鼻腔低温等离子消融术对持续性变应性鼻炎的近期疗效观察  

Nasal coblation plasma surgery for the treatment of persistent allergic rhinitis： an evaluation of short-term outcomes

作　　者：李佩忠[1,2] 顾东升[1] 陆美萍[2] 李玉瑾[1] 沈艳[2] 程雷[3] 

机构地区：[1]南京医科大学附属淮安第一医院耳鼻咽喉科, 江苏223300 [2]南京医科大学第一附属医院耳鼻咽喉科 [3]南京医科大学国际变态反应研究中心

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第11期891-894,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 观察鼻腔低温等离子消融术对持续性变应性鼻炎（allergic rhinitis,AR）的治疗效果.方法 纳入100例尘螨致敏的中-重度持续性AR患者为研究对象,其中男68例,女32例；年龄16 ～62岁,平均36.3岁.应用CoblatorⅡ型低温等离子治疗仪行双侧下鼻甲和鼻丘部位组织消融,手术前和手术后3个月采用视觉模拟量表（visual analogue scale,VAS）对患者鼻部总体症状进行评分,并且行鼻激发试验（nasal provocation test,NPT）、鼻阻力测量和T＆T嗅觉测试,评价近期疗效.使用SPSS 19.0软件进行统计学分析.结果 ①术前鼻部总体症状VAS评分平均（x-±s,下同）为（7.0±2.0）分,术后3个月降为（2.5±1.5）分,差异有统计学意义（t =18.00,P=0.0001）.②所有患者术前屋尘螨NPT均为阳性,术后3个月88例（88.0％）患者转为阴性,12例（12.0％）仍为阳性.③术前鼻腔总阻力为（0.772±0.224） kPa·s·L-1^,术后3个月降为（0.221±0.112）kPa·s·L^-1,差异有统计学意义（t=22.00,P=0.0001）.④术前31例（31.0％）患者嗅觉减退（轻度22例、中度9例）,术后3个月13例（13.0％）患者仍有嗅觉减退（轻度7例、中度6例）,差异有统计学意义（x2=10.44,P=0.005）.结论 中-重度持续性AR行鼻腔低温等离子消融术可获得良好的近期疗效,对患者的鼻部症状、鼻黏膜高反应性以及鼻腔通气和嗅觉功能有明显改善作用,但远期疗效有待进一步观察.Objective To evaluate the therapeutic effect of nasal coblation plasma surgery for the treatment of persistent allergic rhinitis （PAR）.Methods One hundred patients with mite-sensitized moderate to severe PAR who underwent nasal coblation plasma surgery （inferior turbinoplasty plus nasal agger ablation） were enrolled in this study.There were 68 male and 32 female patients aged 16 to 62 years （mean,36.3 years）.The visual analogue scale （VAS） for global rhinitis symptoms,nasal provocation test （NPT）,anterior rhinomanometry,and T＆T olfactometry were used to assess the short-term outcomes,preoperatively and postoperatively at the end of three months after surgical procedure.SPSS19.0 software was applied for statistical analysis.Results At three months after treatment,the total nasal symptom VAS scores significantly decreased from 7.0 ± 2.0 to 2.5 ± 1.5 （x-± s; t =18.00,P =0.0001）.All patients were allergic to house dust mites with positive NPT before treatment.At three months from the coblation intervention,88.0% of the patients changed from positive NPT to negative,while 12.0% remained as positive.There was a significant reduction in total nasal resistance,which diminished from 0.772 ± 0.224 to 0.221 ±0.112 kPa · s · L-1 after treatment （t =22.00,P =0.0001）.Preoperative olfactory tests showed hyposmia in 31.0% of the patients,with 22 cases for slight and 9 cases for moderate disorder.Three months after treatment,13.0% were diagnosed as hyposmic,with 7 cases for slight and 6 cases for moderate disorder （x2 =10.44,P =0.005）.Conclusion Nasal coblation plasma surgery provides favorable shortterm outcomes in terms of remarkable improvement in nasal symptoms,hyperreactivity of nasal mucosa,nasal flow and olfactory function in patients with moderate to severe PAR,but long-term effect needed further observation.

关 键 词：鼻炎 变应性 常年性 消融技术 治疗结果 鼻激发试验 鼻腔测压 嗅觉 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]