内窥镜鼻窦手术对颅内窦源性感染儿科患者的影响：系统回顾与荟萃分析

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology Pub Date : 2024-11-26 DOI:10.1016/j.ijporl.2024.112176

Elysia Grose , Jenny B. Xiao , Evan Fang , Brigitte Routhier-Chevrier , Jennifer M. Siu , Nikolaus E. Wolter

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引用次数: 0

摘要

本综述旨在阐明内窥镜鼻窦手术（ESS）对患有窦源性颅内感染的儿科患者的治疗效果所起的作用。方法在MEDLINE、Embase和Cochrane图书馆中检索了描述急性鼻窦炎（ARS）颅内并发症儿科患者的治疗效果的文章，这些患者接受了ESS手术，或未接受开放神经外科方法（ONA）或外窦方法（ESA）。主要研究结果包括死亡率、翻修手术、住院时间和神经系统后遗症。结果48篇文章符合最终资格标准，共有710名儿科患者和905例颅内并发症。最常见的并发症是硬膜下积液（n = 261，29%）、硬膜外脓肿（n = 213，24%）和Pott's Puffy肿瘤（PPT）（n = 95，10%）。将接受ESS（单独或与ONA联合）治疗的患者与仅接受ONA治疗的患者进行比较，结果显示，患者接受翻修手术的风险降低（RR=0.66，95% CI=0.38-1.12；RR=0.63，95% CI=0.36-1.09），神经系统后遗症的风险降低（RR=0.65，95% CI=0.15-2.74；RR=0.50，95% CI=0.20-1.26），但这些差异并无统计学意义。如果将接受联合干预的患者与仅接受ESS的患者进行比较，则翻修手术风险（RR = 1.04，95 % CI = 0.62-1.72）和神经系统后遗症风险（RR = 0.99，95 % CI = 0.37-2.64）相似。结论目前的研究主要包括小型回顾性研究，结果发现，在死亡率、翻修手术、住院时间和神经系统后遗症方面，单纯接受ESS、ESS联合ONA或单纯接受ONA的患儿之间没有统计学意义上的显著差异。尽管ESS可能有利于处理某些小儿窦源性颅内感染，但由于颅内并发症类型的差异以及文献中报道的ESS手术程度不一致，因此很难确定其真正的有效性。

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The impact of endoscopic sinus surgery in pediatric patients with sinogenic intracranial infection: A systematic review and meta-analysis

Objective

This review aims to elucidate the role of endoscopic sinus surgery (ESS) on the outcomes of pediatric patients with sinogenic intracranial infections.

Methods

MEDLINE, Embase, and the Cochrane library were searched for articles that described the outcomes in pediatric patients who had intracranial complications of acute rhinosinusitis (ARS) and underwent ESS with or without open neurosurgical approaches (ONA) or external sinus approaches (ESA). Primary outcomes of interest include mortality, revision surgery, length of stay and neurological sequelae. Random effects meta-analysis was performed.

Results

Forty-eight articles met the final eligibility criteria, totaling 710 pediatric patients and 905 intracranial complications. The most common complications were subdural empyema (n = 261, 29 %), epidural abscess (n = 213, 24 %), and Pott's Puffy tumor (PPT) (n = 95, 10 %). When comparing patients who underwent ESS (alone or combined with ONA) to those who underwent ONA only, there was a decreased risk of revision surgery (RR = 0.66, 95 % CI = 0.38–1.12 and RR = 0.63, 95 % CI = 0.36–1.09, respectively) and decreased risk of neurological sequelae (RR = 0.65, 95 % CI = 0.15–2.74 and RR = 0.50, 95 % CI = 0.20–1.26, respectively), however these differences were not statistically significant. When patients who underwent combined intervention were compared to ESS only, the risk of revision surgery (RR = 1.04, 95 % CI = 0.62–1.72) and neurological sequelae (RR = 0.99, 95 % CI = 0.37–2.64) were similar. Risk of mortality was minimal and similar across all interventions.

Conclusion

The current study including primarily small retrospective studies found no statistically significant differences between children who received ESS alone, ESS with ONA or ONA alone, on mortality, revision surgery, length of stay and neurological sequelae. Although ESS may be beneficial for managing certain pediatric sinogenic intracranial infections, its true effectiveness is difficult to determine due to the variability in the types of intracranial complications and the inconsistent extent of ESS procedures reported in the literature.

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来源期刊

International journal of pediatric otorhinolaryngology 医学-耳鼻喉科学

CiteScore

3.20

自引率

6.70%

发文量

276

审稿时长

62 days

期刊介绍： The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.