鼻前庭成形术结合中药治疗萎缩性鼻炎的疗效观察

目的探讨萎缩性鼻炎的治疗方法.方法采用鼻前庭成形术加服中药治疗萎缩性鼻炎58例,并与单行鼻前庭成形术42例做对照组比较.结果显示术后一年观察组的显效率为61.7%,优于对照组31.0%,P＜0.005.术后2年观察组的显效率72.4%,与对照组71.4%相当,P＞0.05.结论说明鼻前庭成形术后加服中药能帮助鼻功能恢复.     

He-Ne激光加复方丹参联合治疗萎缩性鼻炎的病理学观察

目的观察中西医结合疗法对萎缩性鼻炎鼻黏膜组织病理学的影响.方法综合应用复方碘薄荷液棉片黏膜表面湿敷、复方丹参液鼻甲组织内注射,He-Ne激光鼻甲前端照射进行治疗,共2个疗程.结果疗程结束后,鼻黏膜纤毛柱状上皮细胞、杯状细胞和腺体从治疗前平均每视野22、1和2个(100×)增加到43、5和3个;血管计数从1～2个增加至5个;鼻黏膜厚度增加.结论He-Ne激光加复方丹参联合治疗能促进萎缩性鼻炎鼻黏膜恢复.     

软耳模材料鼻前庭部分堵闭术治疗萎缩性鼻炎疗效观察

目的观察软耳模材料鼻前庭部分堵闭术治疗萎缩性鼻炎的临床疗效。方法30例萎缩性鼻炎患者，采用软耳模材料行鼻前庭部分堵闭以缩窄前鼻孔，术后随访1年以上，观察其远期临床疗效。分别于治疗前和治疗后1年，各随机抽取10例患者，采集下鼻甲前端黏膜组织进行病理组织学检查，比较观察其病理组织学变化。结果随访结果表明，本组病例显效率70．00％，有效率23．33％，无效率6．67％，总有效率93．33％：病理组织学观察结果显示，治疗后的鼻腔黏膜组织结构明显改善。结论软耳模材料鼻前庭部分堵闭术是治疗萎缩性鼻炎的有效方法，值得在临床推广应用。     

鼻内类固醇激素对变应性鼻炎动物模型鼻腔黏膜的影响

目的:通过变应性鼻炎(AR)动物模型观察鼻内类固醇激素对鼻腔黏膜的影响。方法:36只SD大鼠随机分为3组:鼻内类固醇激素组(A组),AR模型组(B组)和正常对照组(C组)。A、B组以卵清蛋白建立大鼠AR模型,C组用生理盐水代替卵清蛋白。然后A组以鼻内类固醇激素喷鼻,B、C组以生理盐水代替。末次激发后观察动物鼻部症状和体征,并取鼻黏膜行苏木精-伊红染色计数鼻黏膜内嗜酸粒细胞(EOS)数,阿辛蓝-过碘酸-希夫染色观察杯状细胞变化,扫描电镜下观察各组鼻黏膜超微结构的改变。结果:鼻内类固醇激素能明显减轻AR鼻部症状,其评分与B组差异有统计学意义(P<0.01);其鼻腔黏膜内EOS数和杯状细胞数明显降低,与B组相比差异有统计学意义(P<0.01),而与C组差异无统计学意义(P>0.05);扫描电镜检查结果显示A组鼻黏膜纤毛结构与C组相似,而B组纤毛倒伏、排列紊乱、缠绕集结、大量分泌物附着等。结论:鼻内类固醇激素能明显缓解AR症状及鼻黏膜炎性反应状态,并对受损纤毛有明显修复作用。     

鼻前庭模治疗萎缩性鼻炎24例报告

萎缩性鼻炎的治疗 ,临床方法较多 ,如用手术治疗 ,患者较痛苦。为探讨该病有效而简单的治疗方法 ,1 995年 1月～ 1 998年 6月 ,我们采用鼻前庭模的方法治疗萎缩性鼻炎 2 4例 ,经 1年以上观察 ,疗效满意。报告如下。1　资料与方法1 .1 　 临床资料本组 2 4例 ( 4 3侧 ) ,男 9例 ( 1 6侧 ) ,女 1 5例( 2 7侧 ) ;年龄 1 6～ 50岁 ,平均 32岁 ,病程 1～ 2 0年。症状 :鼻干燥、鼻塞、头昏。检查 :下鼻甲均萎缩 ,鼻腔内见黄绿色结痂、有臭味、嗅觉减退。1 .2 　 治疗方法先清洗鼻前庭 ,用凡士林纱条填于鼻内阻隔鼻前庭后部 ,取适量软硅胶 (二甲聚…     

鼻敏宁对变应性鼻炎鼻黏膜上皮细胞凋亡活性的干预作用

目的 探讨鼻敏宁对变应性鼻炎个体鼻黏膜细胞凋亡活性的干预作用。方法 制作变应性鼻炎动物模型，以鼻敏宁进行干预，观察鼻黏膜不同组织层面细胞凋亡活性的变化及与嗜酸性粒细胞数量的关系。结果 变应性鼻炎模型组动物各项指标均显示异常，与正常对照组相比差异有统计学意义（P〈0．01）。应用鼻敏宁干预后，各项指标均恢复正常，与正常对照组相比差异无统计学意义（P〉0．01）。结论 鼻敏宁能有效调节变应性鼻炎个体鼻黏膜细胞凋亡活性，减轻炎症反应，保护鼻黏膜上皮。     

豚鼠变应性鼻炎模型鼻黏膜的病理改变

目的：观察变应性鼻炎鼻黏膜的病理变化。方法：用橄榄油将甲苯-2,4-二异氰酸酯配成浓度为10%的溶液作为致敏剂,滴鼻,建立豚鼠变应性鼻炎动物模型8例。8例正常豚鼠作对照。致敏结束、模型成功后,取两组鼻黏膜组织,光镜下观察病理变化。结果：模型组鼻黏膜上皮脱落,杯状细胞增生,鳞状上皮组织转化,上皮坏死,固有层和黏膜下层腺体增生,血管扩张,组织水肿,并见特征性的嗜酸性粒细胞、肥大细胞浸润,这种病理改变与变应性鼻炎的临床表现大致吻合。对照组鼻黏膜上皮层为假复层纤毛柱状上皮,连续、完整、清晰,可见正常的黏膜上皮层、固有层和黏膜下层。结论：变应性鼻炎鼻黏膜出现特征性的炎症病理改变。     

鼻敏温阳方对肾阳虚证变应性鼻炎鼻黏膜嗜酸性粒细胞的影响

目的 观察中药鼻敏温阳方对肾阳虚证变应性鼻炎大鼠鼻黏膜嗜酸性粒细胞的影响.方法 70只雄性健康大鼠,制备肾阳虚型变应性鼻炎模型,然后分为空白、模型、西替利嗪、大剂量中药、小剂量中药5组.除空白组为10只外,其余每组均为15只动物.干预试验结束后,处死动物,游离鼻中隔黏膜,常规切片,HE染色,观察比较各组的组织学改变及嗜酸性粒细胞浸润情况.结果 模型组鼻黏膜嗜酸性粒细胞计数明显高于西替利嗪组、大剂量中药组、小剂量中药组和空白组,而大剂量中药组者又明显低于西替利嗪组和小剂量中药组,西替利嗪组与小剂量中药组的浸润细胞数差异不具有统计学意义.结论 鼻敏温阳方治疗肾阳亏虚型变应性鼻炎,可能通过减轻鼻黏膜嗜酸性粒细胞的聚集及活化而阻断变态反应的进程.     

鼻内镜下改良下鼻甲成形术临床观察

目的 探讨鼻内镜下改良下鼻甲成形术的临床疗效及手术技巧。方法 114例慢性肥厚性鼻炎患者随机分组,A组57例行鼻内镜下改良下鼻甲成形术,B组57例行鼻科微型切吸器下鼻甲黏膜下切除术,比较两组的疗效。结果 两组患者术后鼻阻力值及VAS评分均较术前显著降低（P<0.05）;两组间术后1月时鼻阻力及VAS评分比较差异无统计学意义（P>0.05）,而术后1年时均下降（P<0.05）;A组术后近、远期疗效差异无统计学意义（P>0.05）,B组有统计学意义（P<0.05）。结论 改良下鼻甲成形术的远期疗效明显好于以微型切吸刀头行黏膜下组织切吸术,是改善慢性肥厚性鼻炎患者鼻塞的理想方法。     

萎缩性鼻炎患者鼻阈缩窄手术前后鼻粘膜的病理和组织化学观察

对遵义地区居民中应用开放式炉灶的、经保守治疗无效的萎缩性鼻炎(AR)患者行鼻域缩窄术,于术前术后钳取鼻粘膜行病理和组织化学观察,并以正常人作为对照。结果是:手术前与手术后3个月比较差异不明显;但随时间的延长鼻粘膜均有显著的变化。术后6年鼻粘膜几乎恢复达正常程度,但恢复的假复层柱状上皮仍有部分纤毛脱落;固有层中腺体数量增加,但腺体部分细胞排列不整;血管内膜虽未见明显增厚,但血管周围仍有炎细胞浸润(对照组则无)。故术后仍未能恢复到完全正常程度,结合本地区AR特点,提示应加强AR的预防工作;鼻阈缩窄手术仍不失为治疗AR的一种好方法。     

Internal nasal dimensions of adults with nasal obstruction

Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency.ObjectiveTo characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry.MethodThis prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA₁, CSA₂, CSA₃), the distance between them and the nostrils (dCSA₁, dCSA₂, dCSA₃), and the volumes of segments 1.0-3.2 cm (V₁), 3.3-6.4 cm (V₂), and 7.0-12.0 cm (V₃) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated.ResultsMean values (± standard deviation) before ND were: 0.83 ± 0.23 (CSA₁), 1.66 ± 0.52 (CSA₂), and 2.36 ± 0.77 (CSA₃) cm²; 2.19 ± 0.20 (dCSA₁), 4.01 ± 0.33 (dCSA₂), and 5.85 ± 0.37 (dCSA₃) cm; 2.77 ± 0.51 (V₁), 6.52 ± 1.99 (V₂), and 26.00 ± 9.62 (V₃) cm³; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction.ConclusionMost patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry.     

鼻喷激素对嗜中性粒细胞性慢性鼻窦炎伴鼻息肉的治疗作用

目的 嗜中性粒细胞(Neu)性慢性鼻窦炎伴有鼻息肉(CRSwNP)主要发生于东亚国家的患者,到目前为止尚未发现有效的治疗方法,本研究旨在评估局部用糖皮质激素布地奈德鼻喷剂对Neu性CRSwNP的治疗作用。方法 15例CRSwNP患者受到招募,并接受局部布地奈德鼻喷剂治疗3个月。分别从正常鼻黏膜组织和CRSwNP患者的鼻息肉(NP)组织中获取样本,用免疫荧光染色方法确定NP的内表型,以免疫组织化学染色方法检测治疗前后NP组织中Neu的浸润情况,用苏木精-伊红和过碘酸-雪夫染色方法分别对治疗前后NP组织中杯状细胞和黏膜下腺体细胞进行检测,最后用酶联免疫吸附试验对治疗前后NP组织中炎症介质髓过氧化物酶(MPO)和γ-干扰素(IFN-γ)以及黏蛋白(MUC)5AC和MUC5B进行了检测。结果 15例CRSwNP患者的NP内表型均为Neu性,Neu在NP组织中浸润数目显著多于正常鼻黏膜,布地奈德鼻喷剂局部治疗后NP组织中Neu计数没有显著降低;杯状细胞的计数和黏膜下腺体细胞的染色评分在NP组织中显著高于正常黏膜组织,治疗后这些指标无显著降低;NP组织中MPO、IFN-γ、MUC5AC和MUC5B...     

扩大鼻瓣膜区治疗鼻瓣膜区狭窄性鼻阻塞

目的:研究治疗鼻瓣膜区狭窄性鼻阻塞的新方法.方法:32例鼻瓣膜区狭窄患者,行下鼻甲前端切除术10例,鼻外侧软骨凸出矫正术4例(左侧2例、双侧2例),骨性梨状孔狭窄扩大术6例(左侧2例、双侧4例),观察手术前后鼻通气改善情况以判定疗效.结果:32例患者经半年～2年随访,疗效显著26例,占81.2,好转6例,占18.8%,总有效率为100%,无手术并发症.结论:手术扩大狭窄鼻瓣膜区符合鼻腔解剖和生理功能,手术操作简单,术野清晰,组织损伤小,出血少,术后反应轻,痛苦小,无手术并发症.     

应用鼻腔冲洗器冲洗鼻腔对慢性鼻-鼻窦炎患者鼻腔黏液纤毛功能的影响

目的观察应用鼻腔冲洗器冲洗鼻腔对慢性鼻-鼻窦炎患者鼻腔黏膜纤毛功能的影响。方法60例单纯性慢性鼻-鼻窦炎患者,随机分为治疗组和对照组。治疗组用3%高渗盐水经鼻腔冲洗器冲洗鼻腔,对照组用3%高渗盐水经灌肠袋冲洗鼻腔,均为每日两次,连续冲洗14天,并辅以短期药物辅助治疗。分别于治疗前、治疗2周及疗后3月以糖精试验法检测鼻腔黏液纤毛清除率,比较两组鼻腔黏膜纤毛功能恢复情况和症状与体征的变化。结果治疗前2组的鼻腔黏液纤毛清除率差异无统计学意义;治疗2周后治疗组清除率为6.15±2.16mm/min,对照组为4.99±1.35mm/min,P＜0.05,前者的症状改善程度也较为明显;疗后3月治疗组清除率为6.81±1.45mm/min,对照组为6.69±2.41mm/min,P＞0.05。结论用鼻腔冲洗器冲洗鼻腔可有效促进鼻腔黏膜纤毛功能的早期恢复,对慢性鼻-鼻窦炎有辅助治疗作用。     

Correlation of nasal obstruction with nasal cross-sectional area measured by computed tomography in patients with nasal septal deviation

Objectives: The objective of the present study was to investigate the relationship between the subjective sensation of nasal obstruction and the corresponding cross-sectional area for nasal airflow in patients with a deviated septum. Methods: Seventy-one patients with a diagnosis of unilateral nasal obstruction due to a deviated nasal septum were evaluated by preoperative computed tomography. Anterior anatomic characteristics (the internal nasal valve angle and the cross-sectional areas at the external nasal valve, the head of the inferior turbinate, and the head of the middle turbinate) and posterior anatomic factors (the cross-sectional areas at the openings of the frontal sinus, maxillary sinus, and end of the nasal septum) were examined. Associations between the computed tomography measurements and the subjective severity of nasal obstruction were analyzed with a visual analog scale (VAS). Results: Anterior and posterior anatomic characteristics were associated with the subjective severity of nasal obstruction. Anterior anatomic factors were related to the VAS scores of patients with anterior septal deviation, and posterior anatomic factors were related to the VAS scores of patients with posterior septal deviation. Conclusions: This study indicated that the anterior and posterior parts of the nasal cavity are both related to nasal obstruction. In some patients, the posterior part of the nasal cavity was more important than other locations in causing nasal obstruction.     

Absence of nasal mucosal atrophy with fluticasone aqueous nasal spray

OBJECTIVE: To evaluate whether 1 year of continuous treatment with intranasal fluticasone propionate would lead to atrophy in the nasal mucosa compared with an active control, oral terfenadine. DESIGN: Prospective, randomized, multicenter, open-label, parallel-group study. SETTING: Two tertiary care academic institutions. PATIENTS: Seventy-five subjects older than 18 years with perennial allergic rhinitis. INTERVENTIONS: Patients received either fluticasone propionate aqueous nasal spray, 200 microg once daily, or terfenadine, 60 mg twice daily, for 1 year. Nasal biopsy specimens were obtained before and after 1 year of treatment and were evaluated for evidence of atrophy. MAIN OUTCOME MEASURES: Epithelial and collagen layer thickness of the nasal mucosa as assessed by light microscopy and the presence and degree of edema, and regularity of collagen fibrils as assessed by electron microscopy. Analyses were performed without knowledge of subject identity or treatment assignment. RESULTS: Neither fluticasone nor terfenadine treatment led to atrophy in the nasal mucosa by clinical or histologic observation. No significant changes from baseline were observed for any assessment of atrophy. In contrast to what would have been expected if atrophy were to occur, mean epithelial layer thickness in the fluticasone group significantly increased compared with terfenadine treatment (P = .03). CONCLUSIONS: Treatment with intranasal fluticasone for 1 year increases the thickness of the nasal epithelium as compared with a year's treatment with terfenadine and does not lead to atrophy in the nasal mucosa. The increased thickness in the fluticasone treatment may represent repair from epithelial damage caused by chronic allergic inflammation.     

鼻腔粘连合并鼻中隔偏曲的手术治疗

目的 探索鼻腔粘连合并鼻中隔偏曲的手术治疗方案.方法 鼻腔粘连合并鼻中隔偏曲患者13例.其中11例在施行粘连分解术的同时行鼻中隔偏曲矫正术和Merocel膨胀海绵持续性填塞鼻腔,1例施行单纯粘连分解术,1例联合施行粘连分解和鼻中隔偏曲黏膜下切除术.术后观察比较鼻腔创伤愈合情况及其功能改善效果.结果 第1组病例均获得痊愈;行单纯粘连分解术的1例症状无改善,改用第1组所用治疗方法后获得成功;第3种术式治疗的病例虽然粘连成功分解,但发生了鼻中隔穿孔.结论 对鼻腔粘连合并鼻中隔偏曲的患者,需在分解粘连的同时施行鼻中隔偏曲矫正术,重建鼻中隔,并行Merocel膨胀海绵持续性鼻腔填塞,有利于创伤愈合.     

鼻内翻性乳头状瘤伴鼻息肉的临床分析

目的:探讨鼻内翻性乳头状瘤伴鼻息肉的临床特征。方法:分别对12例鼻内翻性乳头状瘤伴鼻息肉患者的肿瘤外露部、深部、基底部及窦腔处进行多点取材,并对病理结果进行分析,判断其临床特点及相关性。结果:内翻性乳头状瘤多位于瘤体的深部及基底部,而息肉组织多位于瘤体的表面。结论:鼻内翻性乳头状瘤伴鼻息肉可能是因内翻性乳头状瘤表面上皮组织长期受炎性刺激而局部形成息肉样变的结果,因此对单侧鼻息肉,应警惕深部肿瘤性疾病的可能性。     

Objective assessment of nasal resistance in patients with nasal disease

Nasal obstruction is a subjective complaint in patients with nasal disease. The ability to quantitate the nasal ventilation dysfunction would be useful for making the appropriate choice of nasal disease management. This cross-sectional study comprised of 200 adult subjects. They underwent assessment of relevant symptoms, nasal examination and investigations before undergoing active anterior rhinomanometry (AAR) assessment. A group of 88 normal subjects and 112 patients with nasal disease were included. The mean total nasal air resistance (NAR) was significantly higher in patients with nasal disease (0.33 Pa/cm(3)/s) as compared to normal subjects (0.24 Pa/cm(3)/s). There was no significant difference in total NAR between patients with symptoms of nasal obstruction and those without the symptoms (p = 0.42). It is concluded that AAR is a sensitive but not a specific tool for the detection of abnormalities in NAR and it failed to relate to the symptom of nasal obstruction.     

Histopathological changes in nasal mucosa with nasal septum deviation

Histopathological changes in septal and nasal mucosa of patients with nasal septum deviation are not well known. Biopsies of septal and lateral nasal mucosae from both sides of nose were obtained from 20 patients undergoing septoplasty and control group of 10 patients undergoing head and neck surgery. Histopathological changes including lymphocytic infiltration and squamous metaplasia were compared. This study determined significantly higher rate of squamous metaplasia and lymphocytic infiltration in septal mucosa opposite the deviation compared to control group. Furthermore, there was a significantly higher rate of lymphocytic infiltration in the lateral nasal wall mucosa opposite the deviation when compared to control group. Increased lymphocytic infiltration and squamous metaplasia are observed on both sides of nasal mucosa; however, they are more severe on the side opposite the deviation. Septal deviation predisposes to chronic mucosal inflammation and squamous metaplasia, both of which may render patients susceptible to chronic rhinosinusitis.