Kim Ji-Sun, Stybayeva Gulnaz, Hwang Se H
Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.
Otolaryngol Head Neck Surg. 2025 Mar;172(3):787-797. doi: 10.1002/ohn.1037. Epub 2024 Oct 28.
To evaluate the clinical efficacy of vidian neurectomy (VN) or posterior nasal neurectomy (PNN) combined with endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).
A systematic search of six databases (PubMed, SCOPUS, Embase, Web of Science, Google Scholar, and Cochrane) was conducted to identify relevant studies up to May 2024.
The effects of combining VN or PNN with ESS were evaluated in comparison to ESS alone. Outcomes were assessed by evaluating changes in Lund-Kennedy score, patient-reported symptom scores (VAS), quality of life, as well as adverse effects and recurrence rate of CRSwNP.
A total of 6 studies, comprising 407 patients, were included in the analysis. The neurectomy group showed significant improvements in Lund-Kennedy score (SMD = 0.7276 [0.5695; 0.8857]), with statistically significant improvements maintained at 6, 12, and 24 months postoperatively. The treatment group maintained better improvements in sinusitis-related quality of life (SMD = 0.4540 [0.1784; 0.7297]) and VAS (SMD = 0.7096 [0.4356; 0.9837]) until 12 months postoperatively, but not at 24 months. Regarding adverse effects, additional neurectomy did not significantly induce epistaxis (odds ratio [OR] = 0.9806 [0.2348; 4.0960]) or dry eye (OR = 2.4194 [0.1114; 52.5255]) compared to the control group. On the other hand, there was no difference in the recurrence rate of CRSwNP between the 2 groups during the follow-up periods.
Additional neurectomy shows better efficacy in improving endoscopic findings and symptoms in patients with CRSwNP and appears to be a safe and effective treatment.
评估翼管神经切断术（VN）或鼻后神经切断术（PNN）联合鼻内镜鼻窦手术（ESS）治疗慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者的临床疗效。
对六个数据库（PubMed、SCOPUS、Embase、Web of Science、谷歌学术和Cochrane）进行系统检索，以识别截至2024年5月的相关研究。
将VN或PNN与ESS联合应用的效果与单纯ESS进行比较评估。通过评估Lund-Kennedy评分、患者报告的症状评分（视觉模拟量表[VAS]）、生活质量的变化，以及CRSwNP的不良反应和复发率来评估结果。
共有6项研究，包括407例患者，纳入分析。神经切断术组的Lund-Kennedy评分有显著改善（标准化均数差[SMD]=0.7276[0.5695；0.8857]），术后6、12和24个月维持有统计学意义的显著改善。治疗组在术后12个月内鼻窦炎相关生活质量（SMD=0.4540[0.1784；0.7297]）和VAS（SMD=0.7096[0.4356；0.9837]）方面维持更好的改善，但在24个月时未维持。关于不良反应，与对照组相比，额外的神经切断术并未显著诱发鼻出血（比值比[OR]=0.9806[0.2348；4.0960]）或干眼（OR=2.4194[0.1114；52.5255]）。另一方面，两组在随访期间CRSwNP的复发率没有差异。
额外的神经切断术在改善CRSwNP患者的内镜检查结果和症状方面显示出更好的疗效，似乎是一种安全有效的治疗方法。
