内镜下翼管神经分支切断术联合益生菌治疗常年性中-重度变应性鼻炎的疗效观察

Observation on the therapeutic effect of endoscopic vidian nerve branch transection combined with probiotics in the treatment of perennial moderate-to-severe allergic rhinitis

摘要:

目的 探讨内镜下翼管神经分支切断术联合益生菌干预治疗常年性中-重度变应性鼻炎（AR）的临床疗效，明确局部神经调控及肠道免疫调节协同方案对患者症状改善、免疫平衡及肠道菌群的影响，为常年性 中-重度AR治疗提供微创与全身调节结合的新策略。方法 选取2023年6月—2024年6月经常规抗过敏药物治疗无效的60例常年性中-重度AR患者，根据随机抽签法分为3组，每组20例。联合组予内镜下翼管神经分支切断术联合益生菌治疗，手术组单纯行内镜下翼管神经分支切断术，益生菌组单纯给予益生菌；干预后各组均给予规范抗过敏药物对症治疗，分别于治疗前及治疗后3、6个月对比分析3组患者视觉模拟评分（VAS）、鼻结膜炎生活质量问卷（RQLQ）评分、血清免疫指标IgE、嗜酸性粒细胞比率（EO%）及并发症发生情况。结果 治疗后 3、6个月，联合组鼻塞、流涕、喷嚏、鼻痒各维度VAS评分及RQLQ评分均显著低于手术组和益生菌组（P< 0.05）；同期血清IgE、EO%水平显著降低，上述指标改善程度均优于其他两组（P<0.05）。结论 内镜下翼管神经分支切断术联合益生菌治疗常年性中-重度AR，可通过局部精准阻断神经缓解症状、通过调节肠道菌群改善全身免疫平衡，二者协同提升疗效并延长作用时间，安全性良好，是一种兼具微创优势与全身免疫调节价值的创新治疗方案，值得临床推广应用。

Abstract:

Objective To explore the clinical efficacy of endoscopic vidian nerve branch transection combined with probiotic intervention in the treatment of perennial moderate-to-severe allergic rhinitis (AR), and to clarify the impact of the “local nerve regulation + intestinal immune modulation” combined strategy on symptom improvement, immune balance, and intestinal flora in patients, so as to provide a new strategy that combines minimally invasive and systemic regulation for the treatment of perennial moderate-to-severe AR.Methods Sixty patients with perennial moderate-to-severe AR who were unresponsive to conventional antiallergic drug treatment from June 2023 to June 2024 were selected and randomly divided into three groups by lottery, with 20 cases in each group. The combined group was treated with endoscopic vidian nerve branch transection combined with probiotics, the surgery group underwent endoscopic vidian nerve branch transection alone, and the probiotics group was treated with probiotics alone. All patients were given standardized antiallergic drug treatment after intervention. The visual analogue scale (VAS) scores for nasal congestion, rhinorrhea, sneezing, and nasal itching, the rhinoconjunctivitis quality of life questionnaire (RQLQ) scores, serum immune indicators including immunoglobulin E (IgE) and eosinophil ratio (EO%), and the occurrence of complications among the three groups were compared and analyzed before treatment and at 3 and 6 months after treatment.Results At 3 and 6 months after treatment, the VAS scores for nasal congestion, rhinorrhea, sneezing, and nasal itching and RQLQ scores of the combined group were significantly lower than those of the surgery group and the probiotics group (P<0.05), the levels of serum IgE and EO% were significantly reduced, and the improvement in these indicators was better than that of the other two groups (P<0.05).Conclusions Endoscopic vidian nerve branch transection combined with probiotics for the treatment of perennial moderate-to-severe AR can relieve symptoms by precisely blocking the nerves locally, and improve systemic immune balance by regulating the intestinal flora. The two methods work together to enhance therapeutic effect and prolong the duration of action, with good safety. It is an innovative treatment approach that combines the advantages of minimally invasive surgery and systemic regulation, and is worthy of clinical promotion and application.