兔鼻源性急性鼻窦炎动物模型

目的：建立一种鼻源性急性鼻窦炎动物模型。方法：将32只新西兰大白兔随机分成A组：单纯膨胀海绵条阻塞鼻腔（10只）;B组：浸有金黄色葡萄球菌的膨胀海绵条阻塞鼻腔（10只）;C组：鼻腔滴注金黄色葡萄球菌菌液不阻塞鼻腔（6只）;D组：空白对照组（6只）。术后2周打开上颌窦,用内镜观察,并取出上颌窦、筛窦黏膜标本分别进行细菌学培养及组织病理学检查。结果：各实验组鼻窦炎模型成功率：A组60％,B组100％,C、D组均0。感染的鼻窦除上颌窦外还累及筛窦。结论：用浸有金黄色葡萄球菌的膨胀海绵条阻塞鼻腔能建立鼻窦炎动物模型,该方法简便易行、无创、成功率高,所引起的鼻窦炎是一种鼻源性鼻窦炎,接近人鼻窦炎的发病机制,更适合有关FESS的研究。     

实验性鼻窦炎的病理及细菌学变化

目的 分析鼻窦炎由急性向慢性转变过程中的病理及细菌学变化.方法 用浸有金黄色葡萄球菌的膨胀海绵条阻塞鼻腔建立鼻源性鼻窦炎动物模型,分别于实验后1、2、4、6、8、10周时内镜下观察上颌窦,取出窦腔黏膜标本分别进行细菌学培养及组织病理学检查.结果 早期黏膜以单核细胞浸润为主;2周后可见淋巴细胞、中性粒细胞浸润,杯状细胞增加、腺体增生;4-6周后大量的杯状细胞生成;8周以后窦腔黏膜水肿严重,黏膜增厚.在整个过程中,杯状细胞增加最明显.早期窦内细菌学培养主要为金黄色葡萄球菌,以后逐渐被肺炎球菌、莫拉杆菌、大肠杆菌所代替.结论 通过鼻腔诱导引起的鼻源性鼻窦炎其黏膜所表现的病理变化经过了四个连续的病理阶段,客观反映了鼻窦炎由急性向慢性转变过程中的病理变化,随着病程的发展,机会致病菌的感染逐渐增多.     

鼻内镜术并发眶内巨大气肿1例

患者 ,男 ,47岁。因进行性双侧鼻阻塞伴流黏稠涕 5年于 2 0 0 2年 1 1月 2日入院。入院诊断“慢性鼻窦炎 ;鼻息肉 ,Ⅱ型Ⅲ期”。鼻内镜检查 :双侧鼻腔黏膜呈慢性充血状 ,鼻中隔居中 ,双侧下鼻甲形态正常 ,中鼻道内可见荔枝肉样新生物生长 ,总鼻道内可见脓性分泌物。鼻窦CT冠状位示 :双侧前中组筛窦、上颌窦黏膜增厚 ,窦腔缩小 ,双侧鼻腔可见软组织密度增高影。入院后行各项常规辅助检查未见异常。于局麻下行鼻内镜下双侧筛窦、上颌窦开放 ,息肉摘除术。手术采取Messerklinger术式 ,切除双侧钩突 ,开放双侧前中组筛窦 ,见双前中组筛窦内黏…     

鼻窦清合剂对兔鼻窦炎上颌窦黏膜形态影响的电镜观察

目的 观察鼻窦清合剂对兔鼻窦炎上颌窦黏膜炎症的影响。方法 行窦口不完全堵塞加用金黄色葡萄球菌建立急慢性鼻窦炎动物模型后,予以鼻窦清合剂高、低剂量灌胃治疗,并设立空白组、模型组、鼻渊舒（鼻渊舒口服液灌胃） 组作为对照;急性期用药1周,慢性期用药2周后,分别通过透射电子显微镜观察 ,比较各组兔上颌窦黏膜形态结构的变化。结果 鼻窦清合剂低剂量组黏膜形态最接近正常组,且急性各组优于慢性各组。结论 鼻窦清合剂可改善兔上颌窦炎症。     

经骨播散在慢性鼻-鼻窦炎发病机制中作用的实验研究

目的　观察慢性鼻-鼻窦炎（CRS）兔模型中接种侧和对侧上颌窦的黏膜和骨组织病理学变化,探讨经骨播散在CRS发病机制中的作用。方法　用绿脓杆菌将新西兰大白兔制成单侧上颌窦炎动物模型。造模前和造模12周后分别进行鼻窦CT扫描,造模12周后取双侧上颌窦内容物做细菌培养及大体标本进行染色观察。结果　14只（100%）兔子接种侧上颌窦黏膜出现慢性炎症组织学改变,并发现骨质发生类似于慢性骨髓炎的病理改变。9只（64%）兔子的对侧上颌窦出现骨髓炎的改变,5只（36%）对侧上颌窦黏膜出现慢性炎症。结论　绿脓杆菌性鼻窦炎显示累及骨组织的能力,在不影响黏膜病变的前提下可以感染远离原发部位的骨组织。这说明炎症可能通过骨性结构进行播散,可能在CRS发病过程中起到一定的作用。     

中药鼻腔冲洗对术后鼻窦炎康复的促进作用

目的 观察中药溶液鼻腔冲洗对慢性鼻窦炎术后康复过程的影响.方法 常规鼻内镜手术治疗的Ⅱ型3期慢性鼻窦炎鼻息肉患者56例,随机分为两组,每组28例,均同法予以围手术期综合治疗.术后第3天开始,实验组应用中药溶液进行鼻腔冲洗,对照组则用生理盐水同法冲洗,1次/d,连续1周.分别于术后2、4周观察术腔黏膜恢复情况,并测试鼻黏膜纤毛传输速率.术后随访6个月,比较两组疗效.结果 术后2周时,2组动物均见术腔黏膜肿胀,有少量结痂和少量分泌物,鼻腔纤毛传输速率无明显组间差异;术后4周时,实验组术腔病变明显减轻,鼻黏膜纤毛传输速率加快.随访结束时,实验组治疗有效率明显高于对照组.结论 中药溶液鼻腔冲洗能够有效促进鼻内镜手术后的术腔康复过程.     

鼻中隔脓肿1例

患者，男，82岁，因高血压、呼吸系统疾病常年住我院老年病科。2005年11月因出现呼吸衰竭，行呼吸机治疗，左鼻腔插入呼吸机通气管，右鼻腔插入胃管，1月后撤掉呼吸机。约20d后患者诉左鼻部胀痛不适，请耳鼻喉科会诊，检查示：体温36．7℃，外鼻无畸形，鼻背稍增宽，表面无明显红肿。前鼻镜检查见左侧鼻中隔前端轻度隆起，质中，轻压痛，双侧鼻甲无肿大，中、下鼻道无脓性分泌物，双鼻腔通气尚可。鼻部CT示鼻中隔前端轻度囊性增厚，两侧上颌窦、筛窦慢性炎症。拟行穿刺抽吸，因患者及家属不同意，故予以链咐油滴鼻，继续抗炎治疗。1周后症状仍无缓解，穿刺抽吸出0．5ml脓性分泌物，细菌培养为金黄色葡萄球菌，遂于局麻下行内窥镜术，切开鼻中隔黏膜并冲洗。术毕用藻酸钙纱条填塞，2d后抽除。1月后复查，患者鼻部疼痛缓解，鼻腔通气畅，鼻中隔隆起消失，无鼻中隔穿孔、鞍鼻等并发症发生。     

慢性鼻-鼻窦炎细菌生物膜形态观察

目的 观察慢性鼻-鼻窦炎患者,鼻内镜所取钩突、筛泡或上颌窦黏膜样本是否存在细菌牛物膜及其形态特征.方法 本实验共取鼻内镜术中黏膜样本12份,实验组为慢性鼻.鼻窦炎鼻内镜手术患者6例,对照组为阻塞性睡眠呼吸暂停综合征鼻内镜手术患者6例.样本用标准的扫描电镜方法 处理.实验组详细记录患者的年龄、性别、症状、鼻窦CT、鼻内镜检查和变应原皮肤点刺试验结果 .结果 扫描电镜下见慢性鼻一鼻窦炎患者鼻腔鼻窦黏膜纤毛缺失、倒伏、排列紊乱,实验组中5例可见不同形成阶段、各种形态的细菌生物膜,1例可见丝状真菌样结构.实验组细菌生物膜出现率为83.3%.对照组6例均未观察到细菌生物膜.结论 慢性鼻-鼻窦炎鼻腔鼻窦黏膜纤毛有不同程度的损伤,黏膜表面存在处于生命周期不同阶段的细菌牛物膜.     

重组人表皮生长因子对鼻-鼻窦炎患者鼻内镜术后创面上皮化的影响

目的　探讨重组人表皮生长因子（recombinant human epidermal growth factor,rhEGF）对慢性鼻-鼻窦炎（CRS）患者鼻内镜术后创面上皮化的影响。方法　选择110例CRS行双侧鼻内镜手术患者,对照组（右侧鼻腔）行鼻腔冲洗以及类固醇激素喷鼻,实验组（左侧鼻腔）加用rhEGF喷鼻,在术后2周、4周、3个月、6个月鼻内镜检查评估鼻腔黏膜情况及主观症状的视觉模拟量表（visual analogue scale,VAS）评分,比较鼻腔黏膜情况、完全上皮化比例、主观症状的VAS评分。结果　术后2周实验组鼻腔黏膜情况优于对照组（P＜0.05）,但主观症状VAS评分无明显差异（P >0.05）;术后4周及3个月时实验组鼻腔黏膜情况、上皮化比例以及主观症状VAS评分均优于对照组（P＜0.05）;术后6个月时则无差异（P >0.05）。结论　CRS患者鼻内镜术后用rhEGF喷鼻,可缩短术后上皮化时间、改善鼻腔黏膜情况及患者主观症状,值得临床应用。     

慢性鼻窦炎手术前后血清和鼻腔分泌物中表皮生长因子水平变化

目的了解慢性鼻窦炎手术前后血清和鼻腔分泌物中表皮生长因子(epidermalgrowth factor,EGF)水平的变化,探讨EGF在鼻内镜术后术腔上皮过程中可能的作用。方法采用放射免疫方法检测慢性鼻窦炎手术患者术前及术后1、2、3、4、6、8周血清和鼻腔分泌物中EGF含量,并分析其变化规律。结果与正常对照比较,慢性鼻窦炎患者血清及鼻腔分泌物中EGF含量均升高,后者更为明显(P<0.0 5);术后第1周鼻腔分泌物中的EGF水平明显降低(P<0.05),第4周后开始升高;血清中EGF水平手术后呈缓慢下降,第6周后者开始上升。结论慢性鼻窦炎手术后血清和鼻腔分泌物中EGF水平存在一定归律的变化,这种变化模式与术后黏膜的转归以及创面修复有关,表明EGF术后鼻腔黏膜修复与上皮化过程中具有重要作用。     

Maxillary prosthesis for better QOL--early setting and faster construction of maxillary prosthesis]

The maxillofacial prosthesis (MFP) is well accepted as one of the modalities to ameliolate the postsurgical crippling in the patients with maxillary malignancy. In this report, we analyzed 55 primary cases of MFP out of 100, from July, 1981 to July, 1987 in terms of the time of start after operation, and the duration and procedure of the MFP-making. MFP-making set about within 4 weeks in 35% of patients, 8 weeks in 25%, 12 weeks in 22%, and more than 12 weeks in 18%. The completion of MFP-making averaged 10 days. As a result of simplifying of MFP-making, we shortened a period requiring MFP-making within 3 days in recent 10 cases. There were no adverse effects of early wear of MFP after operation. We believe that early wear of MFP after operation improve the quality of life of patients with maxillary malignancy and considered that wear of MFP is not the completion of treatment, but is one of the procedures of treatment for the patients undergone maxillectomy.     

鼻部横纹肌肉瘤12例临床分析

目的 探讨鼻腔、鼻窦横纹肌肉瘤的临床特征、诊疗方法及预后。方法 回顾性分析12例鼻部横纹肌肉瘤的临床资料,原发于鼻腔2例,上颌窦3例,筛窦1例,以上颌窦、筛窦为中心向周围膨胀侵犯4例,原发部位不明2例;单纯手术切除2例,手术加放疗加化疗8例,化疗加放疗2例;采用鼻内窥镜手术6例,鼻侧切开术4例,同期颈清扫5例。 结果 随访1年、3年生存率分别为75.0%（9/12）、33.3%（4/12）;7例1年内复发,其中5例行挽救性手术,2例放弃再次治疗。结论 鼻部横纹肌肉瘤预后差,早期诊断、广泛手术切除、综合治疗能提高生存率;鼻内窥镜手术能减少手术创伤,对早期病例有一定优越性。     

功能性鼻内窥镜手术治疗上颌窦曲菌病

目的：探讨鼻内窥镜下非侵袭性上颌窦曲菌病的治疗及影响疗效的因素。方法：分析我院行功能性鼻内窥镜手术（Ｆｕｎｃｔｉｏｎａｌ ＥｎｄｏｓｃｏｐｉｃＳｉｎｕｓ Ｓｕｒ ｇｅｒｙ,ＦＥＳＳ）治疗的非侵袭性上颌窦曲菌病４１例的手术径路及抗真菌剂的使用对疗效及转归的影响。结果：双径路（经尖牙窝加下颌窦自然开口）术式的术后愈合期为４．７周,而单径路（经上颌窦自然开口）术式的术后愈合期为９．３周,两组差异有显著性意义（Ｐ〈０．０１）,使用抗真菌剂冲洗术腔组的术后愈合期为６．４周,未使用抗真菌剂的术后愈合期为６．７周,但其差异无统计学意义（Ｐ〉０．０５）,结论：ＦＥＳＳ是治疗非侵袭性上颌窦曲菌病的有效方法,双径路疗效优于单径路,是否用抗真菌剂冲术腔对疗效无明显影响。     

Mucociliary function of the maxillary sinuses after restoring ventilation: a radioisotopic study of the maxillary sinus

Ostium patency and sinus ventilation play a key role in the normal function of the sinuses and the pathogenesis of sinusitis. Experience with endoscopic treatment modalities has indicated that even severe mucosal disease in the maxillary and frontal sinuses will heal after eradication of an infectious focus in the ethmoid and maintaining ventilation and drainage of sinuses. The aim of this study was to use scintigraphic methods to evaluate possible differences in mucociliary function of chronically diseased maxillary sinuses after establishment of ventilation. Fourteen patients (22 maxillary sinuses) and 3 controls (6 maxillary sinuses) were evaluated after functional endoscopic sinus surgery. The drainage ratios of sinuses at 20 min were calculated at the 3rd postoperative day and again at 3 weeks. When the early and late postoperative drainage ratios were compared it was found that mucociliary function returned to normal after 3 weeks in sinuses with cysts but without hyperplastic mucosal degeneration. While the mucociliary function and drainage improved significantly in sinuses with hyperplastic mucosa, depending on the severity and extension of the pathology present, it was still less than levels found in normal sinuses at 3 weeks.     

内镜鼻窦手术后局部应用Merogel对促进术腔黏膜上皮化的临床效果观察

目的　观察使用美国Xomed公司生产的Merogel(透明质酸 )作为内镜鼻窦手术后的术腔填塞物对促进术腔上皮化的作用。方法　对 16例 (32侧 )经鼻内镜全鼻窦开放术患者进行同体对照观察 ,左侧为Merogel观察组 ,右侧为空白对照组 ,连续内镜随访 12周 ,观察双侧术腔上皮化过程。结果　Merogel侧治愈 93 75 % ,好转 6 2 5 % ,平均上皮化时间 3 4周 ;对照侧治愈 87 5 0 % ,好转12 5 0 % ,平均上皮化时间 8 3周。表明使用Merogel侧术腔上皮化时间比对照组明显缩短。结论　内镜鼻窦手术后局部使用Merogel ,可以促进术腔上皮化过程     

Treatment of Oroantral Communications after Tooth Extraction. Is Drainage into the Nose Necessary or Not?

Seventy-six patients with oroantral communications after tooth extraction and chronic maxillary sinusitis were treated as follows: bacterial cultures were taken in all of them and maxillary sinuses were irrigated with an antibiotic from the cephalosporin group. Then, in 36 patients, drainage using the Caldwell-Luc procedure was performed, including a naso-antral window. In all patients operations were completed by closing oroantral communications with flaps of the mucosa of the alveolar process close to the fistula. Antibiotics according to antibiogram were administered to all patients at least 10 days after surgery. Retrospective comparison between the results obtained in the first group and those in the second group 1, 3 and 6 months after operation was based on objective findings (condition of the oroantral communication, maxillary sinusitis), side effects (pain, numbness of the operated area, headache) and control radiographs (clear maxillary sinus or with mucosal thickening). The study suggests that transnasal drainage is not required in maxillary sinus surgery and in the closure of oroantral communications. Equally good results are achieved by treating with antibiotics and without drainage of the maxillary sinus into the nose.     

Functional recovery of rabbit maxillary sinus mucosa in two different experimental injury models

OBJECTIVE/HYPOTHESIS: Ciliary wave disorder (CWD) is essential for effective mucociliary transport. The purpose of this study was to investigate morphologic and functional restoration in recovered sinus mucosa after 12 weeks of experimentally induced rhinosinusitis and regenerated sinus mucosa after mechanical injury. STUDY DESIGN: Prospective study with animal models. METHODS: Ten New Zealand white rabbits weighing between 2.5 and 3 kg were used for this experiment. In the recovered mucosa group (n = 5), the natural ostium of the maxillary sinus was closed with a synthetic sponge and removed 2 weeks later. In the regenerated sinus mucosa group (n = 5), maxillary sinus mucosa was stripped off through the anterior wall. Left sinus mucosae were used as controls. Twelve weeks postoperatively, ciliary beat frequency (CBF) and CWD were measured using an image analysis system. Morphologic changes in cilia were also observed using a scanning electron microscope (SEM). RESULTS: The average CBFs in control, recovered, and regenerated mucosa were 13.21 +/- 3.66 Hz, 13.20 +/- 3.53 Hz, and 14.16 +/- 3.87 Hz, respectively. The average CWDs in these groups were 8.46 +/- 4.4, 21.04 +/- 14.73, and 24.43 +/- 19.2, respectively. SEM showed that loss of cilia and irregularities of ciliary arrangements were prominent in regenerated sinus mucosa. CONCLUSION: Although 12 weeks is enough for morphologic regeneration of the ciliated epithelium after experimental sinusitis in rabbit maxillary sinuses, it does not appear long enough for full functional recovery. Restoration of CBFs does not equate to concurrent CWD restoration.     

Sequential Fluorescent Labeling Observation of Maxillary Sinus Augmentation by a Tissue-engineered Bone Complex in Canine Model

Aim To evaluate the effects of maxillary sinus floor elevation by a tissue-engineered bone complex of β-tricalcium phosphate （β-TCP） and autologous osteoblasts in dogs. Methodology Autologous osteoblasts from adult Beagle dogs were cultured in vitro. They were further combined with β-TCP to construct the tissue-engineered bone complex. 12 cases of maxillary sinus floor elevation surgery were made bilaterally in 6 animals and randomly repaired with the following 3 groups of materials： Group A （osteoblasts/D-TCP）; Group B （β-TCP）; Group C （autogenous bone） （n=4 per group）. A polychrome sequential fluorescent labeling was performed post-operatively and the animals were sacrificed 24 weeks after operation for histological observation.
Results Our results showed that autologous osteoblasts were successfully expanded and the osteoblastic phenol- types were confirmed by ALP and Alizarin red staining. The cells could attach and proliferate well on the surface of the ~3-TCP scaffold. The fluorescent and histological observation showed that the tissue-engineered bone complex had an earlier mineralization and more bone formation inside the scaffold than β-TCP along or even autologous bone. It had also maximally maintained the elevated sinus height than both control groups. Conclusion Porous 13-TCP has served as a good scaffold for autologous osteoblasts seeding. The tissue-engineered bone complex with β-TCP and autologous osteoblasts might be a better alternative to autologous bone for the clinical edentulous maxillary sinus augmentation.     

经上颌窦前壁双管穿刺径路治疗上颌窦囊肿

目的 研究上颌窦囊肿的手术治疗方法,为临床治疗提供理论依据。方法 对40例上颌窦囊肿患者行经上颌窦前壁双管穿刺径路鼻内镜手术治疗。结果 术后均无牙列酸痛、面部麻木等不适,单纯上颌窦囊肿患者均术后3 d出院。随诊3个月至半年经鼻内镜及鼻窦CT检查,无脓性分泌物,未见囊肿复发。结论 经上颌窦前壁双管穿刺径路治疗上颌窦囊肿具有手术方法简单、治愈率高、创伤小的优点,可减轻患者痛苦,值得临床推广应用。     

鼻窦球囊扩张术治疗慢性上颌窦炎的非随机对照前瞻性临床研究

目的 评价鼻窦球囊扩张术与传统鼻内镜鼻窦开放术治疗慢性上颌窦炎的临床疗效、安全性及患者接受程度的差异。方法 将50例慢性上颌窦炎患者随机均分入两组,其中A组25例行鼻窦球囊扩张术,B组25例行鼻内镜下上颌窦开放术。术后随访12个月,评价临床疗效、安全性、患者手术舒适度。结果 术后检查及随访期间,A组脱落病例2例,B组脱落病例3例,共对45例患者进行评价。45例患者症状均明显改善,术后鼻内镜检查A组开放的33个窦口中有30个窦口开放、黏膜恢复良好,1个窦口狭窄,2个窦口周围黏膜水肿;B组开放的32个窦口中,27个开放完好,2个窦口狭窄,3个窦口黏膜水肿。两组患者术后均无视力改变、眼部肿胀及脑脊液鼻漏等其他并发症发生。A组与B组术后3个月、随访结束（术后12个月）SNOT-20评分以及CT评分均无统计学差异;术后3个月、随访结束后（术后12个月）Lund -Kennedy内镜黏膜形态评分得分以及手术舒适度评分（出院当天）A组明显优于B组（P<0.05）。结论 鼻窦球囊扩张术与传统内镜在治疗慢性上颌窦炎方面均具有较好的临床疗效及安全性,但在术后远期黏膜恢复及手术舒适度方面,鼻窦球囊扩张术明显优于传统鼻内镜手术,值得临床推广及应用。