鼻内镜下选择性翼管神经切断术治疗慢性鼻窦炎合并变应性鼻炎的临床效果

Clinical effect of selective pterygoid canal neurotomy under nasal endoscope on chronic sinusitis complicated by allergic rhinitis

目的探讨鼻内镜下选择性翼管神经切断术治疗伴有变应性鼻炎(AR)的慢性鼻窦炎患者的临床效果。方法选取2018年10月至2021年10月在焦作市人民医院就诊的80例慢性鼻窦炎合并AR患者为研究对象。将2018年10月至2019年12月来焦作市人民医院就诊的患者32例纳入对照组,将2020年1月至2021年10月来我院就诊患者48例纳入观察组。对照组给予常规手术及保守治疗,观察组在常规手术方案基础上,开展选择性翼管神经切断术。术后随访6个月,对比两组临床疗效,于手术前(T0)、术后6个月(T1)时对比两组鼻腔功能[视觉模拟评分(VAS)]、鼻黏膜功能[Lund—Kennedy内镜黏膜形态评分、鼻腔阻力(NR),鼻黏膜纤毛传输时间(MTT)、鼻黏膜纤毛输送率(MTR)]及术后并发症发生情况。结果治疗后,观察组治疗总有效率(95.83%,46/48)高于对照组(78.13%,25/32),差异有统计学意义(P<0.05)。T0时,两组外形、通气VAS评分、嗅觉功能评分比较差异未见统计学意义(P>0.05)。与T0时比较,T1时,两组外形、通气VAS评分、嗅觉功能评分均降低(P<0.05);且观察组水平显著低于对照组(P<0.05)。T0时,两组Lund—Kennedy评分、NR、MTT、MTR比较,差异未见统计学意义(P>0.05)。与T0时比较,T1时两组Lund-Kennedy评分、NR、MTT均降低,观察组低于对照组(P<0.05),MTR均升高,观察组高于对照组(P<0.05)。观察组并发症总发生率(6.25%,3/48)低于对照组(25.00%,8/32),差异有统计学意义(P<0.05)。结论针对慢性鼻窦炎伴AR患者,采取鼻内镜下同期鼻中隔矫正术治疗,可提高临床疗效,改善患者鼻腔功能及嗅觉功能,减少术后并发症。

Objective To investigate the clinical effect of selective pterygoid canal neurotomy under nasal endoscope on chronic sinusitis with allergic rhinitis(AR).Methods Eighty patients with chronic sinusitis complicated with AR who were treated in Jiaozuo People’s Hospital from October 2018 to October 2021 were selected as the study subjects.Thirty-two patients who visited Jiaozuo People’s Hospital from October 2018 to December 2019 were included in the control group,and 48 patients who came to our hospital from January 2020 to October 2021 were included in the observation group.The control group was given routine operation and conservative treatment,and the observation group was given selective pterygoid canal neurotomy on the basis of routine operation.The patients were followed up for6 months after operation,and the clinical effects of the two groups were compared.The nasal function[visual analog score(VAS)],nasal mucosal function[Lund Kennedy endoscopic mucosal morphology score,nasal resistance(NR),nasal mucosal cilia transport time(MTT),nasal mucosal cilia transport rate(MTR)]and postoperative complications were compared between the two groups before operation(T0)and 6 months after operation(T1).Results After treatment,the total effective rate of the observation group(95.83%,46/48)was higher than that of the control group(78.13%,25/32),and the difference was significant(P<0.05).At T0,there was no significant difference between the two groups in appearance,ventilation VAS score and olfactory function score(P>0.05).Compared with T0,the appearance,ventilation VAS score and olfactory function score of the two groups decreased at T1(P<0.05),and the level in the observation group was significantly lower than that in the control group(P<0.05).At T0,there was no significant difference in Lund Kennedy score,NR,MTT and MTR between the two groups(P>0.05).Compared with T0,the Lund Kennedy score,NR and MTT of the two groups decreased at T1,and the MTR of the observation group was higher than that of the control group(P<0.05).The total incidence of complications in the observation group(6.25%,3/48)was lower than that in the control group(25.00%,8/32),and the difference was significant(P<0.05).Conclusions For patients with chronic sinusitis and AR,nasal septum correction under nasal endoscope can improve the clinical efficacy,improve the nasal function and olfactory function of patients,and reduce postoperative complications.