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后鼻神经切除术治疗变应性鼻炎合并慢性鼻-鼻窦炎伴鼻息肉的疗效

Efficacy of posterior nasal neurectomy for allergic rhinitis combined with chronic rhinosinusitis with nasal polyps.

作者信息

Li Song, Cheng Jinzhang, Yang Jingpu, Zhao Yin, Zhu Zhiling, Zhao Chang, Wang Zonggui

机构信息

Department of Otorhinolaryngology-Head and Neck Surgery, Second Hospital of Jilin University , Changchun , Jilin , China.

Adelaide ENT Surgery, The University of Adelaide , Adelaide , SA , Australia.

出版信息

Acta Otolaryngol. 2019 Oct;139(10):890-894. doi: 10.1080/00016489.2019.1654132. Epub 2019 Aug 27.

Abstract

Allergic rhinitis combined with chronic rhinosinusitis with nasal polyps (ARwCRSwNP) is very common clinically. Conventionally, the treatment for these patients is surgical method for CRSwNP followed by treatment with a nasal steroid spray or other antiallergic drugs to control AR. In recent years, some rhinologists introduced vidian neurectomy (VN) or posterior nasal neurectomy (PNN) into endoscopy to treat refractory AR and reported an encouraging outcome. Furthermore, we explore the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP. To investigate the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP. Eighty-five patients with ARwCRSwNP who were admitted to our hospital from November 2016 to July 2018 were enrolled in two groups. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN; group B underwent conventional FESS alone. VAS, RQLQ, SNOT-22 and postoperative nasal endoscopy were used to evaluate the improvement in symptoms and the recurrence of nasal polyps. The experimental group had better control of sneezing ( < .05) and rhinorrhea ( < .01) than the control group. For those who underwent surgery more than 6 months prior in both groups, the recurrence rate was 29.6% (8/27) in the experimental group and 44.4% (8/18) in the control group, and there was no significant difference (χ = .483,  = .487). FESS combined with PNN can improve the symptoms of sneezing and rhinorrhea caused by ARwCRSwNP more obviously than FESS alone, but there is no clear statistical advantage of this procedure for improving the overall symptoms and controlling the recurrence of nasal polyps.

摘要

变应性鼻炎合并慢性鼻-鼻窦炎伴鼻息肉(ARwCRSwNP)在临床上非常常见。传统上,这些患者的治疗方法是针对CRSwNP进行手术,随后使用鼻用类固醇喷雾剂或其他抗过敏药物来控制变应性鼻炎。近年来,一些鼻科医生在内镜手术中引入了翼管神经切断术(VN)或后鼻神经切断术(PNN)来治疗难治性变应性鼻炎,并报告了令人鼓舞的结果。此外,我们探讨了内镜下PNN治疗ARwCRSwNP后鼻息肉复发的控制情况及症状改善情况。为了研究内镜下PNN治疗ARwCRSwNP后鼻息肉复发的控制情况及症状改善情况。2016年11月至2018年7月入住我院的85例ARwCRSwNP患者被分为两组。A组接受传统功能性内镜鼻窦手术(FESS)联合PNN;B组仅接受传统FESS。采用视觉模拟量表(VAS)、鼻-鼻窦结局测试22项问卷(SNOT-22)、鼻相关生活质量问卷(RQLQ)及术后鼻内镜检查来评估症状改善情况及鼻息肉复发情况。实验组在控制打喷嚏(P<0.05)和流涕(P<0.01)方面比对照组更好。对于两组中手术超过6个月的患者,实验组的复发率为29.6%(8/27),对照组为44.4%(8/18),差异无统计学意义(χ² = 0.483,P = 0.487)。FESS联合PNN比单纯FESS能更明显地改善ARwCRSwNP引起的打喷嚏和流涕症状,但该手术在改善整体症状和控制鼻息肉复发方面没有明显的统计学优势。

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