上颌窦扩大内窥镜方法中的鼻泪管管理:系统回顾与循证建议》。

IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY American Journal of Rhinology & Allergy Pub Date : 2024-09-01 Epub Date: 2024-05-27 DOI:10.1177/19458924241249802
Neal Rajan Godse, Satyan Sreenath, Brian C Lobo, Raj Sindwani
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引用次数: 0

摘要

背景:利用上颌窦扩大内窥镜方法进行各种肿瘤的鼻内镜治疗越来越受欢迎。鼻泪管(NLD)可能会不慎损伤,或在肿瘤切除过程中需要切除,或为了增强可视性而切除。对鼻泪管的处理可以采取单独横断、横断加支架或进行正式的泪囊鼻腔造口术以避免术后损伤后遗症。本研究的目的是回顾文献,确定上颌窦扩张术中 NLD 的最佳处理方法:方法:对 Ovid、Embase、Medline 和 Cochrane 数据库进行了系统性回顾,以确定涉及上颌窦扩大入路且明确报告了 NLD 状况和术后结果的研究:结果:19 项研究被纳入分析,并分为两组:NLD保留组(9项研究,共191名患者)和NLD涉及组(10项研究,共296名患者)。在 NLD 保护亚组中,191 名患者中有一名患者(0.5%)出现了眼睑外翻。在涉及 NLD 的亚组中,单纯的锐性横切是最常见的 NLD 切除方法,与较低的上睑下垂发生率相关(研究比率:0 至 18.2%;亚组总比率:7.0%,21/296)。症状的自然缓解很常见(60%-100% 的病例):结论:从暴露和肿瘤控制的角度来看,在可行的情况下应保留 NLD。结论:从暴露和肿瘤控制的角度来看,在可行的情况下应保留 NLD。当病理或方法要求切除 NLD 时,无论采用哪种手术技术,持续性上睑下垂的发生率都很低。当采用上颌扩大切口时,尤其是良性肿瘤,需要切除 NLD 时,锐性横切是最简单的切除方法,术后上睑下垂的发生率很低,并得到现有文献的支持。
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Management of the Nasolacrimal Duct in Expanded Endoscopic Approaches to the Maxillary Sinus: A Systematic Review with Evidence-based Recommendations.

Background: Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches.

Methods: A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes.

Results: Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases).

Conclusions: The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature.

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来源期刊
CiteScore
5.60
自引率
11.50%
发文量
82
审稿时长
4-8 weeks
期刊介绍: The American Journal of Rhinology & Allergy is a peer-reviewed, scientific publication committed to expanding knowledge and publishing the best clinical and basic research within the fields of Rhinology & Allergy. Its focus is to publish information which contributes to improved quality of care for patients with nasal and sinus disorders. Its primary readership consists of otolaryngologists, allergists, and plastic surgeons. Published material includes peer-reviewed original research, clinical trials, and review articles.
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