鼻后神经切断术治疗变应性鼻炎

Efficacy and safety of nasal posterior neurotomy for moderate to severe allergic rhinitis: a Metaanalysis

摘要:

目的通过Meta分析的方法对鼻后神经切断术治疗变应性鼻炎（allergic rhinitis,AR）的有效性与安全性进行分析，以明确该类手术的临床应用价值并提供相关循证学依据。方法通过计算机检索建库至 2019年4月，在Embase、Pubmed、Web of Science数据库、万方数据库、维普中文科技期刊数据库（VIP）及中国期刊全文数据库（CNKI）公开发表的研究鼻后神经切断术治疗AR的临床研究，根据纳入排除标准对文献进行筛选、质量评价和数据提取后，应用Revman 5.3软件对文献原始数据进行Meta分析。结果总共纳入9篇临床研究，包含1 343例患者。Meta分析结果显示，鼻内镜下鼻后神经切断术治疗AR的有效率很高［RD=0.89, 95%CI (0.82, 0.95),P<0.001］，术后鼻通气阻力减小［MD=0.33, 95%CI (0.03，0.62),P=0.03］，鼻塞症状评分降低［MD=3.30, 95%CI (0.60，6.00),P=0.02］，喷嚏症状评分减小［MD=3.21, 95%CI (1.80，4.62)，P<0.001］，流涕症状评分减小［MD=3.33, 95%CI (0.66，6.00)，P=0.01］，并发症发生率很低［RD=0.04, 95%CI (0.01, 0.08), P=0.03］，结果均具有统计学意义。结论鼻后神经切断术治疗AR有效率约为89%，术后鼻通气阻力和鼻塞、打喷嚏、流涕等症状明显减轻，且术后并发症的发生率约为4%，因此该术式对于药物治疗无效的中重度AR患者是一种有效可行的治疗方式。

Abstract:

Abstract:ObjectiveTo analyze the efficacy and safety of nasal posterior neurotomy for the treatment of allergic rhinitis (AR) by Metaanalysis to determine the clinical application value of this surgical procedure and provide relevant evidencebased evidence.MethodsEmbase, Pubmed, Web of Science, Cochrane Library, Wanfang Database, VIP, and CNKI from the establishment of database to April 2019 were systemically searched for the clinical studies on the treatment of AR by nasal posterior neurotomy. After screening, quality evaluation and data extraction according to the exclusion criteria, Metaanalysis was conducted using the Revman 5.3 software.ResultsA total of 9 clinical studies were identified, including 1 343 patients. Metaanalysis showed that nasal endoscopic posterior neurotomy was effective in the treatment of AR ［RD=0.89, 95% CI (0.82, 0.95), P<0.001］, and the postoperative nasal ventilation resistance decreased［MD=0.33, 95% CI (0.03, 0.62), P=0.03］, nasal congestion symptom score decreased［MD=3.30, 95% CI (0.60, 6.00), P=0.02］, sneezing symptom score decreased［MD= 3.21, 95% CI (1.80, 4.62), P<0.001］, salivation symptom score decreased［MD=3.33, 95% CI (0.66, 6.00), P=0.01］, and the incidence of complications was very low ［RD= 0.04, 95% CI (0.01, 0.08), P=0.03］. All the results were statistically significant.ConclusionsThe effective rate of posterior neurotomy for the treatment of AR is about 89%, postoperative nasal ventilation resistance and nasal congestion, sneezing, salivation and other symptoms are significantly relieved, and the incidence of postoperative complications is about 4%. Therefore, this procedure is an effective and feasible treatment for patients with moderate to severe AR who failed to respond to medical treatment.