内镜下翼管神经切断术治疗变应性鼻炎合并支气管哮喘的疗效评估  

Effect of endoscopic vidian neurectomy in patients with coexisting allergic rhinitis and bronchial asthma

作　　者：艾金刚[1] 卿翔 郜儒[1] 刘鸿慧[1] 谢祚仲[1] 李维[1] 王天生[1] 谭国林[1] Ai Jingang;Qing Xiang;Gao Ru;Liu Honghui;Xie Zuozhong;Li Wei;Wang Tiansheng;Tan Guolin(Department of Otorhinolaryngology Head and Neck Surgery,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院耳鼻咽喉头颈外科,长沙410013

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第5期452-457,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(81870708、81902785);湖南省重点研发计划(2017SK2043)。

摘　　要：目的评估内镜下双侧翼管神经切断术对难治性变应性鼻炎(AR)合并支气管哮喘患者的临床疗效,并分析其影响因素。方法回顾性分析2008年5月1日至2013年4月30日于中南大学湘雅三医院耳鼻咽喉头颈外科接受内镜下双侧翼管神经切断术(手术组,70例)和药物保守治疗(药物组,39例)的109例中重度持续性难治性AR合并哮喘的患者临床资料,其中男47例,女62例,年龄(32.7±6.8)岁。其中有95例患者完整随访3年以上。比较手术组和药物组在治疗后6个月、1年及3年时的鼻结膜炎生活质量问卷(RQLQ)评分、视觉模拟量表(VAS)评分、哮喘生活质量问卷(AQLQ)评分、总哮喘症状评分(TASS)、一秒钟用力呼气量(FEV1)和药物评分等数据的变化。采用多因素分析方法确定翼管神经切断术后影响改善疗效的因素。结果随访期间手术组RQLQ评分显著低于术前[术前、术后6个月、1年、3年分别为(2.39±0.61)分(±s,后同)、(0.81±0.43)分、(0.89±0.32)分、(1.06±0.24)分,P值均<0.001],VAS评分亦显著低于术前[术前、术后6个月、1年、3年分别为(7.13±1.04)分、(2.52±1.47)分、(2.70±1.42)分、(2.85±1.64)分,P值均<0.05],且RQLQ和VAS评分均显著低于同期药物组。手术组术后AQLQ评分显著高于术前[术前、术后6个月、1年、3年分别为(3.78±0.81)分、(4.99±0.45)分、(4.75±0.71)分、(4.62±0.64)分,P值均<0.05],且显著高于同期药物组。手术组术后TASS评分及FEV1较术前没有显著变化。手术组术后AR相关药物评分显著降低[术前、术后6个月、1年、3年分别为(0.99±0.21)分、(0.37±0.12)分、(0.39±0.26)分、(0.45±0.11)分,P值均<0.05],哮喘相关药物评分亦显著降低[术前、术后6个月、1年、3年分别为(1.27±0.31)分、(0.82±0.29)分、(0.85±0.23)分、(0.96±0.19)分,P值均<0.05],且所有药物评分均显著低于同期药物组。随访结束时,手术组患者AR和哮喘的治疗有效率分别为90.6%(58/64)和45Objective To evaluate the clinical significance of endoscopic vidian neurectomy(EVN)on outcomes in patients with coexisting refractory allergic rhinitis(AR)and bronchial asthma,and to analyze its influence factor.Methods Clinical data of 109 patients with moderate to severe persistent intractable AR and bronchial asthma who were allocated to the bilateral EVN group(surgery group,70 cases)or conservative medication group(drug group,39 cases)from 1 May 2008 to 30 April 2013 in Department of Otorhinolaryngology Head and Neck Surgery,Third Xiangya Hospital,Central South University were retrospectively analyzed,including 47 cases of male and 62 cases of female aged(32.7±6.8)years.Ninety-five patients were followed up for at least 3 years.The Rhinoconjunctivitis Quality of Life Questionnaire(RQLQ),Visual Analog Scale(VAS),Asthma Quality of Life Questionnaire(AQLQ),Total Asthma Symptom Score(TASS),forced expiratory volume in 1 second of predicted(FEV1)and medication scores were evaluated at 6 months,1 year and 3 years after undergoing the initial treatments in the two groups.Multiple factor analysis was used to determine the factors influencing the improvement after EVN.Results Postoperative scores of RQLQ were significantly lower than preoperative scores during follow-up in surgery group(the preoperative score and postoperative score at 6 months,1 year,3 years after operation was 2.39±0.61(±s),0.81±0.43,0.89±0.32,1.06±0.24,respectively,all P<0.001).Postoperative scores of VAS were significantly lower than preoperative scores during follow-up in surgery group(the preoperative score and postoperative score at 6 months,1 year,3 years after operation was 7.13±1.04,2.52±1.47,2.70±1.42,2.85±1.64,respectively,all P<0.05).Scores of RQLQ and VAS in surgery group were significantly lower than those of drug group.Postoperative scores of AQLQ were significantly higher than preoperative scores during follow-up in surgery group(the preoperative score and postoperative score at 6 months,1 year,3 years after operation was 3.

关 键 词：鼻炎 变应性 支气管哮喘 翼管神经切断术 

分 类 号：R76[医药卫生—耳鼻咽喉科] R5[医药卫生—临床医学]