Zhao J H, Liu J F, Han D Z, Yang Y, Zhao Y B, Wang F J, You Fangjia
Department of Otorhinolaryngology, China-Japan Friendship Hospital, Beijing 100029, China.
Department of Otorhinolaryngology, China-Japan Friendship Hospital, Beijing 100029, China China Japan Friendship Clinical College, Beijing University of Traditional Chinese Medicine, Beijing 100029, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Mar 7;57(3):295-300. doi: 10.3760/cma.j.cn115330-20210710-00447.
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. 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. 1 2019 to Jun. 10 2021 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. 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 6.47±2.17, eyes 1.15±0.89 3.60±2.57, pharynx 1.30±1.36 4.25±3.64, ear 1.10±1.03 2.67±2.00, whole body 1.08±1.24 3.60±1.17, total 7.13±4.31 20.58±9.05, all <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 2.93±1.33, nose 1.38±1.18 3.93±1.50, eyes 0.58±0.66 1.80±1.25, practical problems 1.10±1.22 3.03±1.84, emotion 1.00±1.81 2.58±2.00, activity 2.77±2.93 vs 6.00±1.85, total 8.99±8.92 22.42±8.69, all <0.05). There was no significant difference in preoperative and postoperative scores of non-nasal/ocular symptoms (1.37±1.60 2.16±1.12, =0.166). There was no other complication except 2 cases with short-term postoperative numbness. Total posterior nasal neurectomy with transection of sphenopalatine neurovascular bundle is a safe, effective and feasible method for the treatment of intractable allergic rhinitis, and its long-term efficacy needs further observation.
从解剖学角度提出经鼻后神经全切术切断蝶腭神经血管束治疗变应性鼻炎，并探讨其临床应用。在中国-日本友好医院耳鼻咽喉解剖实验室，通过鼻内镜经鼻中道入路对2个新鲜尸头（4侧）进行解剖，观察与手术入路相关的颅面骨结构。选取2019年2月1日至2021年6月10日在中国-日本友好医院耳鼻咽喉科治疗的12例变应性鼻炎患者，所有患者均采用蝶腭神经血管束完全切断技术行鼻后神经切断术，术后随访1年。随访期间，2例患者失访。其余10例患者中男性4例，女性6例，年龄29～69岁。采用视觉模拟评分法（VAS）和鼻结膜炎生活质量问卷（RQLQ）评估手术效果。应用SPSS 25.0软件进行统计学分析。解剖过程中获得了鼻内镜经鼻中道入路的重要解剖标志，如筛骨嵴、蝶腭孔/切迹、腭眶突和蝶腭突。术后鼻、眼、咽、耳及全身的VAS评分及总VAS评分均显著低于术前，差异有统计学意义（鼻：2.50±1.70比6.47±2.17；眼：1.15±0.89比3.60±2.57；咽：1.30±1.36比4.25±3.64；耳：1.10±1.03比2.67±2.00；全身：1.08±1.24比3.60±1.17；总评分：7.13±4.31比20.58±9.05，均P<0.05）。患者术后睡眠、鼻、眼、实际问题、情绪、活动的RQLQ评分及总RQLQ评分均显著低于术前，差异有统计学意义（睡眠：0.80±0.69比2.93±1.33；鼻：1.38±1.18比3.93±1.50；眼：0.58±0.66比1.80±1.25；实际问题：1.10±1.22比3.03±1.84；情绪：1.00±1.81比2.58±2.00；活动：2.77±2.93比6.00±1.85；总评分：8.99±8.92比22.42±8.69，均P<0.05）。非鼻/眼症状术前、术后评分差异无统计学意义（1.37±1.60比2.16±1.12，P=0.166）。除2例术后短期麻木外，无其他并发症。经鼻后神经全切术切断蝶腭神经血管束是治疗难治性变应性鼻炎的一种安全、有效且可行的方法，其长期疗效有待进一步观察。
