鼻内镜下高选择性翼管神经切断术治疗难治性鼻黏膜高反应性疾病的临床研究  

Clinical study of endoscopic highly selective vidian neurotomy in the treatment of refractory nasal mucosal hyperreactive rhinopathy

作　　者：于青青[1] 萧建新[1] 张超[1] 施思斯[1] 白晶 唐隽[1] YU Qingqing;XIAO Jianxin;ZHANG Chao;SHI Sisi;BAI Jing;TANG Jun(Department of Otolaryngology Head and Neck Surgery,the First People’s Hospital of Foshan,Foshan 528000,China)

机构地区：[1]广东省佛山市第一人民医院耳鼻咽喉头颈外科,广东佛山528000

出　　处：《中国耳鼻咽喉颅底外科杂志》2023年第2期96-100,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：广东省医学科学技术研究基金项目(A2022442)。

摘　　要：目的分析鼻内镜下高选择性翼管神经切断术治疗难治性鼻黏膜高反应性疾病的有效性及安全性。方法收集2019年1月—2021年3月门诊就诊的难治性变应性鼻炎(AR)及血管运动性鼻炎(VMR)并同意行高选择性翼管神经切断术的患者为研究对象,进行鼻内镜下双侧高选择性翼管神经切断术,术后进行定期随访,分别记录患者术前及术后1、3、6、12个月时鼻眼部、哮喘症状评分、鼻结膜炎生活质量评分、用药评分的变化,并记录术后并发症的发生情况。结果随访结束时临床资料完整的患者共35例,术后1、3、6、12个月时鼻部、眼部症状总评分、哮喘总评分、症状总评分、生活质量评分、用药评分均较术前降低,差异均具有统计学意义(P均<0.001);1例患者术后出现单侧鼻腔出血,另1例患者术后出现短暂的头痛,所有患者随访期间均未出现眼干、眼异物感、上腭麻木感、萎缩性鼻炎等并发症。结论鼻内镜下高选择性翼管神经切断术可以有效改善顽固性鼻黏膜高分泌及高敏感状态,提高患者生活质量,同时避免了翼管神经切断术后干眼的缺点,并发症少,是治疗难治性鼻黏膜高反应性疾病的一种安全有效的手段。Objective To investigate the clinical efficacy and safety of endoscopic highly selective vidian neurotomy in the treatment of refractory nasal mucosal hyperreactive rhinopathy.Methods Patients diagnosed with refractory allergic rhinitis(AR)and vasomotor rhinitis(VMR)and agreed to receive highly selective vidian neurotomy in our outpatient department from January 2019 to March 2021 were selected.All the patients received bilateral endoscopic highly selective vidian neurotomy and were followed up for one year.Symptom scores,quality-of-life scores as well as drug scores were evaluated before and 1 month,3 months,6 months and 12 months after surgery respectively.Meanwhile,adverse reactions were recorded.Results A total of 35 cases had complete follow-up data.Their total symptom scores,total nasal symptom scores,total eye symptom scores and total asthma symptom scores 1 month,3 months,6 months and 12 months after surgery were all significantly reduced compared with preoperative values(all P<0.001).The quality-of-life scores and drug scores were significantly improved 1 month,3 months,6 months and 12 months after surgery compared with preoperative levels(all P<0.001).One patient had unilateral nasal bleeding after surgery,and another had transient postoperative headache.However,no patients had complications such as dry eye,ocular foreign body sensation,upper palate numbness,or atrophic rhinitis during follow-up.Conclusion Endoscopic highly selective vidian neurotomy,which can effectively improve the high secretion and high sensitivity state of refractory rhinitis,improve the quality of life of patients,and avoid the disadvantages of postoperative dry eyes,is an effective and safe means for the treatment of refractory nasal mucosal hyperreactive rhinopathy.

关 键 词：变应性鼻炎 血管运动性鼻炎 鼻黏膜高反应性疾病 翼管神经切断 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]