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

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

目的 探讨翼管神经切断术(vidian neurectomy,VN)治疗2型慢性鼻窦炎伴过敏性鼻炎(chronic rhinosinusitis with allergic rhinitis,CRSwAR)的临床疗效及价值。方法 回顾性研究接受内镜鼻窦手术(endoscopic sinus surgery,ESS)联合VN治疗的47例中重度2型CRSwAR患者,通过鼻腔鼻窦结局测试-22条(sinonasal outcome test-22,SNOT-22)问卷、过敏相关血清学检查(外周血嗜酸性粒细胞、血清总免疫球蛋白E、血清过敏原等)、电子鼻咽镜(Lund-Kennedy评分法)和鼻窦CT(Lund-Mackay评分法)评估患者术前及术后1年的病情严重程度及病变范围。结果 患者术前SNOT-22评分为[38.00(23.00,54.25)]分,术后1年评分为[10.00(5.00,18.50)]分,较术前降低,差异有统计学意义(P<0.001)。其中鼻塞、打喷嚏、流清涕、流脓涕、嗅觉减退的临床症状均有改善且评分低于治疗前,差异有统计学意义(P<0.001)。术前Lund-Kennedy评分、Lund-Mackay评分分别为[9.00(6.75,12.00)]分、[15.50(10.75,22.00)]分,术后1年评分分别为[3.00(2.00,4.00)]、[3.50(1.00,6.50)]分,差异均有统计学意义(P<0.001)。术后1个月出现眼干者有18例(38.30%),出现上腭麻木者有2例(4.26%),随访1年除2例患者仍有眼干外,余患者眼干、上腭麻木症状基本消失,无颅、眼眶等严重并发症发生。2型CRSwAR患者术后1年治疗总有效率为89.36%。外周血嗜酸性粒细胞、血清总免疫球蛋白E、血清过敏原等指标治疗前后改变差异无统计学意义(P=0.130,P=0.184,P=0.763)。结论 ESS联合VN是治疗中重度2型CRSwAR的安全、有效的手段,能明显改善鼻塞、流涕、打喷嚏、嗅觉减退等症状,且无严重并发症发生。

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.