鼻内镜术后布地奈德对术腔恢复及术腔黏膜修复过程的影响

目的探讨慢性鼻窦炎、鼻息肉鼻内镜术后局部应用布地奈德术腔黏膜阶段性修复的特点及规律,为鼻内镜术后处理措施提供依据。方法对62例慢性鼻窦炎、鼻息肉患者行鼻内镜术,术后1~4周清理鼻腔及局部应用激素布地奈德1周,鼻内镜检同时取筛窦外侧壁、筛窦顶及上颌窦口处囊泡或黏膜组织,分别进行光、电镜观察对比。结果局部应用布地奈德1周,鼻内镜检术腔黏膜光滑,水肿基本消失,无囊泡形成。电镜下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。28例纤毛横断而可见9+2型微管结构,24例为9+1型微管结构,10例中心微管缺如。上皮细胞高尔基复合体发达,内质网轻度扩张,线粒体部分呈凝集变性,有的线粒体为Ⅰ度肿胀,溶酶体基本正常。结论局部应用布地奈德能有效切断这种失衡修复的上皮化组织-囊泡的过程,继而遏制病变复发,使术腔上皮化呈均衡状态恢复。

Effect of Budesonide on recovery of operative cavity and repair of its mucous membrane after nasal endoscopic surgery

Objective It is to explore the characteristics and regularity of repair of mucous membrane in operative cavity treated with Budesondie in local place after chronic sinusitis and nasal polyps nasal endoscopic surgery,so to provide basis for the treatment after operation.Methods 62 patients with chronic sinusitis or nasal polyps were performed on nasal endoscopic surgery.After 1-4 weeks nasal cavity was cleaned up and Budesonide was applied in local position for 1 week.At the same time,the vesicles or mucosa from nasal ethmoid outside wall,the ethmoid roof and apertura sinus maxillaries were biopsied and observed under light and transmission electron microscope.Results After one week's use of Budesonide,we could found mucosa was smooth,and intumescence was almost disappeared with no vesicles under nasal endoscope.Transmission electron microscope: epithelia were pseudostratified ciliated columnar epithelium,cilia were neatly arranged,microvilli located between cilia.The cross section of majority cilia were 9+2 form microtubule in 28 cases and 9+1 form microtubule in 24 cases,but cilia of 10 cases could be found no microtubule.Golgi complex were up-growth and endoplasm reticulum expanded mildly,and mitochondrial were apart coagulation degeneration in epithelial cells,some mitochondrial was I degree swelling and lysosome were basically normal.Conclusion Topical application of Budesonide can effectively cut off this imbalance between the self-repair of epithelial tissue and the formation of vesicle,and inhibit the recurrence of the pathological changes,and finally keep the restoration of balance of the nasal epithelial change.