| Objective: To explore the effect of surgical treatment for the subjective efficiency of moderate/severe persistent allergic rhinitis with deviation of nasal septum.Methods: For 25 patients of moderate/severe persistent allergic rhinitis with deviation of nasal septum, to make a treatment of endoscopic surgery. Follow up the cases in one year, record the preoperative and postoperative symptoms and sign by filling up the “visual analog scale(VAS)”, then judge the treatment results. Pathological staining was used to explore the mucosa of the inferior turbinate tissues. The infiltration of eosinophils and damage of epithelium were examined by the hematoxylin-eosin(HE) staining; goblet cells were counted by the alcian blue-periodic acid-schiff(AB-PAS) staining; the percentage area of extracellular matrix was determined by the Massonc’s trichrome(MT); IL-17 positive cells were examined by immunohistochemical staining. Through the above methods, we can assess the impact of surgery on the mucosa remodeling.Results:1. The results of the VAS evaluating the preoperative and postoperative symptoms. The VAS score related with nasal itching, sneezing, rhinorrhea, nasal obstruction of the preoperation and postoperative 3 months、postoperative 6 months、postoperative 12 months was 67.68±19.51、65.56±19.23、68.12±19.37、84.48±10.73,18.08±9.75、22.56±9.22、20.56±7.82 、 15.44±9.31,21.36±11.23 、 24.00±10.84 、 25.12±10.64 、 17.24±9 and 26.24±6.23、29.68±5.54、30.20±4.75、24.56±6.10. The difference between preoperative and postoperative was statistically significant(P<0.05). The difference between the postoperative 3 months and the postoperative 6 months has no significance(P>0.05). The difference has statistical significance between the postoperative 6 months and the postoperative 12 months(P<0.05).2. The results of histopathological observations.(1) Observing through HE staining, the number of eosinophils in the preoperation group was(60.38±13.17) cells/HP, the postoperative 3 months(8.95±4.90) cells/HP, the postoperative 6 months(12.03±5.79) cells/HP, the postoperative 12 months(26.46±6.80) cells/HP. Compared with each other,the difference was statistically significant(P<0.05). We discovered the mucosal damage of the preoperation is mainly Level 2, the postoperative 3 months Level 0, the postoperative 6 months Level 0, the postoperative 12 months Level 0. Compared with the each other, the difference has statistical significance(P<0.05).(2) Observed through AB-PAS staining, the number of goblet cells in the preoperation group was(129.72±32.66) cells/mm2, the postoperative 3 months(57.64±21.08) cells/mm2, the postoperative 6 months(95.57±23.59) cells/mm2, the postoperative 12 months(115.31±30.84) cells/mm2. Compared with each other, the difference was statistically significant(P<0.05).(3) Observed through MT staining: the thickness of the basement membrance in the preoperation group was(12.58±4.18) μm, the postoperative 3 months(5.06±1.33) μm, the postoperative 6 months(6.80±1.90) μm, the postoperative 12 months(8.43±2.02) μm. Compared with each other, the difference was statistically significant(P<0.05). The percentage area of extracellular matrix were respectively(54.54±15.70)%、(41.25±6.58)%、(43.24±7.22)% 、(48.85±10.33)%. Compared with each other, the difference was statistically significant(P<0.05).(4) Observed through immunohistochemical staining, the number of IL-17 positive cells in the preoperation group was(71.22±13.50) cells/HP, the postoperative 3 months(14.15±6.30) cells/HP, the postoperative 6 months(23.84±7.84) cells/HP, the postoperative 12 months(32.78±8.77) cells/HP.Compared with each other, the difference was statistically significant(P<0.05).Conclusion:1. Surgery treatment could significantly improve the subjective symptoms of patients with moderate/severe persistent allergic rhinitis. The curative effect in the near future is obvious. Although the long-term effect impaired, the subjective symptoms ameliorated significantly in contrast with the preoperation.The surgical therapy can be regarded as an effective treatment for patients with allergic rhinitis associated with abnormal anatomy of the nasal cavity.2. Surgery treatment could significantly attenuate the the mucosa remodeling, but it will aggravate with the passage of time. The patients should avoid the exposure to allergen and be administrated with drug or immune therapy after the operation. |
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