鼻窦黏液囊肿的临床研究进展

鼻窦黏液囊肿的形成与鼻腔疾病、外伤、术后粘连等引起的鼻窦自然开口堵塞有关。囊壁内衬上皮多为假复层纤毛柱状上皮。临床主要表现为囊肿压迫相应部位出现一系列症状 ,如突眼、复视、头痛等。CT和MRI联合应用有助于鼻窦黏液囊肿的诊断 ,囊液蛋白的含量决定囊肿的影像的密度。经鼻内镜袋状化 (或造袋术 )手术是目前理想的术式 ,术中不必切除全部囊壁。     

鼻内镜治疗慢性鼻窦炎鼻息肉术后术腔上皮修复过程中组织病理学观察

目的:探讨慢性鼻窦炎鼻息肉鼻内镜术后术腔上皮阶段性修复的特点及规律,为改进鼻内镜术后处理措施提供依据。方法:对20例慢性鼻窦炎鼻息肉患者,在鼻内镜术后7~14 d取筛窦外侧壁、筛窦顶及上颌窦口处囊泡组织,分别进行光、电镜观察。结果:①内镜下见囊泡呈灰白色或淡黄色,半透明,有的含有囊液,有的为实质性。②光镜下见16例囊泡上皮为假复层纤毛柱状上皮,2例为复层鳞状上皮,2例在假复层纤毛柱状上皮中有节断性鳞状上皮组织转化;固有层水肿,上皮层及上皮下层有多量炎性细胞浸润,上皮下可见黏液腺、混合腺及其导管;小血管扩张充血。③电镜下见上皮为假复层纤毛柱状上皮,纤毛排列尚整齐,其间有微绒毛。多数纤毛横断面可见9 2型微管结构,有些中心微管缺如,有些仅有1个中心微管。上皮细胞中高尔基复合体发达,内质网扩张,线粒体多数呈明显凝集变性,有的线粒体呈1~2度肿胀,溶酶体增多。上皮内可见炎性细胞浸润,多数为中性粒细胞及淋巴细胞,也可见嗜酸粒细胞及浆细胞。结论:囊泡是鼻内镜术后术腔上皮再生反应活跃的表现,是术腔上皮化过程中的一个早期不平衡的再生过程,提示术后囊泡是类似鼻息肉组织病理学改变的早期局限性、病理性修复的现象。清除这种失衡的上皮化组织———囊泡,能有效遏制鼻息肉复发,使术腔上皮化均衡展开。     

鼻前庭囊肿发生机制的探讨

目的：探讨鼻前庭囊肿的发生机制及临床表现。方法：回顾地分析42例鼻前庭囊肿的临床表现、病理学检查和手术治疗效果。结果：42例鼻前庭囊肿被覆上皮类型中，24例为假复层柱状上皮，5例为复层鳞状上皮，5例为单层立方上皮，8例为其中2种上皮的混合；23例发现有杯状细胞。所有病例均经唇龈沟进路手术切除，随访6个月～10年未见复发。结论：鼻泪管系统的发育异常在鼻前庭囊肿的发生机制中可能起主要作用。手术治疗鼻前庭囊肿时，彻底切除较内镜下开窗引流更为合理。     

鼻咽部上皮组织与鼻咽癌细胞的超微结构

本文报道收集11例鼻咽部上皮组织及30例鼻咽低分化癌活检标本,用树脂包埋,半薄切片定位,超薄切片和电镜观察,并做石蜡切片,光镜观察。对鼻咽部上皮组织电镜观察,可见假复层纤毛柱状上皮中的纤毛柱状细胞,有较发达的粗面内浆网、高尔基体及分泌颗粒(以上三者统称为管泡系统),亦有少量桥粒及微丝;复层鳞状上皮中的棘细胞,有较丰富的微丝、桥粒及     

下鼻甲肥大的外科治疗

1病理生理基础下鼻甲由内侧黏膜层、下鼻甲骨及外侧黏膜层组成。下鼻甲骨为来自上颌骨的独立骨片，从前向后弧状隆起，它维持着下鼻甲的基本形状。下鼻甲黏膜大部分为假复层纤毛柱状上皮，受外界刺激后可转变为复层立方上皮或复层鳞状上皮。下鼻甲黏膜中含有丰富的黏液腺、浆液腺、混合型腺体及杯状细胞，其分泌的液体在黏膜表面形成一层黏液毯，正常的黏液纤毛清除系统是维持鼻腔正常生理功能的基础。黏膜下层有丰富的毛细血管，毛细血管和小静脉之间形成海绵状血窦，内有丰富的含血腔隙，深层的小动脉和小静脉形成动静脉吻合，这些都是调节鼻阻力的主要结构。黏膜基底层具有防御屏障的功能，内侧黏膜基底层明显厚于外侧。     

中耳炎和鼻窦炎:类似的疾病

中耳炎和鼻窦炎是儿童门诊常见病，这两个诊断具有许多共同特征。儿童鼻窦粘膜水肿很常见，因各种原因行CT扫描的儿童几乎一半显示鼻窦粘膜异常。Gwaltney报告上呼吸道疾病的青少年中，筛漏斗闭塞发生率占95％。鼻窦和鼻窦通道的粘膜由假复层柱状纤毛上皮构成，纤毛运动将分泌物向鼻窦自然开口引流而排出，沿通道从鼻窦流到鼻咽。中耳腔除侧壁是鼓膜外，其它与鼻窦腔类似。中耳自然开口离开膜性壁，而是位于咽鼓管。中耳向内方经咽鼓管引流流到鼻咽，其方式类似其它具窦。咽鼓管和中耳的粘膜都是覆盖假复层柱状纤毛上皮。事实上，中耳是一…     

咽鼓管咽口黏膜上皮的超微结构

目的观察咽鼓管咽口黏膜上皮的超微结构。方法取4例健康人咽鼓管咽口的组织做透射电镜标本，观察黏膜上皮的超微结构。结果咽鼓管咽口黏膜上皮为假复层纤毛柱状上皮，由纤毛柱状细胞、无纤毛柱状细胞、分泌细胞、中间细胞和基底细胞等组成，这些细胞的基部均贴附在基底膜上。可见亮颗粒分泌细胞。各类细胞可见表面活性物质板层体。黏膜下见弹性纤维和胶原纤维构成弹性纤维带。结论咽鼓管咽口黏膜上皮为假复层纤毛柱状上皮，可见亮颗粒分泌细胞，各类细胞可见板层体存在，分泌表面活性物质，弹性纤维带维持和形成咽鼓管咽口。     

慢性鼻窦炎对咽鼓管咽口黏膜上皮超微结构的影响

目的探讨慢性鼻窦炎对咽鼓管咽口黏膜上皮超微结构的影响,进一步反映对中耳、咽鼓管功能的影响。方法取6例慢性鼻窦炎患者和4例健康人咽鼓管咽口的组织做透射电镜标本,对比观察两类组织黏膜上皮的超微结构。结果①健康人咽鼓管咽口黏膜上皮为假复层纤毛柱状上皮,可见亮颗粒分泌细胞,各类细胞可见表面活性物质样板层体。②慢性鼻窦炎咽鼓管咽口可出现部分假复层纤毛柱状上皮脱落,细胞的纤毛、微绒毛倒伏、脱落,胞质泡状系统融合、扩张、溶解,分泌颗粒、杯状细胞增多。细胞间隙增大,有瘢痕,有炎症细胞浸润。表面活性物质样板层体减少、消失。结论正常咽鼓管咽口黏膜上皮为假复层纤毛柱状上皮,慢性鼻窦炎可引起咽鼓管咽口上皮、上皮各类细胞的超微结构发生改变,表面活性物质样板层体减少、消失。     

咽鼓管咽口表面活性物质板层体超微结构的观察

目的 观察咽鼓管咽口黏膜上皮表面活性物质板层体的超微结构.方法 取4例知情同意受检的健康人咽鼓管咽口的组织做透射电镜标本,观察表面活性物质板层体的超微结构.结果 咽鼓管咽口下壁黏膜上皮为假复层纤毛柱状上皮,可见亮颗粒分泌细胞,各类细胞可见表面活性物质板层体,圆或椭圆形,层状或线圈状小体,致密电子密度,散在.结论 咽鼓管咽口下壁黏膜上皮为假复层纤毛柱状上皮,上皮内有亮颗粒分泌细胞,上皮各类细胞可见表面活性物质板层体,分泌表面活性物质,参与咽鼓管的功能.     

电动鼻窦切割钻和微波切除部分下鼻甲对鼻黏膜纤毛清除系统的影响

目的：探讨电动鼻窦切割钻（HUMMER）和微波切除部分下鼻甲对鼻黏膜纤毛清除系统的影响，为临床选择合理术式提供理论依据。方法：HUMMER切除部分下鼻甲组（HUMMER组）和微波切除部分下鼻甲组（微波组）各20例，无鼻腔疾病的健康对照组10例。每例患者分别于术前、术后3个月和术后6个月取材，健康对照组任选5例取材。每次取每个研究对象的下鼻甲黏膜，分别行光镜和扫描电镜观察。所有患者取材之前用糖精试验测定鼻黏膜纤毛输送率（MTR）。结果：①HUMMER组术前、术后3个月和术后6个月MTR分别为（3．63±0．57）、（3．76±0．43）、（6．09±1．19）mm／min，术后6个月与术前、术后3个月比较差异均有统计学意义（均P〈0．01）。微波组术后3、6个月MTR分别为（3．96±0．40）和（3．95±0．32）mm／min，与健康对照组（6．20±0．68）mm／min比较差异均有统计学意义（均P〈0．01）。微波组术后6个月与HUMMER组术后6个月MTR比较差异有统计学意义（P〈0．01）。②光镜及扫描电镜观察：HUMMER组和微波组术前鼻黏膜上皮内杯状细胞增多，纤毛排列紊乱、缺失，粗细长短不一，部分黏膜上皮由假复层纤毛柱状上皮化生为单层立方上皮；HUMMER组术后鼻黏膜上皮再生为假复层纤毛柱状上皮，基本和正常黏膜纤毛系统表现一致。微波组术后鼻黏膜纤毛上皮很少再生，黏膜上皮化生为鳞状上皮，纤毛断裂缺失较重。结论：HUMMER切除部分下鼻甲术在保护和恢复鼻腔功能方面优势比较明显。     

鼻内镜术后中鼻道黏膜变化及其临床意义

目的观察鼻内镜术后中鼻道黏膜变化及其临床意义。方法慢性鼻窦炎鼻息肉病人34例,FESS术后1个月和3个月取其前筛区黏膜标本;以鼻中隔偏曲病人30例(既往无鼻窦炎病史)作为对照,于鼻中隔矫正术中取其钩突黏膜标本;均行光镜观察,IL-2、TNF-α的免疫组化染色以及糖精试验。结果①光镜观察:FESS术后1个月前筛区黏膜上皮有26例(76%)为鳞-柱交界上皮,8例为假复层柱状纤毛上皮;术后3个月前筛区黏膜34例基本恢复为假复层柱状纤毛上皮。②糖精试验:FESS术后1个月与3个月比较、FESS术后1个月与正常对照组比较MTR之间均存在显著差异(P<0.05),FESS术后3个月与正常对照组间无显著差异。③免疫组化染色结果:FESS术后1个月IL-2、TNF-α阳性细胞数明显高于术后3个月组(P<0.05)及正常对照组(P<0.01);FESS术后3个月IL-2、TNF-α阳性细胞数与对照组无明显差异(P>0.05)。结论①鼻内镜术后中鼻道黏膜的恢复包括炎性反应和组织重塑。②术后及时应用糖皮质类固醇对预防复发非常重要。③术后随访应大于3个月或更长。     

筛骨垂直板气化与黏液囊肿

目的　观察鼻中隔筛骨垂直板气化的发生率 ,探讨筛骨垂直板黏液囊肿诊断和治疗问题。方法　复习作为资料保存的 1994～ 1996年 3 2例鼻中隔偏曲患者的CT资料 ,介绍 1例罕见的筛骨垂直板黏液囊肿 (鼻中隔黏液囊肿 )。结果　 3 2例鼻腔 鼻窦冠状CT资料中 ,6例 (18% )有筛骨垂直板气化 ,其中 2例气化部位在筛骨垂直板前部 (额鼻中隔气化 ) ,4例气化部位在筛骨垂直板后部(蝶鼻中隔气化 )。对 1例鼻中隔黏液囊肿患者在内镜下施行了造袋术 ,经随访 10个月 ,无复发。结论　筛骨垂直板气化是鼻中隔支架的一种解剖变异 ,其临床意义在于它有可能形成黏液囊肿。对于筛骨垂直板黏液囊肿 ,在内镜下施行造袋术是首选方法     

Pneumatization of perpendicular plate of the ethmoid bone and mucocele]

OBJECTIVE: To find out the prevalence of pneumatization of perpendicular plate of the ethmoid bone, and to discuss the diagnosis and management of perpendicular plate mucocele (nasal septal mucocele). METHODS: The CT data from 32 patients with septal deviation were reviewed, and an unusual case of perpendicular plate mucocele was reported. RESULTS: Six cases (6/32, 18%) were found to have pneumatization of perpendicular plate of the ethmoid bone, with 2 located in the anterior portion (frontal-septal pneumatization), and 4 located in the posterior portion (spheno-septal pneumatization). A patient with perpendicular plate mucocele was treated by the technique of marsupialization under nasal endoscope. This patient was followed-up for 10 months without recurrence. CONCLUSION: As a kind of variation of nasal septum, the clinical significance of pneumatization of perpendicular plate should be emphasized. We reported the first case of perpendicular plate mucocele, originated possibly from the pneumatization of perpendicular plate of the ethmoid bone. Marsupialization under endoscope was considered to be the initial management for this unusual disease.     

上颌窦源性后鼻孔囊性息肉临床与病理学特点

目的分析上颌窦来源的后鼻孔息肉临床表现及病理特征.方法1998年10月至2004年9月,在施行鼻内镜手术的鼻息肉鼻窦炎患者1023例（1895侧）中,确诊为上颌窦源性后鼻孔息肉46例（4.5%）,均为单侧发病,年龄5～65岁,平均15岁,有前期手术史者5例.术后随访1年以上,息肉组织标本经石蜡包埋后切片,光镜下观察病理学特点.结果1年随访治愈率达100%,其中3例局部复发再行鼻内镜下处理治愈.上颌窦源性后鼻孔息肉的临床特点：①单侧发病;②以单侧进行性鼻阻为主诉症状;③儿童多见,多为单个息肉;④息肉均源于上颌窦口窦内侧,蒂部悬于后鼻孔,上颌窦内为一薄壁囊肿,破溃后常有淡黄色液体流出.病理学检查：息肉被覆假复层纤毛柱状上皮,黏膜下炎性细胞浸润,主要为中性粒细胞,嗜酸性细胞浸润较少见,间质水肿,并有潴留囊肿形成,囊肿为单个,较大,内有炎性潴留物.结论上颌窦源性后鼻孔息肉特殊的病理特征及临床表现说明其发病机制可能存在特殊性,临床治疗也应区别对待.依其病理特征诊断为＂上颌窦源性后鼻孔囊性息肉＂更为确切.     

Scanning electron microscopic study of the nasolabial cyst: its clinical and embryological implications

OBJECTIVE: Nasolabial cyst is an uncommon midfacial cyst. It is considered to be a developmental anomaly arising from the rest of nasal respiratory epithelium. Although the cyst is a well-recognized entity, there remains some confusion of its origin, cell types, and ultrastructures. Based on the routine light microscopic study, some authors reported the epithelial cells of the inner lining of the nasolabial cyst were ciliated; some others reported they were nonciliated. To clarify this, a scanning electron microscopic study is needed. STUDY DESIGN: This was a prospective clinical series. METHODS: A transnasal marsupialization method was used to treat 10 patients with nasolabial cyst. With patients under local anesthesia, the roof of the cyst wall and a disk of nearby nasal mucosa were excised together with a sickle knife and scissors. Surgical specimens were dissected and processed for scanning electron microscopy and histochemistry. Patients were followed up for 8 to 65 months. RESULTS: Marsupialization of cysts was successfully performed on all patients. Electron microscopically, the inner surface of the nasolabial cysts in all the cases was lined with nonciliated columnar epithelium consisting chiefly of goblet cells and basal cells. It is suggested that goblet cells contributed to clear, thin, and yellow mucus present in the cyst lumen. Instead of cilia, these epithelial cell surfaces were equipped with numerous short, globular, or irregular microvilli. Apical cytoplasm of adjacent cells did not tightly adhere to each other. Instead, microsulci of 1 to 3 microm in width formed between cells. Cytoplasmic processes from the lateral border spanned the microsulcus and contacted with those from neighboring cells. CONCLUSION: The novel study has proved that the lining epithelium on the inner surface of the nasolabial cyst is columnar epithelium that chiefly consisted of two types of cells: goblet cells and basal cells. Not present were ciliated cells that were essential in the other portion of the respiratory tract. Numerous microvilli, instead of cilia, covered the inner lining of the nasolabial cyst, probably as a result of lacking the stimulation of air in ventilation as that on the other portion of the respiratory tract. The cilia of the epithelium were ill developed.     

Efficacy of endoscopic sinus surgery for paranasal sinus mucocele including modified endoscopic Lothrop procedure for frontal sinus mucocele

This study evaluated the efficacy of the modified endoscopic Lothrop procedure (MELP) for complicated frontal mucoceles and endoscopic marsupialization for other paranasal sinus mucoceles. It was a retrospective, consecutive case review of sinus mucoceles treated endoscopically by a single surgeon over a four-year period (1998-2002). There were 41 mucoceles in 28 patients, including 24 frontal, eight frontoethmoidal, three ethmoidal, five maxillary and one frontal mucocele. Twenty-one patients underwent the modified Lothrop procedure for frontal mucoceles, and seven underwent simple drainage and marsupialization for frontoethmoidal, ethmoidal and maxillary mucoceles. At median follow-up of 16 months, all patients had a patent mucocele opening. Patients treated by drainage and marsupialization did not have any complications or mucocele recurrence. All patients treated by the modified endoscopic Lothrop procedure had improvement in symptoms and signs. Four patients had minor complications including epistaxis and adhesions and five required further surgery. The average hospital in-patient stay was 2 +/- 1.4 days. Endoscopic techniques, including MELP are effective in the short term for the management of complex and simple paranasal sinus mucoceles. MELP has a useful place in the management of mucoceles with a significant bony partition from an adjacent sinus or nasal cavity. It is also indicated when the mucocele is associated with loss of lateral support in the sinus with risk of medial-wall collapse of the orbital contents obstructing drainage.     

Localization of ZO-1 and E-cadherin in the nasal polyp epithelium

The tight junction and adherens junction complex of epithelial cells, which show disturbed localization in some inflammatory conditions, serve as an important paracellular barrier in polarized epithelial cells. However, very little information is available about the expression of the tight-junction protein, ZO-1, and the adherens-junction protein, E-cadherin, in nasal polyp epithelium. The aim of this study was to investigate the localization of ZO-1 and E-cadherin in nasal polyp epithelia by means of immunohistochemistry. We classified nasal polyp epithelia from 20 patients into pseudostratified ciliated columnar epithelia, basal and mucous cell hyperplasia and squamous metaplasia according to their dominant cell type. The expression of ZO-1 and E-cadherin in each epithelial cell type was analyzed and compared with normal ethmoidal mucosa, which was taken as a control. In pseudostratified ciliated columnar epithelia, as in the normal control epithelia, ZO-1 showed a spot-like distribution on the apicolateral junction of the adjoining cells. E-cadherin labeling was seen as a distinct basolateral staining on the mid-portion of the lateral walls. In basal and mucosal cell hyperplasia-dominant epithelia, the localization of ZO-1 positivity was similar to that in the normal mucosa, whereas the E-cadherin on the lateral walls showed a more intense distribution along the lateral cell-to-cell junction. In the nasal polyp epithelia showing squamous metaplasia, ZO-1 was rarely expressed; by contrast, E-cadherin exhibited stronger expression on the periphery of the cells in a circumferential fashion. In conclusion, in nasal polyp epithelia, ZO-1 showed down-regulation as in the worsening of epithelial dedifferentiation, whereas E-cadherin exhibited up-regulation with the increasing severity of epithelial remodeling.