Khajuria Ankur, Khademi Mansour Hamid Reza, Muhammad Ibrahim, Asare Akua, Tammasse Iin, Suresh Jonathan, Leiberman Christopher, Pacheco-Barrios Niels, Brown Stav, Dogan Teoman, Rohrich Rod
From the Kellogg College, University of Oxford, Oxford, United Kingdom.
Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Plast Reconstr Surg Glob Open. 2024 Nov 5;12(11):e6275. doi: 10.1097/GOX.0000000000006275. eCollection 2024 Nov.
Perioperative bleeding is a challenge in rhinoplasty and septoplasty. Tranexamic acid (TXA) may help reduce this, but its effectiveness is unclear. This systematic review and meta-analysis aimed to evaluate TXA's impact on bleeding in these procedures.
The protocol was registered a priori to PROSPERO (CRD42023393458). PubMed, Embase, Google Scholar, and Web of Science were searched from inception to October 2023. Eligible studies were randomized controlled trials of adult patients undergoing rhinoplasty or septoplasty. Primary outcomes were intraoperative blood loss, surgery duration, and surgeon satisfaction. A random-effects model was used. Methodological quality was assessed using GRADE. The risk of bias was assessed using Cochrane's RoB 2 tool for randomized studies.
The search yielded 154 results; 11 randomized controlled trials, with 968 patients, were included. The meta-analysis showed a significant reduction in intraoperative blood loss with TXA (MD -39.67; 95% CI: -15.10 to -64.24; = 0.002) and superior surgeon satisfaction in favor of TXA use (SMD -2.73; 95% CI: -5.33 to -0.12; = 0.04). Subgroup analyses for intraoperative blood loss, according to administration routes, were also in favor of intravenous TXA (MD -13.02; 95% CI: -1.65 to -24.38; = 0.02) and oral TXA (MD -44.98; 95% CI: -83.66 to -6.31; = 0.02); no statistical difference was noted in surgery duration (MD -0.99; 95% CI: 0.63 to -2.81; = 0.23). All studies were found to be of high quality, with low bias.
The findings support TXA's efficacy in reducing blood loss during rhinoplasty and septoplasty, with high surgeon satisfaction.
围手术期出血是隆鼻术和鼻中隔成形术中的一项挑战。氨甲环酸（TXA）可能有助于减少出血，但其有效性尚不清楚。本系统评价和荟萃分析旨在评估TXA对这些手术中出血的影响。
该方案已预先在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42023393458）登记。检索了从数据库建立至2023年10月的PubMed、Embase、谷歌学术和科学网。纳入的合格研究为成年患者接受隆鼻术或鼻中隔成形术的随机对照试验。主要结局指标为术中失血量、手术时长和外科医生满意度。采用随机效应模型。使用GRADE评估方法学质量。使用Cochrane的RoB 2工具对随机研究进行偏倚风险评估。
检索共获得154项结果；纳入了11项随机对照试验，涉及968例患者。荟萃分析显示，使用TXA可显著减少术中失血量（MD -39.67；95%CI：-15.10至-64.24；P = 0.002），且使用TXA的外科医生满意度更高（SMD -2.73；95%CI：-5.33至-0.12；P = 0.04）。根据给药途径对术中失血量进行的亚组分析也支持静脉注射TXA（MD -13.02；95%CI：-1.65至-24.38；P = 0.02）和口服TXA（MD -44.98；95%CI：-83.66至-6.31；P = 0.02）；手术时长无统计学差异（MD -0.99；95%CI：0.63至-2.81；P = 0.23）。所有研究质量均较高，偏倚较低。
研究结果支持TXA在减少隆鼻术和鼻中隔成形术期间失血量方面的疗效，且外科医生满意度较高。
