Evaluation of the efficacy of endoscopic posterior nasal neurectomy with pharyngeal neurectomy of allergic rhinitis combined with chronic rhinosinusitis with nasal polyps
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摘要: 目的 探讨鼻后神经及咽支切断术对合并常年性变应性鼻炎(perennial allergic rhinitis，PAR)的慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps，CRSwNP)患者手术疗效的影响。方法 选择2020年7月—2021年7月在安徽医科大学附属省立医院耳鼻咽喉头颈外科就诊的83例合并PAR的CRSwNP患者。所有患者均行常规鼻窦开放术+鼻息肉切除术。根据患者是否行鼻后神经及咽支切断术将患者分为实验组和对照组，实验组(39例)采取鼻内镜下鼻窦手术联合鼻后神经加咽支切断术，对照组(44例)采取鼻内镜下鼻窦术，未行鼻后神经及咽支切断术。所有患者在治疗前、术后6个月及术后1年时进行视觉模拟评分(VAS)量表、鼻结膜炎生活质量问卷(RQLQ)及改良的Lund-Kennedy(modified Lund-Kennedy，MLK)内镜评分。同时收集其他相关数据，对术前术后的随访资料进行分析评估。结果 术后随访1年，两组患者的术后6个月鼻塞VAS评分、术后1年鼻息肉复发率差异均无统计学意义(P>0.05)。而实验组患者术后6个月、1年的流涕、打喷嚏及咽部症状VAS评分、MLK内镜评分、RQLQ评分、术后1年鼻塞VAS评分均较对照组显著降低，两者比较差异有统计学意义(P < 0.05)。结论 对于合并PAR的CRSwNP患者，在行鼻内镜鼻窦手术的同时行鼻后神经及咽支切断能显著改善近期手术疗效，且鼻后神经及咽支切断术是一种安全有效的手术治疗方式。Abstract: Objective To investigate the effect of posterior nasal neurectomy(PNN) with pharyngeal neurectomy (PN) on chronic sinusitis with nasal polyps (CRSwNP)complicated with perennial allergic rhinitis (PAR).Methods 83 patients with perennial allergic rhinitis combined with chronic group-wide sinusitis with nasal polyps who attended our hospital from July 2020 to July 2021 were selected. All patients underwent conventional functional endoscopic sinusitis surgery(FESS)+ nasal polypectomy. Patients were divided according to whether they underwent PNN+PN. 38 cases in the experimental group underwent FESS combined with PNN+PN; 44 cases in the control group underwent conventional FESS alone. All patients underwent the VAS, RQLQ, and MLK before treatment, and at 6 months and 1 year after surgery. Meanwhile, other relevant data were collected and the preoperative and postoperative follow-up data were collected and analyzed to assess the differences between the two groups.Results The total postoperative follow-up period was 1 year. The recurrence rate of nasal polyps at 1 year postoperatively and the nasal congestion VAS score at 6 months postoperatively were not statistically significant in the two groups(P>0.05). However, the patients in the experimental group had statistically significantly lower effusion and sneezing VAS scores, MLK endoscopy scores and RQLQ scores at 6 months and 1 year postoperatively, and nasal congestion VAS scores at 1 year postoperatively compared to the control group(P < 0.05).Conclusion For patients with perennial AR complicated with CRSwNP, the combination of the PNN+PN in FESS can significantly improve the short-term curative effect, and PNN+PN is a safe and effective surgical treatment.
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Key words:
- posterior nasal neurectomy /
- allergic rhinitis /
- rhinosinusitis /
- efficacy analysis
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表 1 AR合并CRSwNP患者基本临床资料比较
项目 实验组(n=39) 对照组(n=44) χ2/t P 例数 39 44 - - 性别/男/女/例 31/8 37/7 0.296 0.586 年龄/岁 41.49±13.47 44.36±13.64 0.965 0.338 鼻中隔偏曲/例(%) 14(35.90) 13(29.55) 0.380 0.538 鼻甲肥大/例(%) 13(33.33) 9(20.45) 1.760 0.185 VAS评分 鼻塞 7.51±1.56 7.55±1.60 0.094 0.925 流涕 7.08±1.42 6.91±1.43 0.536 0.594 喷嚏 5.18±1.07 4.95±0.91 1.031 0.305 咽部症状 4.64±1.04 4.48±1.07 0.707 0.482 RQLQ评分 3.55±0.23 3.59±0.17 0.972 0.334 MLK内镜评分 7.15±1.37 7.59±1.20 1.547 0.126 
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表 2 AR合并CRSwNP患者治疗前后VAS评分对比
X±S 时间 实验组 对照组 t P 鼻塞 术前 7.51±1.56 7.55±1.60 0.094 0.925 术后6个月 1.85±0.74 2.02±0.63 1.171 0.245 术后1年 1.71±0.69 2.50±0.82 4.673 < 0.001 流涕 术前 7.08±1.42 6.91±1.43 0.536 0.594 术后6个月 1.80±0.77 3.20±0.85 7.886 < 0.001 术后1年 1.949±0.83 3.55±0.70 9.551 < 0.001 喷嚏 术前 5.18±1.07 4.95±0.91 1.031 0.305 术后6个月 1.23±0.78 2.55±0.73 7.947 < 0.001 术后1年 1.41±0.79 2.75±0.65 8.492 < 0.001 咽部症状 术前 4.64±1.04 4.48±1.07 0.707 0.482 术后6个月 1.03±0.36 2.05±0.71 8.049 < 0.001 术后1年 1.21±0.52 2.41±0.66 9.150 < 0.001
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表 3 两组治疗前后RQLQ评分对比
X±S 时间 实验组 对照组 t P 术前 3.55±0.23 3.59±0.17 0.972 0.334 术后6个月 1.07±0.13 1.31±0.12 8.963 < 0.001 术后1年 1.16±0.17 1.41±0.12 8.014 < 0.001
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表 4 两组治疗前后MLK评分对比
X±S 时间 实验组 对照组 t P 术前 7.15±1.37 7.59±1.2 1.547 0.126 术后6个月 1.23±0.84 2.16±0.86 4.954 < 0.001 术后1年 2.13±1.01 3.09±1.12 4.107 < 0.001
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