鼻内镜下低温等离子刀鼻后神经切断术治疗难治性变应性鼻炎的疗效观察

Observations on the curative effect of the resection of posterior nasal nerve with low-temperature plasma knife under nasal endoscope in treatment of refractory allergic rhinitis

摘要:

目的 探讨鼻内镜下低温等离子刀鼻后神经（PNN）切断术治疗难治性变应性鼻炎（RAR）的临床疗效。方法 回顾性研究2018年1月－2018年12月25例于恩施土家族苗族自治州中心医院行鼻内镜下低温等离子刀PNN切断术患者的临床资料，采用视觉模拟评分法（VAS）对患者治疗前和治疗后1年鼻塞、鼻痒、流涕、喷嚏和鼻部症状总体情况进行评价；并对切断 ≤ 2分支和 >2分支PNN者的鼻塞、鼻痒、流涕、喷嚏和鼻部症状总体改善和控制情况进行比较。结果 术前鼻塞、鼻痒、流涕、喷嚏和鼻部症状总体VAS评分分别为（8.38±1.12）、（7.21±0.98）、（7.60±1.12）、（5.45±1.04）和（8.89±1.01）分，术后1年分别为（2.60±0.39）、（2.29±0.12）、（2.65±0.24）、（1.52±0.67）和（2.43±1.05）分，术前术后比较，差异均有统计学意义（P < 0.05），术后1年鼻部症状总体VAS评分明显下降；切断 > 2分支者术后鼻塞、鼻痒、流涕、喷嚏及鼻部症状总体VAS评分分别为（3.84±1.03）、（3.58±1.09）、（4.98±1.47）、（4.24±0.56）和（8.06±0.26）分，切断 ≤ 2分支者分别为（4.42±1.02）、（4.42±0.67）、（5.36±0.98）、（5.42±1.14）和（10.08±1.32）分，两组患者鼻塞和流涕VAS评分比较，差异均无统计学意义（P >0.05），两组患者喷嚏、鼻痒和鼻部症状总体VAS评分比较，差异均有统计学意义（P < 0.05）。术后随访期无明显眼干和上腭麻木等并发症发生。结论 鼻内镜下低温等离子刀PNN切断术能有效缓解RAR患者的鼻部症状，短期疗效确切，且具有神经定位清楚、术野清晰、操作方便安全、创伤小和术后并发症少等优点，值得临床推广应用。

Abstract:

Objective To investigate the clinical efficacy of the resection of posterior nasal nerve (PNN) with low-temperature plasma knife via nasal endoscope in treatment of refractory allergic rhinitis (RAR).Methods A retrospective analysis was conducted on the clinical data of 25 patients who were treated with resection of posterior nasal nerve with low-temperature plasma knife via nasal endoscope from January 2018 to December 2018. Nasal obstruction, rhinocnesmus, rhinorrhea, sneezing and the general condition of nasal symptoms of the patients before and one year after the treatment was evaluated and analyzed using the visual analogue scale (VAS). In addition, the improvement and control of nasal obstruction, rhinocnesmus, rhinorrhea, sneezing and the general condition of nasal symptoms were compared between patients with ≤ 2 branches of posterior nasal nerve cut off and those with > 2 branches cut off.Results Preoperative VAS scores of nasal obstruction, rhinocnesmus, rhinorrhea, sneezing and the general condition of nasal symptoms were (8.38 ± 1.12), (7.21 ± 0.98), (7.60 ± 1.12), (5.45 ± 1.04) and (8.89 ± 1.01), respectively. There were (2.60 ± 0.39), (2.29 ± 0.12), (2.65 ± 0.24), (1.52 ± 0.6) and (2.43 ± 1.05), respectively after one year of the operation. The differences were all statistically significant (P < 0.05), the overall VAS of nasal symptoms decreased one year after surgery. The scores of nasal obstruction, rhinocnesmus, rhinorrhea, sneezing and the general condition of nasal symptoms after the operation for patients with > 2 branches cut off were (3.84 ± 1.03), (3.58 ± 1.09), (4.98 ± 1.47), (4.24 ± 0.56) and (8.06 ± 0.26), respectively. There were (4.42 ± 1.02), (4.42 ± 0.67), (5.36 ± 0.98), (5.42 ± 1.14) and (10.08 ± 1.32), respectively after the operation for patients with ≤ 2 branches cut off. Between the two groups, the scores for nasal obstruction and rhinorrhea were not of statistically significant difference (P > 0.05), while the scores for sneezing, rhinocnesmus, and the general condition of nasal symptoms has statistically significant difference (P < 0.05). During the follow-up period, no obvious complications such as disturbed lacrimal secretion and sensory disorders of the cheek and gum were found.Conclusion The resection of posterior nasal nerve with low temperature-plasma knife via nasal endoscope have advantages include being able to effectively relieve the nasal symptoms of RAR patients, remarkable short-term efficacy, clear localization of posterior nasal nerve, clear surgical field, convenient and safe operation, micro trauma, and fewer postoperative complications, which make it worthy of extending clinical application.