高选择性鼻后神经丛切断术治疗中重度常年性变应性鼻炎近期疗效观察  

Observation of short-term treatment effect of highly selective posterior nasal neurectomy on patients with moderate-severe perennial allergic rhinitis

作　　者：李晓光[1,2] 陈建伟[2] 姜霞[2] 姜嘉鑫[3] 姜彦 LI Xiaoguang;CHEN Jianwei;JIANG Xia;JIANG Jiaxin;JIANG Yan(Department of Otolaryngology Head and Neck Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Otolaryngology,Changyi People’s Hospital,Weifang 261300,China;Lifescience Department of Faculty of Health Science,Queen’s University,Kingston,ontario,Canada,K7L 3N6)

机构地区：[1]青岛大学附属医院耳鼻咽喉头颈外科,山东青岛266000 [2]昌邑市人民医院耳鼻咽喉科,山东潍坊261300 [3]女王大学健康科学学院生命科学系,加拿大安大略省金斯顿K7L 3N6

出　　处：《中国耳鼻咽喉颅底外科杂志》2022年第1期18-21,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：潍坊市卫健委科研项目(wfwsjk_2019_098)。

摘　　要：目的探讨鼻内镜下高选择性鼻后神经丛切断术治疗中重度常年性变应性鼻炎(AR)的方法及疗效。方法对30例经规范的药物和(或)免疫治疗1年以上疗效欠佳的中重度常年性AR患者作为观察组,实施双侧鼻内镜下高选择性鼻后神经丛切断术;选取同一时期上述疗效欠佳的30例AR患者作为对照组,继续接受药物治疗。根据中重度常年性AR的诊断和疗效评定标准对主要症状进行治疗前后VAS评分,通过积分法评估手术效果。结果术后1年进行随访评价,对照组有效6例,无效24例,总有效率20.00%;观察组有效29例,无效1例,总有效率96.7%,两组间疗效差异具有统计学意义(P<0.05);观察组鼻塞、鼻漏、喷嚏VAS评分较对照组低(P<0.05),症状较对照组改善显著。所有患者随访期间均未出现活动性鼻出血、干眼及腭部麻木等并发症。结论鼻内镜下高选择性鼻后神经丛切断术治疗中重度常年性AR短期内疗效确切,能够完全切断鼻后神经的3个主要分支及细小分支,有效避免损伤翼腭窝内容物,降低术后并发症发生率。Objective To explore the method and therapeutic effect of endoscopic highly selective posterior nasal neurecotmy for the treatment of moderate-severe perennial allergic rhinitis(AR).Methods A total of 30 patients with moderate-severe PAR refractory to routine medical therapy and immunotherapy were selected as the observation group,and endoscopic bilateral highly selective posterior nasal plexus transection was performed.At the same time,30 patients with poor curative effect were selected as the control group,and continued on their regular medicine.The main symptoms were scored by visual analogue scale(VAS),and the surgical effect was evaluated by integral method.Results All the patients were followed up for one year.Follow-up evaluation revealed that 6 cases were effective and 24 were ineffective with a total effective rate of 20.00%in the control group,and 29 cases were effective and one was ineffective with a total effective rate of 96.7%in the observation group.The difference between the two groups was statistically significant(P<0.05).The VAS scores of nasal congestion,rhinorrhea and sneezing in the observation group were lower than those in the control group(all P<0.05),and the symptoms in the observation group were relieved significantly.During the follow-up period,active epistaxis,dry eye and palate numbness occurred in none of them.Conclusions Endoscopic highly selective posterior nasal neurectomy may take effect in treating moderate-severe PAR in short time.With avoiding injury of the sphenopalatine ganglion in the complete amputation of branches of posterior nasal nerve,postoperative complications are reduced.

关 键 词：变应性鼻炎 中重度 常年性 内镜术 高选择性鼻后神经丛切断术 手术疗效 术后并发症 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]