背景：非过敏性鼻炎（NAR）的特征是鼻漏，鼻塞,打喷嚏,在没有对过敏原全身致敏的情况下。对于药物治疗和保守手术干预难以治疗的病例，更有针对性的程序，如内镜下翼管神经切除术（EVN）和后鼻神经切除术（PNN），包括手术（SPNN）和冷冻消融（CPNN）方法，可以减轻NAR的症状。
目的：本研究的目的是比较疗效，副作用配置文件，NAR的EVN和PNN之间的并发症发生率。
方法：使用Embase对报告EVN或PNN患者原始数据的主要文章进行系统评价，Medline,PubMed,和Cochrane数据库自2006年以来，根据PRISMA指南。该研究的主要结果是NAR症状严重程度的改善。次要结果包括术后副作用或并发症的发生率。
结果：总计，58篇文章符合检索标准，共有9项研究（包括2项RCT）符合纳入条件。有229名接受EVN的NAR患者的合并样本(n=65;28.4%)，SPNN（n=50；21.8%），或CPNN（n=114；49.8%）。对于所有三种技术，鼻部症状有统计学上的显著改善，尤其是鼻漏,鼻塞,和阻塞以及生活质量。结果报告的异质性阻碍了荟萃分析和疗效的直接比较。EVN术后并发症的合并发生率(n=65)，SPNN(n=50)，干眼的CPNN（n=70）分别为30.8%和0%和2.9%，上颚/脸颊麻木为16.9％，0％和1.4％，出血分别为0%和6%和4.3%。
结论：EVN，SPNN,和CPNN对于NAR难以治疗的患者同样有效。与EVN相比，SPNN和CPNN的并发症（干眼和腭/脸颊麻木）发生率较低。
BACKGROUND: Nonallergic rhinitis (
NAR) is characterized by rhinorrhea, nasal obstruction, and sneezing, in the absence of systemic sensitization to allergens. For cases refractory to medical therapy and conservative surgical interventions, more targeted procedures, such as endoscopic vidian neurectomy (EVN) and posterior nasal neurectomy (PNN), including surgical (SPNN) and cryoablative (CPNN) methods, may reduce symptoms of
NAR.
OBJECTIVE: The purpose of this study was to compare the efficacy, side effect profile, and complication rate between EVN and PNN for NAR.
METHODS: A systematic
review of primary articles that reported original patient data for either EVN or PNN was conducted using Embase, Medline, PubMed, and Cochrane databases since 2006, according to PRISMA guidelines. The primary outcome of the study was an improvement in
NAR symptom severity. Secondary outcomes included the incidence of postoperative side effects or complications.
RESULTS: In total, 58 articles met the search criteria with a total of 9 studies (including 2 RCTs) eligible for inclusion. There was a pooled sample of 229
NAR patients that underwent EVN (n = 65; 28.4%), SPNN (n = 50; 21.8%), or CPNN (n = 114; 49.8%). For all 3 techniques, there was a statistically significant improvement in nasal symptoms, particularly rhinorrhea, nasal congestion, and obstruction along with quality of life. Heterogeneity in outcome reporting prevented meta-analysis and direct comparison of efficacy. The pooled incidence of postoperative complications for EVN (n = 65), SPNN (n = 50), and CPNN (n = 70) was 30.8% versus 0% versus 2.9% for dry eye, 16.9% versus 0% versus 1.4% for palatal/cheek numbness, and 0% versus 6% versus 4.3% for bleeding.
CONCLUSIONS: EVN, SPNN, and CPNN are similarly efficacious for patients with NAR refractory to medical management. SPNN and CPNN are associated with lower rates of complications (dry eye and palatal/cheek numbness) compared with EVN.
