鼻内镜下翼管神经切断术治疗中-重度持续性变应性鼻炎的远期临床疗效

摘要

Objective To evaluate the efficacy of endoscopic vidian neurectomy in the management of moderate-severe persistent allergic rhinitis, and to explore its possible mechanism. Methods One hundred and ninety-one patients with moderate-severe persistent allergic rhinitis were divided into three groups; endoscopic vidian neurectorny was carried out in 71 patients ( group A) , partial inferior turbenectomy and/or septal-plasty in 39 patients (group B) , and 81 patients were as control (group C).The life quality was assessed at 6 month, 1 year and 3 years after operation using rhinoconjunctivitis quality of life questionnaire (RQLQ ) and visual analogue scale (VAS). Results Among 191 cases, one hundred and forty-five cases had complete follow-up documents. The average score of RQLQ and VAS score ((x) ± s)were significantly decreased at the time of 6 months(0. 84 ±0. 41, 2. 55 ±1.57), 1 year(0.91 ±0.43,2.63±1.71)and 3 years (1.03 ±0.46,2.81 ± 1.75) after endoscopic vidian neurectomy than scores before operation (2. 25 ±0.49,7. 34 ± 1. 11) ,F = 115.45, 133. 09, respectively, P<0.001, and also significantly lower than scores in patients in group B or control group at the same period after treatment By patient's selfevaluation, the ratio of greatly-improved, improved and not-improved was respectively, 65.5% (38 cases) ,24. 1% (14 cases) , 10. 4% (6 cases) , and significantly higher in patients in group A than in patients in group B (U = 237.0, P<0.001) and group C( U = 246. 0,P <0. 001). There was no severe complication in all patients observed. Conclusion Endoscopic vidian neurectomy is an effective and safe technique in the management of moderate-severe persistent allergic rhinitis.%目的 评估鼻内镜下翼管神经切断术治疗中-重度持续性变应性鼻炎的临床疗效,探讨其可能的作用机制.方法 191例变应性鼻炎患者被分为3组,分别进行鼻内镜下翼管神经切断术(A组,71例)、下鼻甲部分切除和(或)鼻中隔矫正术(B组,39例)和保守治疗(C组,81例,对照组).应用鼻结膜炎生存质量调查问卷(rhinoconjunctivitis quality of life questionnaire,RQLQ)和视觉模拟量表(visual analogue scale,VAS)评估术前、术后6个月、1年和3年的鼻炎相关生活质量.结果 通过对145例资料完整的病例进行分析,经鼻内镜下翼管神经切断组(A组)RQLQ平均((x)±s,以下同)得分和VAS评分在术后6个月(0 84±0.41、2 55±1.57)、1年(0 91±0 43、2.63±1.71)、3年(1.03±0.46、2.81±1.75)都显著低于术前(2.25±0.49、7.34±1.11),F值分别为115.45、133.09,P值均<0.001,且分别低于B、C组治疗后6个月、1年、3年的RQLQ平均得分和VAS评分(P值均<0.001).患者对治疗后3 0～5.5年总体主观评估结果显示,A组显著改善率、改善率、无改善率分别为65.5%(38例)、24.1%(14例)、10.4%(6例),总体有效性显著高于B组(U=237.0,P<0.001)和C组(U=246.0,P<0.001).没有发生严重的手术并发症.结论 鼻内镜下翼管神经切断术是一种治疗中-重度持续性变应性鼻炎安全、有效的手段.