鼻后神经切断术治疗慢性鼻窦炎伴鼻息肉合并哮喘的疗效及其对鼻黏膜嗜酸性粒细胞的影响

Efficacy of posterior nasal neurotomy in patients with bronchial asthma and chronic rhinosinusitis with nasal polyps and its effect on eosinophils in nasal mucosa

摘要:

目的 探讨鼻后神经切断术治疗慢性鼻窦炎伴鼻息肉（CRSwNP）合并哮喘的疗效，以及手术对鼻黏膜内嗜酸性粒细胞（EOS）的影响。方法 选取该院确诊的CRSwNP合并哮喘患者15例，行鼻后神经切断术。术后随访1年，采用视觉模拟法（VAS）评估疗效。有7例患者术前和术后1年采集了中鼻甲黏膜，比较手术前后鼻腔黏膜EOS浸润度的变化。结果 所有患者术后症状明显减轻，术后1年VAS平均（2.87±0.74）分，与术前的（8.33±0.90）分比较，差异有统计学意义（t = 16.99，P < 0.05）。无鼻出血、眼干和腭部麻木感等并发症出现。7例患者鼻黏膜EOS浸润度较术前明显下降（t = 8.26，P < 0.05）。结论 鼻后神经切断术治疗CRSwNP合并哮喘患者安全有效，可明显减少鼻腔黏膜内EOS浸润。

Abstract:

Objective To investigate the effect of posterior nasal neurotomy for chronic rhinosinusitis with nasal polyps (CRSwNP) coexisting asthma, and its effect on eosinophils (EOS) in nasal mucosa.Method 15 cases of patients with CRSwNP coexisting asthma were enrolled in the study, posterior nasal neurotomy were performed. After a follow-up period for a year, visual analogue scale (VAS) method was used to evaluate the clinical therapeutic effect. Biopsy specimens from the middle turbinate mucosa obtained from seven patients before operation and 1 year after operation were examined and analysis of changes in EOS in nasal mucosa.Result One year after operation. Of the 15 patients, postoperative scores of VAS (2.87 ± 0.74) was lower than preoperative score (8.33 ± 0.90). The differences between postoperative and preoperative scores were statistically significant (t = 16.99, P < 0.05). No obvious complication was found after operation such as epistaxis, dry eye and palate numbness. The EOS infiltration index decreased significantly compared with pre-operation (t = 8.26, P < 0.05).Conclusion The posterior nasal neurotomy is well tolerated, safe and effective in the majority of patients with CRSwNP coexisting asthma, which can effectively reduce EOS infiltration in nasal mucosa.