鼻内镜下高选择性翼管神经切断术治疗变应性鼻炎

Endoscopic highly selective vidian neurotomy for the treatment of allergic rhinitis

目的分析鼻内镜下高选择性翼管神经切断术对中重度持续变应性鼻炎(AR)的疗效和安全性。方法选取2018年1月—2019年9月华中科技大学协和深圳医院就诊的伴中重度持续性AR的鼻中隔偏曲患者60例为研究对象,依据随机数字表法分成对照组(26例)和治疗组(34例)。对照组患者采取鼻内镜鼻中隔矫正术治疗鼻中隔偏曲,治疗组在鼻中隔矫正基础上开展高选择性翼管神经切断,包含鼻后神经及翼管神经咽支切断术,术后1、3、6个月对患者进行定期随访,分别对两组患者手术前后鼻炎用药评分(TRMS)、视觉模拟量表(VAS)、鼻结膜炎生活质量量表(RQLQ)评分进行评估,并记录患者局部、全身不良反应出现情况。结果随访6个月,对研究终止时随访成功且临床资料完整的46例患者进行分析,其中治疗组26例,对照组20例。两组患者术前TRMS、VAS及RQLQ评分比较差异无统计学意义(P>0.05);两组患者术后1、3、6个月VAS及RQLQ评分与治疗前比较差异具有统计学意义(P<0.05),且治疗组术后1、3、6个月VAS及RQLQ评分评分低于对照组,术后3、6个月TRMS评分低于对照组(P<0.05)。两组患者术后1个月的TRMS评分对比差异无统计学意义(P>0.05)。对照组手术前后TRMS评分对比差异无统计学意义(P>0.05),治疗组术后3、6个月TRMS评分低于术前(P<0.05)。治疗组并发症发生和对照组比较差异无统计学意义(P>0.05)。结论鼻内镜下高选择性翼管神经切断术是治疗中重度持续性AR一种安全、有效的手术方式。

Objective To analyze the clinical effect and safety of endoscopic highly selective vidian neurotomy on the treatment of moderate to severe persistent allergic rhinitis(PAR).Methods Sixty patients suffering from nasal septal deviation combined with moderate to severe PAR admitted to Huazhong University of Science and Technology Union Shenzhen Hospital from Jan 2018 to Sept 2019 were selected.All the patients were randomly divided into control group(n=26)and treatment group(n=34).The patients in the control group received endoscopic nasal septoplasty and those in the treatment group received endoscopic nasal septoplasty combined with highly selective vidian neurotomy including posterior nasal neurotomy and pharyngeal branch of vidian neurotomy.Total rhinitis medication scores(TRMS),visual analogue scale(VAS)and rhinoconjunctivitis quality of life questionnaire(RQLQ)scores as well as incidences of local and systemic adverse reactions between the two groups were compared at the timepoints before treatment,1 month,3 months,and 6 months after treatment.Results Forty-six cases were followed up for 6 months postoperatively and had complete general data,including 26 in the treatment group and 20 in the control group.Before treatment,the differences of TRMS,VAS and RQLQ scores between the two groups were statistically insignificant(all P>0.05).One month,3 and 6 months after treatment,the differences of VAS and RQLQ scores between the two groups were statistically significant(all P<0.05),and VAS and RQLQ scores of the treatment group were lower than those of the control.Three and 6 months after treatment,TRMS scores of the treatment group were lower than those of the control group(all P<0.05),while the difference of TRMS score in one month after treatment was statistically insignificant(P>0.05).The differences of pre-and postoperative TRMS in the control group were statistically insignificant(P>0.05),while the TRMS scores in 3 months and 6 months after treatment were lower than those before treatment in the treatment group(P<0.05).The difference of complication rate between the two groups was statistically insignificant(P>0.05).Conclusion The endoscopic highly selective vidian neurotomy is safe and effective for the treatment of moderate to severe PAR.