目的：探讨鼻内镜下高选择性鼻后神经丛切断术治疗中重度常年性变应性鼻炎的方法及疗效。方法：对20例经规范的药物和(或)免疫治疗 1 年以上疗效欠佳的中重度常年性变应性鼻炎患者作为观察组实施双侧鼻内镜下高选择性鼻后神经丛切断术,选取同一时期上述疗效欠佳的20例病人作为对照组继续接受药物治疗。根据中重度常年性AR的诊断和疗效评定标准对主要症状进行治疗前后VAS评分,通过积分法评估手术效果。结果：术后6个月进行随访评价,对照组有效3例, 无效17例,总有效率15.00% ; 观察组有效20例, 无效0例, 总有效率100.00% ,两组间疗效差异有统计学意义(P＜0.05) ;观察组鼻塞、鼻漏、喷嚏VAS 评分较对照组低(P＜0.05) , 症状较对照组改善显著。所有患者随访期间均未出现活动性鼻出血、干眼及腭部麻木等并发症。结论：鼻内镜下高选择性鼻后神经丛切断术治疗中重度常年性变应性鼻炎短期内疗效确切,能够完全切断鼻后神经的三个主要分支及细小分支,有效避免损伤翼腭窝内容物,降低术后并发症发生率。
Objective:This section is to explore the method and effect of highly selective posterior nasal neurecotmy during endoscopic for the treatment of moderate-severe perennial allergic rhinitis.Methods: 20 patients with moderate-severe perennial allergic rhinitis who had been treated with standard drugs and immunotherapy for more than one year were selected as the observation group, and high selective posterior nasal plexus transection was performed under bilateral nasal endoscopy. At the same time, 20 patients with poor curative effect were selected as the control group. According to the diagnosis and curative effect evaluation standard of moderate and severe perennial AR, the main symptoms were scored by VAS before and after treatment, and the operation effect was evaluated by integral method.Results: The follow-up evaluation was performed after 6 months. Among them, 3 cases were effective and 17 cases were ineffective in the control group, the total effective rate was 15.00%; In the observation group, 20 cases were effective and 0 case was ineffective, the total effective rate was 100.00%, and the difference between the two groups was statistically significant (P < 0.05); The VAS scores of nasal congestion, rhinorrhea and sneezing in the observation group were lower than those in the control group (P < 0.05), and the symptoms were improved significantly. During the follow-up period, no active epistaxis, dry eye or palate numbness occurred in all patients. Conclusion: highly selective posterior nassal neurectomy effective in treating moderate and severe perennial allergic rhinitis in short time. The operation can effectively avoid the injury of the Sphenopalatine ganglion in the pterygopalatine fossa.Therefore,postoperative complications are reduced .