| Objectives:To compare the improvement of nasal discomfort,quality of life and psychological status of patients with moderate-severe perennial allergic rhinitis(PAR)after endoscopic highly selective branches neurotomy of vidian nerve and focused ultrasound.The effective rate,incidence of adverse reactions,length of hospital stay and hospitalization cost of the two surgical methods were compared,and the respective advantages of endoscopic highly selective branches neurotomy of vidian nerve and focused ultrasound therapy were discussed.Methods:Sixty patients with moderate to severe PAR who were responding poorly to medical treatment and selected for surgical treatment in the Department of Otolaryngology,Head and Neck Surgery of Zhengzhou University People’s Hospital from September 2018 to February 2020 and who all met the diagnostic criteria of "Guidelines for the Diagnosis and Treatment of Allergic rhinitis(Tianjin,2015)" were selected as the research subjects.According to the order of admission,the patients were randomly divided into group A and group B by lotting.Group A(30cases)received highly selective branches neurotomy of vidian nerve under nasal endoscopy,and group B(30 cases)received focused ultrasound treatment.The nasal cavity was irrigated with normal saline and nasal spray of budesonide 1 week before surgery.All patients were given oral antibiotics for 2 days and mucous drainage agent for 1 week after surgery.Normal saline was used to irrigate the nasal cavity and budesonide nasal spray for 1 to 3 months after surgery according to the recovery of the nasal cavity.After that,no anti-allergy drugs were used to avoid affecting the one-year postoperative efficacy observation.The patients came to the outpatient department of our hospital for reexamination of nasal endoscopy 1 week,2 weeks,1month and 3 months after surgery to observe the conditions of nasal scab,nasal adhesion and mucosal epithelialization,and record postoperative adverse reactions.After that,the interval of reexamination was determined according to the recovery of the nasal cavity.Visual analogue scale(VAS)of nasal symptoms,nasal conjunctivitis quality of life questionnaire(RQLQ),nasal resistance(NAR)measurement and Kessler psychological distress scale(K10)were collected before and 1 year after treatment,all of which were provided by the patients themselves.In addition,data were collected on length of hospital stay and costs of hospitalization.Application of SPSS 25.0 statistical software for data analysis,using chi-square test to evaluate gender,efficient,adverse reaction rate between the two groups of difference,measurement data using K-S or S-W test was nearly normal distribution,application of paired t test to evaluate two groups before and after treatment VAS,NAR,K10 dated,application of independent sample t test evaluation before and after treatment between the two groups of VAS,RQLQ,NAR,K10 dated,and using independent sample t test to evaluate differences between two groups of the length of hospital stay and medical expenses.Pearson correlation analysis was used to assess the correlation between nasal and ocular symptoms and psychological status.Results:1.Pearson correlation analysis was performed on the preoperative RQLQ of 18 patients with a total score of over 21 points in terms of nasal and eye symptoms and the total score of K10,and the results showed that there were significant correlations between nasal congestion,sneezing,nasal itching,nasal symptoms and eye symptoms and the total score of K10(P<0.05).2.Compared with before treatment,VAS,NAR and K10 scores in group A and B at 1 year after surgery were significantly improved,and the differences were statistically significant(P<0.05);At 1 year after surgery,VAS,NAR and K10 scores in group A were lower than those in group B,and the differences were also statistically significant(P<0.05);All dimensions of RQLQ scale in group A were lower than that in group B,and the differences between groups were statistically significant(P<0.05).3.The length of hospital stay in group A was(5.70±0.95)days,and that in group B was(2.53±0.73)days.The length of hospital stay in group A was longer than that in group B,and the difference between the two groups was statistically significant(P<0.05);The hospitalization cost of group A was(12.00±0.90)thousand YUAN,and that of group B was(6.90±0.80)thousand YUAN.The hospitalization cost of group A was higher than that of group B,and the difference was statistically significant(P<0.05).4.The total effective rate of group A was 90.00%(27/30)and group B was53.33%(16/30).The total effective rate of group A was significantly higher than that of group B,and the difference was statistically significant(P<0.05);The incidence of adverse reaction in group A within 3 months after operation was 6.67%(2/30)lower than that in group B(20.00%,6/30),but the difference was not statistically significant(P>0.05).Conclusions:1.Both endoscopic highly selective branches neurotomy of vidian nerve and focused ultrasound are effective adjuvant methods for the treatment of moderate to severe perennial allergic rhinitis,which can significantly reduce symptoms,improve the quality of life and improve the psychological state;2.Compared with focused ultrasound,endoscopic highly selective branches neurotomy of vidian nerve has a more significant effect,while the latter has the advantages of shorter hospitalization time and lower hospitalization cost. |
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