目的:鼻出血的控制一直是耳鼻喉科医师面临的重大挑战。解决难治性病例的最可行的选择之一是结扎或烧灼蝶腭动脉。这项研究的目的是评估疗效,安全,以及这些干预措施的长期结果。
方法:两位独立的耳鼻喉科医生通过查阅网络上的主要科学数据库,全面搜索了有关控制/复发性鼻出血的研究,包括PubMed,谷歌学者,Medline,EMBASE,WebofScience,还有Cochrane图书馆.根据系统评价和荟萃分析的首选报告项目(PRISMA)声明进行系统评价。考虑审查研究的标准是基于人群,干预,比较,结果,定时和设置(PICOTS)框架。
结果:16项研究纳入系统评价,总共454名患者。其中,289人接受了蝶腭动脉结扎术,而100人接受了相同动脉的烧灼术。此外,56例患者在同一手术中同时进行了蝶腭动脉的结扎和烧灼。再出血和并发症的发生率分别为12.1%(55/454)和3%(14/454),导致两种情况下的费率相对较低。
结论:我们的综述强调了手术入路的重要性,特别是蝶腭动脉的结扎或烧灼,在处理难治性病例时。并发症发生率低,在接受蝶腭动脉结扎术的患者中,主要是暂时性的流泪减少,强调了这些干预措施的安全性和可行性。
OBJECTIVE: The control of
epistaxis has always posed a significant challenge for otolaryngologists. One of the most viable options to address refractory cases is the ligation or cauterization of the sphenopalatine artery. The objective of this study was to assess the efficacy, safety, and long-term outcomes of these interventions.
METHODS: Two independent otolaryngologists conducted a comprehensive search for studies dealing with management of uncontrolled/recurrent
epistaxis by consulting the main scientific databases on the web, including PubMed, Google Scholar, Medline, EMBASE, Web of Science, and the Cochrane Library. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The criteria for considering studies for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework.
RESULTS: Sixteen studies were included in the systematic review, comprising a total of 454 patients. Among these, 289 individuals underwent ligation of the sphenopalatine artery, while 100 underwent cauterization of the same artery. Additionally, 56 patients underwent both ligation and cauterization of the sphenopalatine artery during the same surgery. The incidence of rebleeding and complications was respectively 12.1% (55/454) and 3% (14/454), resulting in relatively low rates in both cases.
CONCLUSIONS: Our review emphasizes the increasing importance of surgical approaches, specifically ligation or cauterization of the sphenopalatine artery, in addressing refractory cases. The low incidence of complications, predominantly temporary decreased lacrimation in patients undergoing ligation of the sphenopalatine artery, highlights the safety and feasibility of these interventions.