筛前神经阻断术与选择性翼管神经切断术治疗中重度变应性鼻炎的疗效比较

目的：探讨鼻内镜下筛前神经阻断术和选择性翼管神经切断术治疗中重度变应性鼻炎的疗效。方法：选取2017年3月至2019年9月温州市人民医院收治的125例中重度变应性鼻炎患者，根据术式的不同分为2组。其中筛前神经阻断组89例，选择性翼管神经切断组36例。分别采用鼻结膜炎生活质量量表（RQLQ）以及临床症状分级评分法统计分析2组患者术前及术后6个月、9个月生活质量、打喷嚏、鼻痒、流涕和鼻塞等症状改善情况。结果：与术前相比，术后6个月及9个月2组患者RQLQ评分、鼻痒、打喷嚏、流清涕、鼻塞临床症状评分均明显下降（P ＜0.01）。筛前神经阻断组患者鼻痒的临床症状评分明显优于翼管神经切断组（P ＜0.01），筛前神经阻断组患者鼻痒和打喷嚏的临床症状评分优于翼管神经切断组（P ＜0.05）。而翼管神经切断组患者流清涕和鼻塞的临床症状评分明显优于筛前神经组（P ＜0.01）。结论：筛前神经阻断术和选择性翼管神经切断术都可以有效治疗变应性鼻炎，但对症状的改善程度有一定差异。对于打喷嚏明显但是鼻塞不明显的患者，可以考虑单独选择筛前神经阻断术；对于流涕、鼻塞为主要症状的患者，建议采用选择性翼管神经阻断术；而重度变应性鼻炎患者，建议两种术式结合。

A comparison between anterior ethmoidal nerve block and selective pterygoid canal neurotomy in the treatment of moderate-to-severe allergic rhinitis

Objective: To explore the efficacy of anterior ethmoidal nerve blockade and selective vidian nerve transection under nasal endoscopy in treating moderate to severe allergic rhinitis. Methods: A total of 125 patients with moderate to severe allergic rhinitis admitted to Wenzhou People’s Hospital from March 2017 to September 2019 were selected and divided into 2 groups according to different surgical procedures. Among them, there were 89 cases in the anterior ethmoidal nerve blockade group and 36 cases in the selective vidian nerve block group. The rhinoconjunctivitis quality of life scale (RQLQ) and clinical symptom grading were used to statisticallyanalyze the improvement of life quality, sneezing, nasal itching, runny nose and nasal obstruction before surgery 6 and 9 months after surgery in 2 groups respectively. Results: Compared with preoperative data, RQLQ scores, nasal itching, sneezing, runny nose, and nasal congestion clinical symptoms scores were significantly decreased in the two groups at 6 months and 9 months after surgery (P<0.01). The clinical symptom scores of nasal itching in the anterior ethmoidal nerve block group were significantly better than those in the vidian nerve cut group (P<0.01), and the clinical symptom scores of nasal itching and sneezing in the preethmoidal nerve block group were better than those in the vidian nerve cut group (P<0.05). The clinical symptom scores of runny nose and nasal congestion in the vidian nerve transection group were significantly better than those in the preethmoidal nerve group (P<0.01). Conclusion: Both anterior ethmoidal nerve blockade and selective vidian nerve transection can effectively treat allergic rhinitis, varying in the improvement degree of symptoms. For patients with obvious sneezing but unobvious nasal congestion, anterior ethmoidal nerve blockade can be considered alone; for patients with runny nose and nasal congestion as the main symptoms, selective vidian nerve blockade is recommended. For severe allergic rhinitis patients, it is recommended to combine the two procedures.