内镜下鼻后神经切断治疗变应性鼻炎的解剖与临床疗效分析  

Endoscopic posterior nasal neurectomy for the treatment of allergic rhinitis:anatomy and analysis of clinical efficacy

作　　者：赵建辉[1] 刘剑锋[1,2] 韩军 杨大章[1] 赵宇[1] 王艺贝[1] 游芳佳[2] Zhao Jianhui;Liu Jianfeng;Han Jun;Yang Dazhang;Zhao Yu;Wang Yibei;You Fangjia(Department of Otorhinolaryngology,China-Japan Friendship Hospital,Beijing 100029,China;China Japan Friendship Clinical College,Beijing University of Traditional Chinese Medicine,Beijing 100029,China)

机构地区：[1]中日友好医院耳鼻咽喉科,北京100029 [2]北京中医药大学中日友好临床学院,北京100029

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第3期295-300,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(81870699);北京市自然科学基金(7212090)。

摘　　要：目的:从解剖着手,提出完全切断鼻后神经治疗变应性鼻炎的方法——蝶腭神经血管束离断技术,并探讨该技术在临床应用中的疗效。方法:于中日友好医院耳鼻喉解剖实验室解剖2例(4侧)新鲜尸头,采用内镜经鼻经中鼻道入路完成蝶腭神经血管束切断术,观测手术入路中相关干性颅面骨的结构。选取于2019年2月1日至2021年6月10日就诊于中日友好医院耳鼻咽喉科的变应性鼻炎患者12例,采用完全离断蝶腭神经血管束技术完成鼻后神经切断术,术后随访1年。随访过程中2例患者失访,完成随访的10例患者中男4例,女6例,年龄29~69岁。应用症状视觉模拟量表(VAS)及鼻结膜炎生活质量调查问卷(rhinoconjunctivitis quality of life questionnaire,RQLQ)评估手术疗效。采用SPSS 25.0软件对数据进行统计学分析。结果:于解剖过程中获得该入路的重要解剖标志,如筛嵴、蝶腭孔/切迹、腭骨眶突和腭骨蝶突。10例患者术后鼻部、眼部、咽部、耳部、全身症状及总VAS评分均明显低于术前,差异有统计学意义[鼻部(2.50±1.70)分比(6.47±2.17)分,眼部(1.15±0.89)分比(3.60±2.57)分,咽部(1.30±1.36)分比(4.25±3.64)分,耳部(1.10±1.03)分比(2.67±2.00)分,全身(1.08±1.24)分比(3.60±1.17)分,总分(7.13±4.31)分比(20.58±9.05)分,P值均<0.05]。RQLQ评分的睡眠、鼻部、眼部、实际问题、情感、活动6个项目得分和总分均低于术前,差异有统计学意义[睡眠(0.80±0.69)分比(2.93±1.33)分,鼻部(1.38±1.18)分比(3.93±1.50)分,眼部(0.58±0.66)分比(1.80±1.25)分,实际问题(1.10±1.22)分比(3.03±1.84)分,情感(1.00±1.81)分比(2.58±2.00)分,活动(2.77±2.93)分比(6.00±1.85)分,总分(8.99±8.92)分比(22.42±8.69)分,P值均<0.05];非鼻/眼症状得分较术前无明显差异[(1.37±1.60)分比(2.16±1.12)分,P=0.166]。除2例患者术后短期出现腭部麻木感外,无其他手术并发症发生。结论:采用蝶腭神经血管束离断技�Objective To propose total posterior nasal neurectomy with transection of sphenopalatine neurovascular bundle from anatomy for the treatment of allergic rhinitis,and to explore its clinical application.Methods Two fresh cadaveric heads(4 sides)were dissected through endoscopic transnasal middle meatus approach at Otorhinolaryngology Anatomy Laboratory of China-Japan Friendship Hospital.The structures of the craniofacial bone related to the surgical approach were observed.Twelve patients with allergic rhinitis who treated in Department of Otorhinolaryngology,China-Japan Friendship Hospital from Feb.12019 to Jun.102021 were selected.All the patients were treated by posterior nasal neurotomy with the technique of complete transection of sphenopalatine neurovascular bundle and followed up for 1 year after sugery.During the follow-up,2 patients were lost.The other 10 patients included 4 males and 6 females,aging from 29 to 69 years.Visual Analogue Scale(VAS)and Rhinoconjunctivitis Quality of Life Questionnaire(RQLQ)were used to evaluate the effect of the surgery.SPSS 25.0 software was used for statistical analysis.Results Important anatomic landmarks of transnasal middle meatus approach were obtained during anatomy,such as ethmoid crest,sphenopalatine foramen/notch,palatine orbital process and sphenopalatine process.The postoperative VAS scores of nose,eye,pharynx,ear and whole body and total VAS scores were significantly lower than those before operation,with statistically significant difference(nose 2.50±1.70 vs 6.47±2.17,eyes 1.15±0.89 vs 3.60±2.57,pharynx 1.30±1.36 vs 4.25±3.64,ear 1.10±1.03 vs 2.67±2.00,whole body 1.08±1.24 vs 3.60±1.17,total 7.13±4.31 vs 20.58±9.05,all P<0.05).The postoperative RQLQ scores of sleep,nose,eyes,practical problems,emotion,activity and the total RQLQ scores of patients were significantly lower than those before operation,with statistically significant difference(sleep 0.80±0.69 vs 2.93±1.33,nose 1.38±1.18 vs 3.93±1.50,eyes 0.58±0.66 vs 1.80±1.25,practical problems 1

关 键 词：鼻后神经 神经切断 变应性鼻炎 蝶腭孔/切迹 筛嵴 蝶突 眶突 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]