鼻后神经切断术在复发性鼻窦炎伴息肉临床治疗中的应用

Application of posterior nasal neurotomy in the clinical treatment of recurrent sinusitis with polyps

摘要:

目的 分析功能性鼻内镜手术联合鼻后神经切断术治疗复发性鼻窦炎伴息肉的临床疗效，以及对重要炎症指标的影响，探讨其临床作用机制。方法 选择2021年1月－2021年12月该院复发性鼻窦炎伴息肉患者54例，采用随机抽签法，分为试验组（27例）和对照组（27例），对照组采用功能性鼻内镜手术，试验组采用功能性鼻内镜手术联合鼻后神经切断术，观察两组患者术前、术后6和12个月总有效率、鼻腔鼻窦结局测试22（SNOT-22）评分、Lund-Kennedy鼻内镜评分和炎症因子［外周血嗜酸性粒细胞（EOS）、免疫球蛋白E（IgE）、血清白细胞介素-4（IL-4）和血清白细胞介素-5（IL-5）］变化情况。结果 术前两组患者各指标比较，差异均无统计学意义；试验组术后6和12个月随访人数分别为25和23例，对照组术后6和12个月随访人数分别为26和25例；术后6和12个月试验组总有效率、SNOT-22评分、Lund-Kennedy鼻内镜评分明显优于对照组，且术后12个月试验组EOS、IgE、IL-4和IL-5水平较对照组明显降低，差异均有统计学意义（P < 0.05）。结论 对于复发性鼻窦炎伴息肉患者，联合鼻后神经切断术的功能性鼻内镜手术，更能抑制机体IgE分泌和黏膜炎症反应，提高术后治疗效果。

Abstract:

Objective To analyze the clinical efficacy of functional endoscopic surgery combined with posterior nasal neurotomy in the treatment of recurrent sinusitis with polyps and its impact on important inflammatory indicators, and explore its clinical mechanism of action.Method 54 patients with recurrent sinusitis and polyps who visited our hospital from January to December 2021 were selected and randomly divided into an experimental group (27 cases) and a control group (27 cases). The control group underwent functional endoscopic sinus surgery, while the experimental group underwent functional endoscopic surgery combined with posterior nasal neurotomy. The total effective rate at preoperative, postoperative 6 and 12 months, sino-nasal outcome test-22 (SNOT-22) score, Lund-Kennedy score of the nasal endoscopy, and changes in important inflammatory factors [eosinophil (EOS), immunoglobulin E (IgE), interleukin-4 (IL-4), interleukin-5 (IL-5)] were compared.Results There was no statistically significant difference in the observation indicators between the two groups of patients before surgery. The number of follow-up patients in the experimental group at 6 and 12 months after surgery was 25 and 23, respectively. The number of follow-up patients in the control group at 6 and 12 months after surgery was 26 and 25, respectively. All postoperative observation indicators was significantly improved compared to before surgery; The total effective rate, SNOT-22 score, and Lund-Kennedy score of the nasal endoscopy in the experimental group were better than those in the control group at 6 and 12 months after surgery, and the levels of EOS, IgE, IL-4, and IL-5 in the experimental group were significantly lower than those in the control group at 12 months after surgery, the differences were statistically significant (P < 0.05).Conclusion For patients with recurrent sinusitis and polyps, functional endoscopic surgery combined with posterior nasal neurotomy can better inhibit IgE secretion and mucosal inflammatory response, and improve the postoperative treatment effect.