山东大学耳鼻喉眼学报 ›› 2017, Vol. 31 ›› Issue (3): 18-21.doi: 10.6040/j.issn.1673-3770.1.2017.020

• 变应性鼻结膜炎防治进展·专题笔谈 • 上一篇    下一篇

难治性变应性鼻炎的外科治疗

刘怀涛1,马瑞霞1,程雷2,3,4   

  1. 1.宁夏医科大学总医院耳鼻咽喉头颈外科, 宁夏 银川 750004;
    2.南京医科大学第一附属医院 江苏省人民医院耳鼻咽喉科;
    3.南京医科大学国际变态反应研究中心;
    4.江苏省临床医学研究院过敏与自身免疫性疾病研究所, 江苏 南京 210029
  • 收稿日期:2017-06-10 出版日期:2017-06-16 发布日期:2017-06-16
  • 通讯作者: 刘怀涛. E-mail:huaitaol@sina.com

Surgical treatment of refractory allergic rhinitis.

LIU Huaitao1, MA Ruixia1, CHENG Lei2,3,4   

  1. 1. Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China;2. Department of Otorhinolaryngology, Jiangsu Province Hospital, The First Affiliated Hospital, Nanjing Medical University;3. International Centre for Allergy Research, Nanjing Medical University;4. The Institute of Allergy and Autoimmune Diseases, Jiangsu Clinical Medicine Research Institution, Nanjing 210029, Jiangsu, China
  • Received:2017-06-10 Online:2017-06-16 Published:2017-06-16

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1331

被引次数

5

摘要： 多年来,一些临床医师一直在尝试外科干预作为补充手段来治疗难治性变应性鼻炎,主要从两个方面入手:一是纠正鼻腔异常的结构,包括鼻中隔矫正术、各种下鼻甲减容手术等;另一方面是降低鼻腔黏膜对各种异常刺激的敏感性,最主要的是神经阻断手术,包括岩翼管神经切断术及鼻后神经切断术等。通过文献复习并结合临床指南以及我们的实践经验,对难治性变应性鼻炎的一些外科治疗方法进行介绍。

关键词: 变应性鼻炎, 外科治疗

Abstract: Some clinicians have been using surgical intervention as an alternative routine to treat refractory allergic rhinitis with two approaches: one to correct abnormal structures of the nasal cavity, such as septoplasty and inferior turbinate volume reduction surgery; the another approach is intended to reduce the hypersensitivity of the nasal mucosa to abnormal stimulation, such as neurectomy mainly includes vidian neurectomy and posterior nasal neurectomy. Based on the literature review and the clinical guidelines, some surgical treatment methods for refractory allergic rhinitis are introduced in this article.

Key words: Allergic rhinitis, Surgical procedures, operative

中图分类号: 

  • R765.4
[1] 董震. 鼻黏膜高反应性疾病[M] // 耳鼻咽喉头颈外科学. 北京: 人民卫生出版社, 2010: 288-297.
[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. 变应性鼻炎诊断和治疗指南(2015年,天津)[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(1):6-24. Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of allergic rhinitis[J]. Chin J Otorhinolaryngol Head Neck Surg, 2016, 51(1):6-24.
[3] Hellings PW, Fokkens WJ, Akdis C, et al. Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today?[J]. Allergy, 2013, 68(1):1-7.
[4] Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma(ARIA)2008 update(in collaboration with the World Health Organization, GA2LEN and AllerGen)[J]. Allergy, 2008, 63 Suppl 86:8-160.
[5] Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: Allergic rhinitis[J]. Otolaryngol Head Neck Surg, 2015, 152(1 Suppl):S1-43.
[6] Bousquet PJ, Demoly P, Devillier P, et al. Impact of allergic rhinitis symptoms on quality of life in primary care[J]. Int Arch Allergy Immunol, 2013, 160(4):393-400.
[7] Passàli D, Passàli FM, Damiani V, et al. Treatment of inferior turbinate hypertrophy: a randomized clinical trial[J]. Ann Otol Rhinol Laryngol, 2003, 112(8):683-688.
[8] Cassano M, Russo L, Del Giudice AM, et al. Cytologic alterations in nasal mucosa after sphenopalatine artery ligation in patients with vasomotor rhinitis[J]. Am J Rhinol Allergy, 2012, 26(1):49-54.
[9] Chen YL, Tan CT, Huang HM. Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients withperennial allergic rhinitis[J]. Laryngoscope, 2008, 118(7):1270-1274.
[10] Lee JY. Efficacy of intra- and extraturbinal microdebrider turbinoplasty in perennial allergic rhinitis[J]. Laryngoscope, 2013, 123(12):2945-2949.
[11] Galan Cortes JG, Perez Casas A, Suarez Nieto C. Autonomic microganglia of the nasal mucosa and their relation to vasomotor rhinitis[J]. Clin Otolaryngol Allied Sci, 1986, 11(5):373-382.
[12] Golding-Wood PH. Pathology and surgery of chronic vasomotor rhinitis[J]. J Laryngol Otol, 1962, 76:969-977.
[13] Chandra R. Transpalatal approach for vidian neurectomy[J]. Arch Otolaryngol, 1969, 89(3):542-545.
[14] Kamel R, Zaher S. Endoscopic transnasal vidian neurectomy[J]. Laryngoscope, 1991, 101(3):316-319.
[15] Jang TY, Kim YH, Shin SH. Long-term effectiveness and safety of endoscopic vidian neurectomy for the treatment of intractable rhinitis[J]. Clin Exp Otorhinolaryngol, 2010, 3(4):212-216.
[16] 谭国林, 马艳红, 刘更盛, 等. 鼻内镜下翼管神经切断术治疗中-重度持续性变应性鼻炎的远期临床疗效[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(6):449-454. TAN Guolin, MA Yanhong, LIU Gengsheng, et al. Therapeutic effect of endoscopic vidian neurectomy on moderate-severe persistent allergic rhinitis[J]. Chin J Otorhinolaryngol Head Neck Surg, 2011, 46(6):449-454.
[17] Marshak T, Yun WK, Hazout C, et al. A systematic review of the evidence base for vidian neurectomy in managing rhinitis[J]. J Laryngol Otol, 2016, 130 Suppl 4:S7-S28.
[18] Konno A. Historical, pathophysiological, and therapeutic aspects of vidian neurectomy[J]. Curr Allergy Asthma Rep, 2010, 10(2):105-112.
[19] Kanaya T, Kikawada T. Endoscopic posterior neurectomy: an altenative to Vidian neurectomy[J]. Clin Exp Allergy Rev, 2009, 9(1):24-27.
[20] Kikawada T. Endoscopic posterior nasal neurectomy: an alternative to vidian neurectomy[J]. Oper Tech Otolaryngol, 2007, 18(2):297-301.
[21] Ikeda K, Oshima T, Suzuki M, et al. Functional inferior turbinosurgery(FITS)for the treatment of resistant chronic rhinitis[J]. Acta Otolaryngol, 2006, 126(7):739-745.
[22] 刘怀涛, 马瑞霞, 闫小会, 等. 鼻后神经切断术治疗高反应性鼻病的临床观察[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(12):1032-1034. LIU Huaitao, MA Ruixia, YAN Xiaohui, et al. Clinical study on resection of the posterior nasal nerve for hyperreactive rhinopathy[J]. Chin J Otorhinolaryngol Head Neck Surg, 2013, 48(12):1032-1034.
[23] Ikeda K, Yokoi H, Saito T, et al. Effect of resection of the posterior nasal nerve on functional and morphological changes in the inferior turbinate mucosa[J]. Acta Otolaryngol, 2008, 128(12):1337-1341.
[24] Ogawa T, Takeno S, Ishino T, et al. Submucous turbinectomy combined with posterior nasal neurectomy in the management of severe allergic rhinitis: clinical outcomes and local cytokine changes[J]. Auris Nasus Larynx, 2007, 34(3):319-326.
[25] 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 Invest, 2016, 96(9):981-993.
[26] Okubo K, Kurono Y, Ichimura K, et al. Japanese guidelines for allergic rhinitis 2017[J]. Allergol Int, 2017, 66(2):205-219.
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