammed Abdullah, Kim Do Hyun
Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2023 May;16(2):148-158. doi: 10.21053/ceo.2022.01718. Epub 2023 Feb 15.
The aim of this study was to compare the effect of steroid-impregnated spacers to that of conventional management after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS).
Six databases were searched from inception until November 2022. Sixteen studies were found that compared the improvement of chronic sinusitis-related symptoms and postoperative outcomes between a steroid-impregnated spacer group and a control group (non-steroid-impregnated spacers). The Cochrane risk of bias tool (for randomized controlled studies) and the Newcastle-Ottawa Scale (for non-randomized controlled studies) were used to assess the quality of the works included.
Regarding the endoscopic findings, the degree of mucosal edema, ethmoid inflammation, crust formation at 2-3 months postoperatively, nasal discharge, polyposis, and scarring/synechia were significantly lower in the steroid-impregnated spacer group. The steroid-impregnated spacer group also showed significantly lower Lund-Kennedy scores and perioperative sinus endoscopy scores than the control group at 2-3 weeks postoperatively. Furthermore, the steroid-impregnated spacer group had lower rates of adhesions, middle turbinate lateralization, polypoid changes, the need for oral steroid use, the need for postoperative therapeutic interventions, and lysis of adhesions than controls. However, no significant between-group differences were found in short-term (2-3 weeks postoperatively) endoscopic findings regarding nasal discharge, postoperative crusting, polyposis, or scarring/synechia.
Steroid-impregnated nasal packing reduced the rates of postoperative intervention and recurrent polyposis and inflammation in CRS patients undergoing ESS.
本研究旨在比较慢性鼻窦炎（CRS）患者在内镜鼻窦手术（ESS）后，类固醇浸渍间隔物与传统治疗方法的效果。
检索了6个数据库，时间跨度从建库至2022年11月。共发现16项研究，比较了类固醇浸渍间隔物组和对照组（非类固醇浸渍间隔物）之间慢性鼻窦炎相关症状的改善情况及术后结果。采用Cochrane偏倚风险工具（用于随机对照研究）和纽卡斯尔-渥太华量表（用于非随机对照研究）评估纳入研究的质量。
在内镜检查结果方面，类固醇浸渍间隔物组术后2至3个月时的黏膜水肿程度、筛窦炎症、结痂形成、鼻分泌物、息肉病以及瘢痕形成/粘连均显著更低。类固醇浸渍间隔物组在术后2至3周时的Lund-Kennedy评分和围手术期鼻窦内镜评分也显著低于对照组。此外，类固醇浸渍间隔物组的粘连发生率、中鼻甲外移率、息肉样改变、口服类固醇使用需求、术后治疗干预需求以及粘连松解率均低于对照组。然而，在术后短期（术后2至3周）的内镜检查结果中，关于鼻分泌物、术后结痂、息肉病或瘢痕形成/粘连方面，两组之间未发现显著差异。
类固醇浸渍鼻腔填塞物降低了接受ESS的CRS患者的术后干预率以及复发性息肉病和炎症的发生率。
