双侧翼管神经切断术治疗变应性鼻炎-鼻窦炎伴鼻息肉患者的临床效果与安全性

李勇 陈武兵 叶华富

[摘要] 目的 探討双侧翼管神经切断术在治疗变应性鼻炎-鼻窦炎伴鼻息肉患者中的临床效果与安全性。 方法 选取我院2016年1月～2017年9月确诊的变应性鼻炎-鼻窦炎伴鼻息肉的病例140例为研究对象，所有患者随机分为对照组和观察组两组，每组70例。对照组采取常规功能性鼻内镜手术（FESS）+药物对症治疗。观察组患者在对照组基础上同时行双侧翼管神经切断术治疗。观察比较两组患者术后肺功能情况及术后并发症发生状况。结果 两组患者手术前用力呼气流量（FEF）、用力呼气容积（FEF）/用力肺活量（FVC）和最大通气量（MVV）的百分比均无明显差异（P>0.05）;手术后各数据均明显优于本组手术前（P<0.05）;术后观察组各数据明显优于对照组（P<0.05）。两组患者手术前VAS评分无明显差异（P>0.05）;手术前两组患者VAS评分均较手术后高，差异有统计学意义（P<0.05）。随着术后时间的推移，两组患者VAS评分有逐渐增高趋势，但明显低于手术前，观察组更明显。且观察组术后同期VAS评分均低于对照组，差异有统计学意义（P<0.05）。两组患者并发症发生情况比较差异无统计学意义（χ2=1.376，P>0.05）。 结论 双侧翼管神经切断术对治疗变应性鼻炎-鼻窦炎伴鼻息肉患者有一定的治疗效果，可推广应用。

[关键词] 双侧翼管神经切断术;变应性鼻炎-鼻窦炎伴鼻息肉;治疗效果;肺功能;并发症

[中图分类号] R765.21          [文献标识码] B          [文章编号] 1673-9701（2020）15-0083-04

Effects and safety of bilateral vidian neurotomy in patients with allergic rhinitis-sinusitis with nasal polyps

LI Yong   CHEN Wubing   YE Huafu   WANG Yilong   TAO Baohong

Department of Otorhinolaryngology Head and Neck Surgery，Taizhou Municipal Hospital in Zhejiang Province，Taizhou 318000，China

[Abstract] Objective To explore the clinical effect and safety of bilateral vidian neurotomy in patients with allergic rhinitis-sinusitis with nasal polyps. Methods 140 patients with allergic rhinitis-sinusitis with nasal polyps diagnosed in our hospital from January 2016 to September 2017 were selected as the study subjects. All patients were randomly divided into the control group and the observation group. The control group（n=70） received conventional function endoscopic sinus surgery（FESS）+symptomatic treatment， while the observation group（n=70） underwent bilateral vidian neurectomy on the basis of the control group. Postoperative pulmonary function and postoperative complications were observed and compared between the two groups. Results The percentages of forced expiratory flow（FEF）， forced expiratory volume（FEV）/forced vital capacity（FVC）， and maximum minute ventilation（MVV） were not significantly different between the two groups， and the differences were not statistically significant（P>0.05）. All data after surgery were significantly better than those before surgery（P<0.05）;all data in the observation group were significantly better than those in the control group（P<0.05）. There was no significant difference in visual analogue scale（VAS） scores between the two groups before surgery， and the difference was not statistically significant（P>0.05）. The VAS scores before surgery were higher than those after surgery， and the difference was statistically significant（P<0.05）. However， the VAS scores after surgery gradually increased with time， but they were significantly lower than those before surgery， and the observation group was more obvious. And the VAS scores of the observation group were lower than those of the control group during the same period after operation， and the differences were statistically significant（P<0.05）. There was no difference in complications between the two groups（χ2=1.376，P>0.05）. Conclusion Bilateral vidian neurotomy has a certain effect on patients with allergic rhinitis-sinusitis with nasal polyps， which is worthy of promotion and application.

[Key words] Bilateral vidian neurectomy;Allergic rhinitis-sinusitis with nasal polyps;Therapeutic effect;Pulmonary function;Complications

变应性鼻炎（Allegic rhinitis，AR），即过敏性鼻炎，也叫变应性鼻炎，属于Ⅰ型变态反应性疾病，常见的变应原主要为吸入的花粉、粉尘、室内尘螨、动物毛屑等，也可能由某些化学物质如碘、油漆或某些食物引起[1-2]。变应性鼻炎是机体暴露于变应原后的鼻黏膜非感染性慢性炎症性疾病。近年来国内外数据均显示[3]AR患病率在逐年升高，并且慢性鼻窦炎患者鼻黏膜持续的慢性炎症刺激最终可引发鼻息肉。而鼻息肉异常增大则可阻断鼻腔通气，严重影响通气功能，威胁健康。最新……