翼管神经切断术与保守方式治疗中重度变应性鼻炎疗效的Meta分析
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摘要
目的:通过Meta分析的方法比较鼻内镜下翼管神经切断术与保守治疗中重度变应性鼻炎(AR)的临床疗效差异。方法:检索包括国内现已发表的相关临床对照研究。所检索的数据库包括Embase、Pubmed、Web of Science、Cochrane Library、中国知网、维普、万方等数据库。对检索的相文献进行阅读和筛选,并使用Review Manager 5.3软件分析纳入文献的相关数据。结果:纳入6篇病例对照研究。Meta分析结果显示,相较于保守治疗,采用鼻内镜下翼管神经切断术治疗中重度AR患者的RQLQ评分[95%CI(-0.98,-0.63),P<0.001]更低、并发症发生率[95%CI(0.17,0.67),P=0.002]更低、VAS评分[95%CI(-3.97,-3.65),P<0.001]更低、有效率[95%CI(1.18,50.52),P=0.03]更高,以上结果2组间差异均有统计学意义。结论:鼻内镜下翼管神经切断术治疗中重度AR疗效优于保守治疗。
Objective:To compare the clinical effects of vidian neurectomy with conservative management in the treatment for moderate-severe allergic rhinitis.Method:The studies using case controlled trials which were retrieved from Embase,Pubmed,Web of Science,Cochrane Library etc.The Cochrane risk assessment criteria were used to evaluate the quality of the articles that met the inclusion criteria.Manager 5.3 software was used to data analysis.Result:Six articles were included in meta-analysis.Meta-analysis showed that vidian neurectomy group got lower RQLQ scores[95%CI(-0.98,-0.63),P<0.001],less incidence of complications[95%CI(0.17,0.67),P=0.002],lower VAS score[95%CI(-3.97,-3.65),P<0.001]and higher clinically effective ratio[95%CI(1.18,50.52),P=0.03]than conservative treatment group.Conclusion:In summary,we believe that nasal endoscopic vidian neurectomy in the treatment of moderate-severe allergic rhinitis is superior to conservative treatment.
Objective:To compare the clinical effects of vidian neurectomy with conservative management in the treatment for moderate-severe allergic rhinitis.Method:The studies using case controlled trials which were retrieved from Embase,Pubmed,Web of Science,Cochrane Library etc.The Cochrane risk assessment criteria were used to evaluate the quality of the articles that met the inclusion criteria.Manager 5.3 software was used to data analysis.Result:Six articles were included in meta-analysis.Meta-analysis showed that vidian neurectomy group got lower RQLQ scores[95%CI(-0.98,-0.63),P<0.001],less incidence of complications[95%CI(0.17,0.67),P=0.002],lower VAS score[95%CI(-3.97,-3.65),P<0.001]and higher clinically effective ratio[95%CI(1.18,50.52),P=0.03]than conservative treatment group.Conclusion:In summary,we believe that nasal endoscopic vidian neurectomy in the treatment of moderate-severe allergic rhinitis is superior to conservative treatment.
引文
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[14]赵家利,李杜若,高进良,等.鼻内镜下翼管神经切断术治疗92例持续性变应性鼻炎的近远期临床观察[J].海南医学院学报,2013,19(8):1153-1155.
[15]GOLDING-WOOD P H.Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis[J].J Laryngol Otol,1961,75:232-247.
[16]UNDEM B J,TAYLOR-CLARK T.Mechanisms underlying the neuronal-based symptoms of allergy[J].J Allergy Clin Immunol,2014,133:1521-1534.
[17]LEE J C,LIN Y S.Endoscopic vidian neurectomy:update on techniques and evidence[J].Curr Opin Otolaryngol Head Neck Surg,2012,20:66-72.
[18]冀永进,张艳廷,赵长青,等.鼻内镜下经蝶窦翼管神经切断术的手术探讨[J].中国耳鼻咽喉颅底外科杂志,2014,20(6):483-486.
[19]MARSHAK T,YUN W K,HAZOUT C,et al.A systematic review of the evidence base for vidian neurectomy in managing rhinitis[J].J Laryngol Otol,2016,130Suppl 4:S7-S28.
[20]NUMMINEN J.Allergic rhinitis[J].Duodecim,2017,133:473-478.
[21]LV C,ZHANG Y,SHEN L.Preliminary Clinical Effect Evaluation of Resveratrol in Adults with Allergic Rhinitis[J].Int Arch Allergy Immunol,2018,175:231-236.
[22]黄宾,李鹏,孟庆翔,等.鼻内镜下鼻后神经切断术治疗中重度持续性变应性鼻炎的疗效观察[J].临床耳鼻咽喉头颈外科杂志,2017,31(19):1501-1503.
[2]WHEATLEY L M,TOGIAS A.Clinical practice.Allergic rhinitis[J].N Engl J Med,2015,372:456-463.
[3]BOUSQUET J,KHALTAEV N,CRUZ A A,et al.Allergic Rhinitis and its Impact on Asthma(ARIA)2008update(in collaboration with the World Health Organization,GA(2)LEN and AllerGen)[J].Allergy,2008,(63Suppl)86:8-160.
[4]CHHABRA N,HOUSER S M.The surgical management of allergic rhinitis[J].Otolaryngol Clin North Am,2011,44:779-795.
[5]SU W F,LIU S C,CHIU F S,et al.Antegrade transsphenoidal vidian neurectomy:short-term surgical outcome analysis[J].Am J Rhinol Allergy,2011,25:e217-220.
[6]SEIDMAN M D,GURGEL R K,LIN S Y,et al.Clinical practice guideline:Allergic rhinitis[J].Otolaryngol Head Neck Surg,2015,152(1Suppl):S1-43.
[7]TAN G,MA Y,LI H,et al.Long-term results of bilateral endoscopic vidian neurectomy in the management of moderate to severe persistent allergic rhinitis[J].Arch Otolaryngol Head Neck Surg,2012,138:492-497.
[8]谭国林,马艳红,刘更盛,等.鼻内镜下翼管神经切断术治疗中-重度持续性变应性鼻炎的远期临床疗效[J].中华耳鼻咽喉头颈外科杂志,2011,46(6):449-454.
[9]OKUBO K,KURONO Y,FUJIEDA S,et al.Japanese Guideline for Allergic Rhinitis 2014[J].Allergol Int,2014,63:357-375.
[10]AMEDEE R G.Long-term Results of Bilateral Endoscopic Vidian Neurectomy in the Management of Moderate to Severe Persistent Allergic Rhinitis[J].Am J Rhinol Allergy,2012,26:418-418.
[11]AI J,XIE Z,QING X,et al.Clinical Effect of Endoscopic Vidian Neurectomy on Bronchial Asthma Outcomes in Patients with Coexisting Refractory Allergic Rhinitis and Asthma[J].Am J Rhinol Allergy,2018,32:139-146.
[12]于博.鼻内镜下翼管神经切断术治疗68例持续性变应性鼻炎效果观察[J].河南外科学杂志,2015,21(5):70-71.
[13]黄钦辉,阙镇如.鼻内镜下翼管神经切断术治疗持续性变应性鼻炎近远期疗效[J].中国实用神经疾病杂志,2015,18(12):95-96.
[14]赵家利,李杜若,高进良,等.鼻内镜下翼管神经切断术治疗92例持续性变应性鼻炎的近远期临床观察[J].海南医学院学报,2013,19(8):1153-1155.
[15]GOLDING-WOOD P H.Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis[J].J Laryngol Otol,1961,75:232-247.
[16]UNDEM B J,TAYLOR-CLARK T.Mechanisms underlying the neuronal-based symptoms of allergy[J].J Allergy Clin Immunol,2014,133:1521-1534.
[17]LEE J C,LIN Y S.Endoscopic vidian neurectomy:update on techniques and evidence[J].Curr Opin Otolaryngol Head Neck Surg,2012,20:66-72.
[18]冀永进,张艳廷,赵长青,等.鼻内镜下经蝶窦翼管神经切断术的手术探讨[J].中国耳鼻咽喉颅底外科杂志,2014,20(6):483-486.
[19]MARSHAK T,YUN W K,HAZOUT C,et al.A systematic review of the evidence base for vidian neurectomy in managing rhinitis[J].J Laryngol Otol,2016,130Suppl 4:S7-S28.
[20]NUMMINEN J.Allergic rhinitis[J].Duodecim,2017,133:473-478.
[21]LV C,ZHANG Y,SHEN L.Preliminary Clinical Effect Evaluation of Resveratrol in Adults with Allergic Rhinitis[J].Int Arch Allergy Immunol,2018,175:231-236.
[22]黄宾,李鹏,孟庆翔,等.鼻内镜下鼻后神经切断术治疗中重度持续性变应性鼻炎的疗效观察[J].临床耳鼻咽喉头颈外科杂志,2017,31(19):1501-1503.