2025 年第 6 期 第 20 卷

翼管神经切断术联合筛前神经切断术对合并变应性鼻炎的慢性鼻窦炎患者嗅觉及临床疗效的影响

Effect of vidian neurectomy combined with anterior ethmoidal neurotomy on olfaction and clinical efficacy in patients with chronic sinusitis complicated with allergic rhinitis

作者：丁乐霓李佩忠

英文作者：Ding Yueni Li Peizhong

单位：南京医科大学附属淮安第一医院耳鼻咽喉头颈外科，淮安223300

英文单位：Department of Otorhinolaryngology Head and Neck Surgery the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University Huaian 223300 China

关键词：慢性鼻窦炎；变应性鼻炎；嗅觉；鼻内镜手术；翼管神经切断术；筛前神经切断术

英文关键词：Chronicsinusitis;Allergicrhinitis;Olfaction;Endoscopicsinussurgery;Vidianneurectomy;Anteriorethmoidalneurotomy

• 摘要：

• 目的 探讨翼管神经切断术(VN)联合筛前神经切断术（AEN）对合并变应性鼻炎的慢性鼻窦炎(CRSwAR)患者嗅觉及临床疗效的影响。方法 回顾性收集2022年12月至2023年12月在南京医科大学附属淮安第一医院耳鼻咽喉科就诊并首次接受手术治疗的中重度CRSwAR伴嗅觉障碍的54例患者病历资料。根据患者施行的具体手术情况分为观察组（26例）和对照组（28例）。对照组行功能性鼻内镜手术治疗，观察组在对照组基础上行单侧VN及双侧AEN治疗。比较2组手术前后外周血嗜酸性粒细胞百分比（EOS%）、Sniffin′sticks嗅觉测试总评分、主观症状学评分［鼻腔鼻窦结局测试（SNOT-22）、鼻结膜炎生存质量调查问卷(RQLQ)评分］、鼻内镜Lund-Kennedy及鼻腔鼻窦CT Lund-Mackay评分，评估并分析手术前后嗅觉、鼻部症状变化情况。通过广义混合线性模型分析影响Sniffin′sticks嗅觉测试总评分的因素，并比较2组术后复发率。结果 2组EOS%均随时间下降（P组内＜0.01）但未见明显交互作用（P交互=0.33）。主体内效应分析显示，Sniffin′sticks嗅觉测试总评分随时间变化（P组内＜0.01），且观察组评分上升程度较对照组更快（P交互＜0.01）。SNOT-22、RQLQ评分均具有时间变化趋势、存在交互作用，2组以上评分方面的治疗效果存在明显差异（均P组间＜0.05）。2组术后1年鼻内镜Lund-Kennedy及鼻腔鼻窦CT Lund-Mackay评分均低于术前，且观察组鼻内镜Lund-Kennedy评分低于对照组［（3.3±0.3）分比（4.7±3.0）分］（均P＜0.05）。广义线性混合模型分析结果显示，鼻内镜Lund-Kennedy评分对Sniffin′sticks嗅觉测试总评分有影响（P=0.031）。观察组复发率低于对照组［7.7%(2/26)比32.1%(9/28)］（P=0.026）。结论 VN及AEN联合功能性鼻内镜手术有利于恢复CRSwAR患者嗅觉功能和鼻黏膜功能，降低术后复发率。

• Objective To investigate the effect of vidian neurectomy (VN) combined with anterior ethmoidal neurotomy (AEN) on olfaction and clinical efficacy in patients with chronic sinusitis complicated with allergic rhinitis (CRSwAR). Methods The medical records of 54 patients with moderate to severe CRSwAR with olfactory dysfunction who were treated in the Department of Otolaryngology, the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University from December 2022 to December 2023 were retrospectively collected. The patients were divided into observation group (26 cases) and control group (28 cases) according to the specific operation conditions. The control group was treated with functional endoscopic sinus surgery, while the observation group was treated with unilateral VN and bilateral AEN on the basis of the control group. The percentage of eosinophils in peripheral blood (EOS%), the total score of Sniffin′sticks olfactory test, subjective symptom score ［sinonasal outcome test (SNOT-22), rhinoconjunctivitis quality of life questionnaire (RQLQ) score］, Lund-Kennedy score of nasal endoscopy and Lund-Mackay score of nasal cavity and paranasal sinus CT were compared between the two groups before and after surgery, and the changes of olfactory and nasal symptoms before and after operation were evaluated and analyzed. The factors affecting the total score of Sniffin′sticks olfactory test were analyzed by generalized mixed linear model, and the postoperative recurrence rate was compared between the two groups. Results Both groups of EOS% decreased over time (Pwithin group＜0.01), but no significant interaction was observed (Pinteraction=0.33). The analysis of within subject effects showed that the total score of Sniffin′sticks olfactory test changed over time (Pwithin group＜0.01), and the observation group showed a faster increase in scores compared to the control group (Pinteraction＜0.01). Both SNOT-22 and RQLQ scores had a temporal trend and interactive effects, and there was a significant difference in the treatment effect between the two groups in terms of the above scores (both Pinter group＜0.05). One year after surgery, the Lund-Kennedy scores of nasal endoscopy and nasal sinus CT in both groups were lower than before surgery, and the observation group had lower Lund-Kennedy scores of nasal endoscopy than the control group［(3.3±0.3) vs (4.7±3.0)］(both P＜0.05). The results  of generalized linear mixed model analysis showed that the Lund-Kennedy score of nasal endoscopy had an effect on the total score of Sniffin′sticks olfactory test (P=0.001). The recurrence rate of the observation group was lower than that of the control group ［7.7%(2/26) vs 32.1%(9/28)］(P=0.026). Conclusion VN and AEN combined with functional endoscopic sinus surgery is beneficial to restore the olfactory function and nasal mucosal function of CRSwAR patients, and reduce the postoperative recurrence rate.