Kim Do Hyun, Jang David W, Hwang Se Hwan
Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
ORL J Otorhinolaryngol Relat Spec. 2025 Apr 29:1-11. doi: 10.1159/000546116.
Recently, several reports have been published about the improvement of rhinitis symptoms through posterior nerve ablation. Therefore, we assess the effect of additional (selective) vidian neurectomy in patients with chronic rhinosinusitis with nasal polyp (CRSwNP) compared to conventional endoscopic sinus surgery.
We analyzed studies comparing the change of endoscopic findings and patient reporting scores (quality of life and nasal symptoms) related to CRSwNP from baseline (before treatment) to posttreatment between the treatment group (endoscopic sinus surgery plus [selective] vidian neurectomy) and the control group (endoscopic sinus surgery only).
Additional (selective) vidian neurectomy significantly improved the Lund-Kennedy score and sinusitis-related life quality scores compared to the control group. In the subgroup analyses of these results according to neurectomy extent (conventional or selective vidian neurectomy), both types of vidian neurectomy changed the Lund-Kennedy score effectively. Conventional vidian neurectomy showed greater improvement of the patient-reported nasal symptom-related VAS than did selective vidian neurectomy, but there was no significant difference in the changes of sinusitis-related life quality scores between the two groups. Regarding the adverse effects of treatment, conventional vidian neurectomy led to significantly more frequent dry eyes than did selective vidian neurectomy.
Selective vidian neurectomy, when performed in conjunction with endoscopic sinus surgery, provides additional benefits in enhancing endoscopic outcomes and alleviating symptoms in patients with CRSwNP. Vidian neurectomy can reduce nasal symptoms more effectively than selective vidian neurectomy, but there is no significant difference in sinus-related symptoms and there may be side effects.
最近，已有多篇关于通过后神经消融改善鼻炎症状的报道。因此，我们评估了与传统鼻内镜鼻窦手术相比，额外（选择性）翼管神经切断术对慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者的疗效。
我们分析了比较治疗组（鼻内镜鼻窦手术加[选择性]翼管神经切断术）和对照组（仅鼻内镜鼻窦手术）从基线（治疗前）到治疗后与CRSwNP相关的内镜检查结果变化以及患者报告评分（生活质量和鼻部症状）的研究。
与对照组相比，额外（选择性）翼管神经切断术显著改善了Lund-Kennedy评分和鼻窦炎相关生活质量评分。在根据神经切断术范围（传统或选择性翼管神经切断术）对这些结果进行的亚组分析中，两种类型的翼管神经切断术均有效改变了Lund-Kennedy评分。传统翼管神经切断术在患者报告的鼻部症状相关视觉模拟量表（VAS）上的改善比选择性翼管神经切断术更大，但两组在鼻窦炎相关生活质量评分变化方面无显著差异。关于治疗的不良反应，传统翼管神经切断术导致干眼的发生率明显高于选择性翼管神经切断术。
选择性翼管神经切断术与鼻内镜鼻窦手术联合应用时，在改善CRSwNP患者的内镜检查结果和缓解症状方面具有额外益处。翼管神经切断术比选择性翼管神经切断术能更有效地减轻鼻部症状，但在鼻窦相关症状方面无显著差异，且可能存在副作用。
