目的:系统回顾文献以评估适应症,安全,以及DrafIIb手术的疗效,并评估支架和皮瓣等技术因素的附加优势。
方法:直到2019年7月在Medline和Cochrane数据库上发表的文章。
方法:在根据2018年PRISMA指南进行系统评价后,1533篇文章中的26篇被纳入并审查了DrafIIb的适应症;手术技术;皮瓣的使用,支架,移植物,或丝裂霉素;手术期间和手术后的并发症;成功率或复发率。
结果:DrafIIb的主要适应症是慢性额部鼻-鼻窦炎(61.82%)。术后通畅率为87.85%。当应用皮瓣/移植物时,率为93.5%,但它们的附加值没有统计学意义。支架可以是翻修手术的替代方案。治疗除慢性鼻窦炎以外的额叶病变也令人满意。安全性与DrafIII相当:未报告围手术期并发症,术后仅少数(0.2%的病例中有眼睑瘀斑和眶周蜂窝织炎,在1.55%的不足)。
结论:正确指示时,DrafIIb正面钻孔是一种安全高效的正面病理治疗手术技术,效率和安全性可与DrafIII相媲美,当不需要双边方法时,使其成为有效的选择。需要更多的研究来确认襟翼的附加值,移植物,和支架。
OBJECTIVE: To systematically review the literature to evaluate the indications, safety, and efficacy of the Draf IIb procedure and to evaluate the added advantages of technical factors such as stents and flaps.
METHODS: Articles published until July 2019 on Medline and Cochrane databases.
METHODS: After a systematic review based on the 2018 PRISMA guidelines was conducted, 26 of 1533 articles were included and reviewed for indications of Draf IIb; surgical technique; use of flaps, stents, grafts, or mitomycin; complications during and after surgery; and success or recurrence rate.
RESULTS: The main indication for Draf IIb was chronic frontal rhinosinusitis (61.82%). The postoperative patency rate was 87.85%. When flaps/grafts were applied, the rate was 93.5%, but their added value was not statistically significant. Stents could be an alternative for revision surgery. Treating frontal pathologies other than chronic rhinosinusitis was also satisfying. Safety was comparable to Draf III: no perioperative complications were reported, only a few postoperative ones (eyelid ecchymosis and periorbital cellulitis in 0.2% of the cases, hyposmia in 1.55%).
CONCLUSIONS: When properly indicated, Draf IIb frontal drilling is a safe and highly effective surgical technique for frontal pathology treatment, with efficiency and safety comparable to the Draf III, making it a valid option when a bilateral approach is not needed. More studies are required to confirm the added values of flaps, grafts, and stents.