鼻内镜下选择性翼管神经切断术对伴有变应性鼻炎的慢性鼻窦炎的疗效观察

doi:10.6040/j.issn.1673-3770.1.2018.028

摘要/Abstract

摘要： 目的探讨鼻内镜下选择性翼管神经切断术治疗伴有中重度变应性鼻炎的慢性鼻窦炎的临床效果。方法选择2015年9月至2016年9月在首都医科大学宣武医院就诊的伴有中重度持续性变应性鼻炎(AR)的慢性鼻窦炎鼻息肉的患者132例。所有患者分为两组,对照组62例采取常规手术方法治疗慢性鼻-鼻窦炎,变应性鼻炎选择保守治疗。观察组70例患者在常规手术基础上行选择性翼管神经切断术,包括鼻后神经切断术和翼管神经咽支的切断。应用视觉模拟量表(VAS)、Lund-Kennedy内镜黏膜形态评分、Lund-Mackay鼻窦CT扫描病变范围评分来对术后随访资料收集分析评估,对患者治疗前和治疗结束后随访情况做自身对比,记录治疗前,手术后6个月、1年、2年的数据。结果随访2年,对研究终止时随访成功且临床资料完整的106例病例进行分析,观察组56例,对照组50例。观察组病例治疗前VAS评分为(7.6±2.2)分,治疗后6个月VAS评分为(2.3±1.2)分,治疗后1年VAS评分为(2.6±1.7)分,治疗后2年VAS评分为(2.8±1.8)分,与治疗前比较差异均具有统计学意义(P<0.05)。观察组采用选择性翼管神经切断术治疗伴有中重度变应性鼻炎的慢性鼻窦炎总的有效率94.6%(53/56)。与对照组相比差异具有统计学意义(P<0.01)。通过对并发症的统计分析发现观察组未发生泪液分泌障碍、萎缩性鼻炎等并发症。其并发症的发生与对照组比较差异无统计学意义(P>0.05)。将术后2年观察组的疗效评估结果与手术前过敏原检测结果进行相关性分析,显示手术疗效与过敏的严重程度并无明确相关性(P>0.05)。结论鼻内镜下选择性翼管神经切断术是治疗伴有中重度持续性变应性鼻炎的慢性鼻窦炎的安全、有效的手段。

关键词: 鼻内镜外科手术, 翼管神经切断, 变应性鼻炎, 慢性鼻-鼻窦炎

Abstract: Objective To evaluate the therapeutic efficacy of endoscopic elective vidian neurectomy in the management of moderate-severe persistent allergic rhinitis with chronic sinusitis and to explore its possible mechanism. Methods One hundred thirty-two patients with moderate-severe persistent allergic rhinitis and chronic sinusitis who visited Xuanwu Hospital Capital Medical University from September 2015 to September 2016 were divided into two groups. Endoscopic elective vidian neurectomy was performed in 70 patients in the observation group, including amputation of the posterior nasal nerve and pharyngeal branch; 62 patients in the control group underwent conventional operation and conservative treatment. The visual analogue scale(VAS)score and Lund-Mackay score were assessed at 6 months, 1 year, and 2 years after operation. Results One hundred and six cases had complete follow-up data. The average VAS score decreased significantly from 7.6±2.2 to 2.3±1.2 at 6 months, to 2.6±1.7 at 1 year, and to 2.8±1.8 at 2 years after operation in the observation group(n= 56, P<0.05). The observation group had a complete control rate of 94.6%(53/56), which was significantly lower than the control group(n=50)at the same period after treatment. There was no severe complication such as xeroma and atrophic rhinitis in both groups. Furthermore, the difference in complications in the observation and control groups was not statistically significant(P>0.05). When correlation analysis of therapeutic efficacy 2 years after operation and the allergen test before operation was performed in the observation group, no significant correlation was observed(P>0.05). Conclusion Endoscopic elective vidian neurectomy is an effective and safe technique in the management of moderate-severe persistent allergic rhinitis with chronic sinusitis.

Key words: Nasal endoscopic surgical procedures, operative, Vidian neurectomy, Allergic rhinitis, Chronic sinusitis

中图分类号:

R765

齐岩,刘俊其,彭舒娅,罗凯,张名霞,王振霖. 鼻内镜下选择性翼管神经切断术对伴有变应性鼻炎的慢性鼻窦炎的疗效观察[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 109-113.

QI Yan, LIU Junqi, PENG Shuya, LUO Kai, ZHANG Mingxia, WANG Zhenlin. Therapeutic ecacy of endoscopic elective vidian neurectomy for moderate-severe persistent allergic rhinitis with chronic sinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(1): 109-113.

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