微波热凝筛前神经及下鼻甲治疗变应性鼻炎

目的总结微波热凝筛前神经及下鼻甲治疗变应性鼻炎的疗效.方法应用微波热凝筛前神经及下鼻甲治疗变应性鼻炎82例.结果随访1年,显效64例(78%),有效15例(18.3%),无效3例(3.7%),总有效率为96.3%.结论微波热凝筛前神经及下鼻甲治疗变应性鼻炎,操作简便,反应轻,疗效好.     

内窥镜下YAG激光烧灼筛前神经治疗变应性鼻炎和血管运动性鼻炎的疗效观察

目的研究鼻内窥镜下YAG激光烧灼治疗变应性鼻炎和血管运动性鼻炎的疗效.方法变应性鼻炎80例,血管运动性鼻炎70例,在鼻内窥镜明视下用YAG激光烧灼筛前神经治疗变应性鼻炎和血管运动性鼻炎.结果变应性鼻炎显效32例(40%),有效12例(15%),无效36例(45%),总有效率为55%.血管运动性鼻炎显效49例(70%),有效15例(21.4%),无效6例(8.6%),总有效率为91.4%.结论鼻内窥镜下YAG激光烧灼筛前神经是治疗变应性鼻炎和血管运动性鼻炎的有效方法,治疗血管运动性鼻炎尤为有效.     

鼻内窥镜下微波阻断翼管筛前神经治疗变应性鼻炎

目的：探讨同时阻断翼管、筛前神经及下鼻甲下缘治疗变应性鼻炎的疗效。方法：鼻内窥镜引导下微波天线分别插入中鼻道后端、鼻顶部鼻骨沟内５０ｍＡ ３Ｓ２次,４０ｍＡ ２ｓ下鼻甲前端下缘条状凝固。结果：治疗１３１６例,显效１０２８例,１年后症状完全控制７１．６％。结论：微波同时阻断翼管、筛前神经及下鼻前端下缘是药物治疗效果不好的变应性鼻炎的有效方法。     

鼻内镜下射频热凝鼻后下神经和筛前神经及下鼻甲治疗常年性变应性鼻炎的临床研究

目的:探讨提高治疗常年性变应性鼻炎的新方法。方法:将常年性变应性鼻炎(PAR)患者80例随机分为两组:观察组40例,应用鼻内镜下射频热凝鼻后下神经、筛前神经及下鼻甲治疗;对照组40例,应用鼻内镜下射频热凝蝶腭神经治疗。将两组远期疗效进行对比。结果:随访1年,观察组总有效率为95.0%(其中显效33例),对照组为47.5%(其中显效6例)。两组总有效率,经χ2检验差异有统计学意义(P<0.01)。观察组无并发症发生,对照组术中出血3例。结论:经鼻内镜下射频热凝鼻后下神经、筛前神经及下鼻甲治疗PAR具有疗效显著、操作简便、无副作用等优点,有较好的临床应用价值。     

鼻内窥镜下微波热凝筛前神经治疗变应性鼻炎

目的：探讨提高变应性鼻炎疗效的方法,方法：应用鼻内窥镜下微波热凝筛前神经治疗变应性鼻炎１０６例,结果随访１年,显效８９例（８４．０％）有效１２例（１１．３％）,无效５例（４．７％）,总有效率达９５．３％。结论：鼻内窥镜下微波热凝筛前神经治疗变应性鼻炎,具有视野清楚,操作简便,疗效好等优点,值得临床应用。     

蝶腭、筛前神经及鼻甲联合手术治疗常年性变应性鼻炎

在鼻内窥镜下为40例行蝶腭、筛前神经及鼻甲联合手术治疗常年性变应性鼻炎.结果:术后1月全部患者症状消失,显效100%;术后1年显效33例,占82.5%;有效6例,占15%,有效率为97.5%.提示该方法可广泛阻滞鼻腔副交感神经来源,降低鼻粘膜感觉灵敏部位敏感性以及感觉-副交感神经反射,破坏喷嚏反射弧的传入通路,使鼻粘膜对外界刺激敏感性下降,血管扩张减轻,腺体分泌减少,对常年性变应性鼻炎有明显疗效.     

鼻内镜下射频热凝筛前神经结合玉屏风颗料治疗常年性变应性鼻炎

目的探讨鼻内镜下射频热凝筛前神经加口服玉屏风颗粒对常年性变应性鼻炎的疗效.方法1 72例常年性变应性鼻炎的患者随机分为3组.治疗组(A组)62例以射频热凝筛前神经及玉屏风颗粒治疗,对照组(B组)50例单纯用射频治疗,对照组(C组)60例单纯用玉屏风颗粒治疗.随访1年.观察其症状、体征进行评分计算改善率.结果治疗组(A组)显效率51.61%(32/62),总有效率85.48%(53/62);对照组(B组)显效率46.00%(23/50),总有效率72.00%(36/50);对照组(C组)显效率33.33%(20/60),总有效率60.00%(36/60).经统计学处理差异有显著性意义(P＜0.01),治疗中未发生不良反应.结论射频热凝筛前神经结合口服玉屏风颗粒对常年性变应性鼻炎具有疗效好,无副作用等特点.     

鼻内镜下微波热凝副交感神经治疗变应性鼻炎51例

目的探讨应用微波热凝术治疗变应性鼻炎的远期疗效。方法鼻内镜下利用微波热凝双侧筛前神经、蝶腭神经及下鼻甲,治疗51例变应性鼻炎,术后用盐水洗鼻3个月以上。结果51例患者中,随访6个月,总有效率100％;随访1年以上有效率82．2％。所有患者均未出现严重并发症。结论鼻内镜下微波热凝副交感神经治疗变应性鼻炎,方法简便,安全有效,远期疗效好,值得临床推广使用。     

伴鼻腔结构不良的变应性鼻炎手术治疗的疗效观察

目的 评价筛前神经及下鼻甲射频消融术,联合鼻内成形术和单纯行筛前神经及下鼻甲射频消融术的术后疗效.方法 选取2006年8月～2008年3月期间,将接受不同手术方法治疗的142例伴鼻腔结构不良的常年性变应性鼻炎患者分成A、B两组,A组为单纯行筛前神经及下鼻甲射频消融术,B组为筛前神经及下鼻甲射频消融术联合鼻内成形术.参照我国兰州标准(2004年),对术前及术后症状和体征进行评分,评定疗效.结果 术后3个月两组的总有效率100%,12个月时两组的总有效率分别为A组:89.6%、B组:92.0%,两组之间疗效无显著差异;24个月时两组之间的总有效率分别为A组:53.8%、B组90.7%,两组之间疗效差异有统计学意义,B组疗效明显高于A组.结论 伴有鼻腔结构不良的常年性变应性鼻炎行筛前神经及下鼻甲射频消融术联合鼻内成形术远期疗效优于单独行筛前神经及下鼻甲射频消融术治疗.     

鼻内镜下翼管神经切断术治疗中-重度持续性变应性鼻炎的远期临床疗效

目的 评估鼻内镜下翼管神经切断术治疗中-重度持续性变应性鼻炎的临床疗效,探讨其可能的作用机制.方法 191例变应性鼻炎患者被分为3组,分别进行鼻内镜下翼管神经切断术(A组,71例)、下鼻甲部分切除和(或)鼻中隔矫正术(B组,39例)和保守治疗(C组,81例,对照组).应用鼻结膜炎生存质量调查问卷(rhinoconju...     

Immunoreactive nerve fibers in the nasal mucosa

Summary The presence of immunoreactive nervous fibers in the respiratory nasal mucosa of rats and guinea pigs was studied by means of a modified peroxidase antiperoxidase technique for whole mounting. The fibers with neuropeptide Y (NPY) always appeared in the walls of blood vessels, while the fibers immunoreactive to calcitonin gene-related peptide (CGRP) were found in nerve tracts near the vessels and the acini of seromucous glands as thick networks located in the subepithelial layers. Immunoreactivity (IR) for galanin was found in the mucosa studied. The findings after surgical and chemical denervation of the trigeminal and superior cervical ganglia may support the theory that the fibers with NPY are of a sympathetic nature with the superior cervical ganglion their site of origin, while the CGRP-IR fibers may have a sensory nature.     

Substance-P-containing nerve fibers in the nasal mucosa

Nerve fibers displaying SP immunoreactivity were detected in the nasal mucosa of several mammals. The fibers were seen around small blood vessels, seromucous glands, and beneath and sometimes within the surface epithelium. In the pterygopalatine ganglion and the trigeminal ganglion, known to innervate the nasal mucosa, SP-positive nerve cell bodies were seen. Sympathetic denervation with 6-hydroxydopamine (6-OHDA) or bilateral cervical sympathectomy did not visibly affect the distribution of SP fibers in the nasal mucosa in mice or rats. The findings are compatible with the view that the bulk of SP fibers to the nasal mucosa derive from the trigeminal ganglion with a possible contribution from the pterygopalatine ganglion.     

鼻内镜下鼻后神经丛解剖研究

目的 探讨鼻内镜下鼻后神经丛(PNNP)的构成及分布特点,为后续行鼻内镜下高选择性PNNP切断术提供解剖学参考。方法 利用5具(10侧)冰鲜尸头灌注标本,经内镜下中鼻道入路,解剖蝶腭孔周围区域内结构;利用5具人体标本解剖前接受的鼻窦CT扫描结果,经影像学工具测量相应结构间距离。利用内镜系统采集解剖图像,影像测量软件获取影像学数据,并由资深放射科医师盲法测量。在解剖过程中,寻找蝶腭孔周围区域重要解剖标志及各结构间的毗邻关系。去除腭骨蝶突及蝶骨鞘突骨质,开放骨性腭鞘管,暴露PNNP咽支,在腭鞘管前口外侧探查定位翼管神经。结果 PNNP出蝶腭孔后均存在3个主要分支与蝶腭动脉分支血管伴行,前下方有与蝶腭鼻后外侧支伴行的鼻腔外侧壁支,后上方有与上鼻甲动脉伴行的上鼻甲支,后内侧有与鼻后中隔动脉伴行的鼻中隔支,蝶腭神经节在翼腭窝内即发出咽支,未穿出蝶腭孔,通过腭鞘管进入鼻咽部,且翼管前口均位于腭鞘管前口的外侧。腭鞘管前口外侧壁至翼管前口内侧壁间距,内镜下测量值(5.90±1.12)mm,影像学测量值(6.30±1.06)mm。结论 通过解剖定位腭鞘管,开放骨性腭鞘管,暴露其中的PNNP咽支,探讨腭鞘管前口与翼管前口之间的位置关系及术中规避翼管神经及蝶腭神经节的安全操作范围,为变应性鼻炎精准手术治疗提供解剖依据。     

Bilateral trigeminal nerve sensory deficits and nasal deformity

A nasal deformity developed in a woman with bilateral trigeminal sensory deficits. A comparison of the clinical and pathologic features of this case with those of several other cases that have been reported previously suggests a relationship between the bilateral fifth nerve lesions and the nasal damage. The aforementioned clinical combination does not appear to be pathognomonic of any specific nosologic entity. However, it probably should be accorded the status of a clinical syndrome since the nasal degeneration apparently occurs only if both fifth nerves are affected.     

鼻腔恶性外周神经鞘肿瘤1例

患者,女,52岁,因左侧鼻塞1年余入院。鼻塞呈持续性,进行性加重,伴咽干,无流涕、鼻出血、嗅觉障碍、头痛、复视。鼻内镜下见左侧鼻腔内一肿物填塞后鼻孔及鼻咽部,色灰白,质稍硬,表面光滑可见毛细血管扩张,无破溃(图1),鼻中隔稍右偏。     

The effect of nasal sensory nerve on the enhanced nasal blood vessel permeability caused by histamine

The rats' nasal blood vessel permeability caused by histamine was significantly lower in the groups pretreated with dicaine or maxillary neurectomy than in the histamine control group. The rats' nasal blood vessel permeability also enhanced with the central side of maxillary nerve stimulated electrically. The latter effect could be blocked by pretreating with atropine. Combining with other experimental results, we suggest that the nasal sensory nerve joins the processes of the nasal blood vessel permeability enhancement caused by histamine.     

经鼻内镜鼻腔筛蝶窦进路视神经减压术17例临床体会

目的总结鼻内镜下鼻腔筛蝶窦进路视神经减压术治疗外伤性视力障碍的临床经验.方法回顾性分析鼻内镜下视神经减压术治疗外伤性视力障碍17例的临床资料.结果随访1～2年,其中13例有不同程度的视力改善,4例无效,全部病例无并发症出现,鼻腔生理结构无改变.结论经鼻内镜筛蝶窦入路行视神经减压术疗效确切.对伤后时间长,经保守治疗无效,而视力损伤严重患者,手术仍有可能挽救患者的视力.     

鼻内窥镜射频热凝筛前神经治疗变应性鼻炎

探讨提高治疗变应性鼻炎效果的方法，方法：利用息肉窥锏上筛前神经射频治疗变就性鼻炎患者８８例，随访１年，结果，显效７３例，有效１１例，无效４例，总有效率达９５．５％，结论鼻内窥镜下筛前神经射频治疗变应性鼻炎具有疗效显著，操作方便，治疗部位准确等优点，有较好临床应用价值。     

Cost-effectiveness analysis comparing in-office posterior nasal nerve ablation to surgical therapies

BackgroundRecently, in-office posterior nasal nerve ablation (PNA) devices have offered a new tool to treat refractory chronic rhinitis, but their cost-effectiveness relative to traditional interventions such as vidian neurectomy (VN) and posterior nasal neurectomy (PNN) remains unexplored.ObjectiveTo compare the cost-effectiveness of these interventions in patients with refractory chronic rhinitis.MethodsA decision tree with embedded Markov models was created to compare the cost-effectiveness of PNN, VN, and PNA, measured in quality-adjusted life years (QALYs) over a 30-year time horizon with a $100,000/QALY willingness-to-pay threshold. One- and two-way sensitivity analyses were completed.ResultsSensitivity analysis found that in-office PNA became cost-effective compared to VN when patients undergoing PNA were less than 20 % more likely than VN to have symptoms recur; this value was assumed to be twice as likely in the base case. In the base case, however, VN and in-office PNA were more effective and less expensive than PNN, while VN was cost-effective when compared to in-office PNA (incremental cost-effectiveness ratio $11,616.24/QALY). Other assumptions were not found to considerably impact incremental cost-effectiveness.ConclusionAlthough highly limited by currently available data, PNA may be cost-effective compared to VN as long-term outcomes on the durability of its effects emerge. These data should not be used by payers considering coverage or utilization since long-term data is still nascent. However, that as new technologies emerge for rhinitis, it will be important to monitor longer-term outcomes to identify high value care, but based on limited data PNA devices may meet this standard.