翼管神经切断术治疗2型慢性鼻窦炎伴过敏性鼻炎的临床疗效分析

doi:10.6040/j.issn.1673-3770.0.2022.471

Abstract

Abstract: Objective To investigate the clinical efficacy and vidian neurectomy(VN)in the treatment of type 2 chronic rhinosinusitis with allergic rhinitis(CRSwAR). Methods This was a retrospective study of 47 patients with moderate to severe type 2 CRSwAR who presented to our department for endoscopic sinus surgery(ESS)combined with VN surgery, from September 2019 to September 2021. The severity and extent of the patient's disease preoperatively and 1 year postoperatively were assessed using the sinonasal outcome test-22(SNOT-22)questionnaire, allergy-related serology(peripheral blood eosinophils, serum total immunoglobulin E, serum allergens, etc.), electronic nasopharyngoscopy(Lund-Kennedy scale), and the sinus CT(Lund-Mackay scale). Results From the analysis, the preoperative and 1-year postoperative SNOT-22 score was ［38.00(23.00,54.25)］ and ［10.00(5.00,18.50)］, respectively. The postoperative score was significantly lower than the preoperative score, and the difference before and after treatment was statistically significant(P<0.001). The clinical symptoms of nasal obstruction, sneezing, clear runny nose, rhinorrhea and reduction of smell all improved after treatment as indicated by the significantly lower scores after treatment than before treatment(P<0.001). The preoperative Lund-Kennedy and Lund-Mackay scores were ［9.00(6.75,12.00)］ and ［15.50(10.75,22.00)］ respectively, while 1 year postoperatively, these scores were significantly different at ［3.00(2.00,4.00)］ and ［3.50(1.00,6.50)］ respectively(P<0.001). One month after surgery, 18 patients(38.30%)had dry eyes and 2 patients(4.26%)had numbness in the palate. At 1 year follow-up, except for 2 patients who still had dry eyes, the symptoms of dry eyes and numbness in the palate basically disappeared and no serious complications such as cranial or orbital problems occurred. The total effective rate of treatment at 1 year after surgery was 89.36% for patients with type 2 CRSwAR. The changes in peripheral blood eosinophils, total serum immunoglobulin E and serum allergens before and after treatment were not statistically significant(P=0.130,P=0.184,P=0.763). Conclusion ESS combined with VN is a safe and effective treatment for moderate to severe type 2 CRSwAR, significantly improving symptoms of nasal obstruction, rhinorrhea, sneezing and reduction of smell without serious complications.

Key words: Vidian neurectomy, Endoscopic sinus surgery, Type 2 chronic rhinosinusitis, Allergic rhinitis, Clinical efficacy

CLC Number:

R765.21

WANG Xiaoai, ZHANG Qianqian, CHENG Xiangyu, LI Zhipeng, ZHANG Weitian, YE Haibo. A clinical efficacy analysis of vidian neurectomy in the treatment of type 2 chronic rhinosinusitis with allergic rhinitis[J].Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(5): 42-49.

References

[1] Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020[J]. Rhinology, 2020, 58(Suppl S29): 1-464. doi:10.4193/Rhin20.600
[2] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018)[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(2): 81-100. doi: 10.3760/cma.j.issn.1673-0860.2019.02.001
[3] Liao B, Liu JX, Li ZY, et al. Multidimensional endotypes of chronic rhinosinusitis and their association with treatment outcomes[J]. Allergy, 2018, 73(7): 1459-1469. doi:10.1111/all.13411
[4] Meltzer EO, Blaiss MS, Derebery MJ, et al. Burden of allergic rhinitis: results from the pediatric allergies in america survey[J]. J Allergy Clin Immunol, 2009, 124(3 Suppl): S43-S70. doi:10.1016/j.jaci.2009.05.013
[5] 李添应, 陈德华, 林志斌, 等. 舌下含服粉尘螨滴剂治疗变应性鼻炎的疗效观察[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(10): 859-862. doi:10.3760/cma.j.issn.1673-0860.2011.10.014 LI Tianying, CHEN Dehua, LIN Zhibin, et al. Efficacy of sublingual immunotherapy with dermatophagoides farianae drops in patients with allergic rhinitis[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2011, 46(10): 859-862. doi:10.3760/cma.j.issn.1673-0860.2011.10.014
[6] 娄鸿飞, 黄嫣然, 王成硕, 等. 尘螨特异性皮下免疫治疗在变应性鼻炎患者中的远期疗效研究[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(21): 1627-1631. doi:10.13201/j.issn.1001-1781.2018.21.006 LOU Hongfei, HUANG Yanran, WANG Chengshuo, et al. Long-term efficacy of house dust mite subcutaneous immunotherapy in allergic rhinitis patients[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(21): 1627-1631. doi:10.13201/j.issn.1001-1781.2018.21.006
[7] Brozek JL, Bousquet J, Agache I, et al. Allergic Rhinitis and its Impact on Asthma(ARIA)guidelines-2016 revision[J]. J Allergy Clin Immunol, 2017, 140(4): 950-958. doi:10.1016/j.jaci.2017.03.050
[8] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国变应性鼻炎诊断和治疗指南(2022年,修订版)[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(2): 106-129. doi: 10.3760/cma.j.cn115330-20211228-00828
[9] 中华医学会耳鼻咽喉科学分会, 中华耳鼻咽喉科杂志编辑委员会. 附:慢性鼻窦炎鼻息肉临床分型分期及内窥镜鼻窦手术疗效评定标准(1997年,海口)[J].中华耳鼻咽喉科杂志, 1998(3): 6
[10] 敖天, 程雷. 慢性鼻窦炎伴鼻息肉的内型研究及其指导下的精准控制与治疗[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 7-14. doi:10.6040/j.issn.1673-3770.1.2022.005 AO Tian, CHENG Lei. An endotype study of chronic rhinosinusitis with nasal polyps and precise control and treatment under the guidance[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 7-14. doi:10.6040/j.issn.1673-3770.1.2022.005
[11] Grayson JW, Hopkins C, Mori, et al. Contemporary classification of chronic rhinosinusitis beyond polyps vs No polyps: a review[J]. JAMA Otolaryngol Head Neck Surg, 2020, 146(9): 831-838. doi:10.1001/jamaoto.2020.1453
[12] Lou HF, Meng YF, Piao YS, et al. Cellular phenotyping of chronic rhinosinusitis with nasal polyps[J]. Rhinology, 2016, 54(2): 150-159. doi:10.4193/Rhino15.271
[13] Wen WP, Liu WL, Zhang L, et al. Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy[J]. J Allergy Clin Immunol, 2012, 129(6): 1522-1528.e5. doi:10.1016/j.jaci.2012.01.079
[14] Cao PP, Wang ZC, Schleimer RP, et al. Pathophysiologic mechanisms of chronic rhinosinusitis and their roles in emerging disease endotypes[J]. Ann Allergy Asthma Immunol, 2019, 122(1): 33-40. doi:10.1016/j.anai.2018.10.014
[15] 张秩荻, 马芙蓉, 刘俊秀, 等. 鼻分泌物Ⅱ型炎症细胞因子在嗜酸粒细胞型慢性鼻窦炎伴鼻息肉中的表达及其预测价值[J].临床耳鼻咽喉头颈外科杂志, 2022, 36(12): 934939. doi: 10.13201/j.issn.2096-7993.2022.12.009
[16] 王鸿, 张罗, 周兵, 等. 慢性鼻窦炎鼻息肉与变应性因素相关性的探讨[J]. 中华耳鼻咽喉头颈外科杂志, 2005, 40(3): 168-171. doi:10.3760/j.issn: 1673-0860.2005.03.004 WANG Hong, ZHANG Luo, ZHOU Bing, et al. Relationship between allergic factors and chronic sinusitis with or without nasal polyps[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2005, 40(3): 168-171. doi:10.3760/j.issn: 1673-0860.2005.03.004
[17] De Greve G, Hellings PW, Fokkens WJ, et al. Endotype-driven treatment in chronic upper airway diseases[J]. Clin Transl Allergy, 2017, 7: 22. doi:10.1186/s13601-017-0157-8
[18] Baroody FM. Allergic rhinitis: broader disease effects and implications for management[J]. Otolaryngol Head Neck Surg, 2003, 128(5): 616-631. doi:10.1016/S0194-59980300257-2
[19] Li S, Cheng JZ, Yang JP, et al. Efficacy of posterior nasal neurectomy for allergic rhinitis combined with chronic rhinosinusitis with nasal polyps[J]. Acta Otolaryngol, 2019, 139(10): 890-894. doi:10.1080/00016489.2019.1654132
[20] Qi Y, Liu JQ, Peng SY, et al. Efficacy of selective vidian neurectomy for allergic rhinitis combined with chronic rhinosinusitis[J]. ORL J Otorhinolaryngol Relat Spec, 2021, 83(5): 327-334. doi:10.1159/000512083
[21] 齐岩, 刘俊其, 彭舒娅, 等. 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. doi:10.6040/j.issn.1673-3770.1.2018.028 QI Yan, LIU Junqi, PENG Shuya, et al. 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. doi:10.6040/j.issn.1673-3770.1.2018.028
[22] GOLDING-WOOD PH. Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis[J]. J Laryngol Otol, 1961, 75: 232-247. doi:10.1017/s0022215100057716
[23] van Gerven L, Boeckxstaens G, Hellings P. Up-date on neuro-immune mechanisms involved in allergic and non-allergic rhinitis[J]. Rhinology, 2012, 50(3): 227-235. doi:10.4193/Rhino.11.152
[24] Pavlov VA, Chavan SS, Tracey KJ. Molecular and functional neuroscience in immunity[J]. Annu Rev Immunol, 2018, 36: 783-812. doi:10.1146/annurev-immunol-042617-053158
[25] Kamimura D, Tanaka Y, Hasebe R, et al. Bidirectional communication between neural and immune systems[J]. Int Immunol, 2020, 32(11): 693-701. doi:10.1093/intimm/dxz083
[26] Konno A. Historical, pathophysiological, and therapeutic aspects of vidian neurectomy[J]. Curr Allergy Asthma Rep, 2010, 10(2): 105-112. doi:10.1007/s11882-010-0093-3
[27] 余少卿, 王向东, 徐睿, 等. 变应性鼻炎的外科手术治疗专家共识(2022, 上海)[J]. 中国耳鼻咽喉颅底外科杂志, 2022, 28(1): 7-17. doi:10.11798/j.issn.1007-1520.202201001 YU Shaoqing, WANG Xiangdong, XU Rui, et al. Expert consensus on surgical management of allergic rhinitis(2022, Shanghai)[J]. Chinese Journal of Otorhinolaryngology-skull Base Surgery, 2022, 28(1): 7-17. doi:10.11798/j.issn.1007-1520.202201001
[28] 李松, 王宗贵, 杨景朴, 等. 鼻内镜下翼管神经切断术进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 72-76. doi:10.6040/j.issn.1673-3770.0.2017.312 LI Song, WANG Zonggui, YANG Jingpu, et al. Progress of transnasal endoscopic vidian neurectomy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(1): 72-76. doi:10.6040/j.issn.1673-3770.0.2017.312
[29] 蔡智谋, 于超生, 文忠. 鼻内镜下鼻后神经切断术研究进展[J]. 中国耳鼻咽喉颅底外科杂志, 2020, 26(1): 105-108. doi:10.11798/j.issn.1007-1520.202001026 CAI Zhimou, YU Chaosheng, WEN Zhong. The research progress on the endoscopic posterior neurectomy[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2020, 26(1): 105-108. doi:10.11798/j.issn.1007-1520.202001026
[30] 张彬, 徐明, 王卢莎, 等. 经鼻内镜鼻后神经切断治疗嗜酸性粒细胞型慢性鼻窦炎的短期疗效观察[J]. 中国耳鼻咽喉头颈外科, 2022, 29(1): 45-47. doi:10.16066/j.1672-7002.2022.01.011 ZHANG Bin, XU Ming, WANG Lusha, et al. Efficacy of endoscopic posterior nasal neurectomy treating eosinophilic chronic rhinosinusitis[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2022, 29(1): 45-47. doi:10.16066/j.1672-7002.2022.01.011
[31] 李晓光, 陈建伟, 姜霞, 等. 高选择性鼻后神经丛切断术治疗中重度常年性变应性鼻炎近期疗效观察[J]. 中国耳鼻咽喉颅底外科杂志, 2022, 28(1): 18-21. doi:10.11798/j.issn.1007-1520.202221352 LI Xiaoguang, CHEN Jianwei, JIANG Xia, et al. Observation of short-term treatment effect of highly selective posterior nasal neurectomy on patients with moderate-severe perennial allergic rhinitis[J]. Chinese Journal of Otorhinolaryngology-skull Base Surgery, 2022, 28(1): 18-21. doi:10.11798/j.issn.1007-1520.202221352
[32] Dalziel K, Stein K, Round A, et al. Endoscopic sinus surgery for the excision of nasal polyps: a systematic review of safety and effectiveness[J]. Am J Rhinol, 2006, 20(5): 506-519. doi:10.2500/ajr.2006.20.2923
[33] Bachert C. Innovative therapeutic targets in chronic sinusitis with nasal polyps[J]. Braz J Otorhinolaryngol, 2016, 82(3): 251-252. doi:10.1016/j.bjorl.2016.03.001
[34] 李华斌, 冯韶燕, 程岚. 嗜酸粒细胞性慢性鼻窦炎的临床特点和治疗策略 [J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(3): 177-179. doi: 10.13201/j.issn.1001-1781.2016.03.001
[35] 王宠舒, 郭翠莲, 刘争. 内在型对慢性鼻窦炎患者临床结局的影响 [J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(5): 644-648. doi: 10.3760/cma.j.cn115330-20210509-00262
[36] 娄鸿飞, 王成硕. 慢性鼻窦炎分型研究进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 10-13. doi:10.6040/j.issn.1673-3770.1.2018.008
[37] Nishijima H, Kondo K, Toma-Hirano M, et al. Denervation of nasal mucosa induced by posterior nasal neurectomy suppresses nasal secretion, not hypersensitivity, in an allergic rhinitis rat model[J]. Lab Investig, 2016, 96(9): 981-993. doi:10.1038/labinvest.2016.72LOU Hongfei, WANG Chengshuo. Progress in classification of chronic sinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(3): 10-13. doi:10.6040/j.issn.1673-3770.1.2018.008
[38] Nishijima H, Kondo K, Toma-Hirano M, et al. Prolonged denervation induces remodeling of nasal mucosa in rat model of posterior nasal neurectomy[J]. Int Forum Allergy Rhinol, 2017, 7(7): 670-678. doi:10.1002/alr.21952
[39] Cruz AA, Popov T, Pawankar R, et al. Common characteristics of upper and lower airways in rhinitis and asthma: ARIA update, in collaboration with GA(2)LEN[J]. Allergy, 2007, 62(Suppl 84): 1-41. doi:10.1111/j.1398-9995.2007.01551.x
[40] Wheatley LM, Togias A. Clinical practice. allergic rhinitis[J]. N Engl J Med, 2015, 372(5): 456-463. doi:10.1056/NEJMcp1412282
[41] Johnstone DE, Dutton A. The value of hyposensitization therapy for bronchial asthma in children: a 14-year study[J]. Pediatrics, 1968, 42(5): 793-802.
[42] Virchow JC, Backer V, Kuna P, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial[J]. JAMA, 2016, 315(16): 1715-1725. doi:10.1001/jama.2016.3964
[43] Feng ML, Zeng XH, Li J. House dust mite subcutaneous immunotherapy in Chinese patients with allergic asthma and rhinitis[J]. J Thorac Dis, 2019, 11(8): 3616-3625. doi:10.21037/jtd.2019.06.35
[44] 艾金刚, 卿翔, 郜儒, 等. 内镜下翼管神经切断术治疗变应性鼻炎合并支气管哮喘的疗效评估[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(5): 452-457. doi: 10.3760/cma.j.cn115330-20200429-00349 AI Jingang, QING Xiang, GAO Ru, et al. Effect of endoscopic vidian neurectomy in patients with coexisting allergic rhinitis and bronchial asthma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2020, 55(5): 452-457. doi: 10.3760/cma.j.cn115330-20200429-00349
[45] Ai JG, Xie ZZ, Qing X, et al. Clinical effect of endoscopic vidian neurectomy on bronchial asthma outcomes in patients with coexisting refractory allergic rhinitis and asthma[J]. Am J Rhinol Allergy, 2018, 32(3): 139-146. doi:10.1177/1945892418764964

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A clinical efficacy analysis of vidian neurectomy in the treatment of type 2 chronic rhinosinusitis with allergic rhinitis

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