鼻内镜手术治疗后鼻孔息肉

目的探讨后鼻孔息肉的起源部位,分析鼻内镜下治疗后鼻孔息肉的疗效。方法回顾性分析1999～2006年间行鼻内镜手术的63例后鼻孔息肉患者的临床资料。结果59例上颌窦后鼻孔息肉,42例可在上颌窦内确切定位起源部位,其中起源于内上壁16例,后壁为9例,前壁为3例,下壁为3例,外侧壁为2例,上壁2例,前内壁为4例,前外侧壁1例,后上壁1例,外下壁1例;2例起源于鼻中隔;1例起源于蝶窦;1例起源于前组筛窦。所有病例均在鼻内镜下手术切除。术后随访6～30个月,4例复发,经二次手术治愈。5例并发鼻腔粘连,经松解后解除粘连。结论后鼻孔息肉多原发于上颌窦内侧壁。采用鼻内镜手术治疗安全、有效。术前明确后鼻孔息肉的起源部位对手术方式的选择至关重要。     

D2-40 immunohistochemical assessment of lymphangiogenesis in normal and edematous sinus mucosa and nasal polyp

OBJECTIVE: The lymphatic system plays an important role in the maintenance of tissue fluid homeostasis, which facilitates interstitial protein transport. Until recently, the lymphatic system of the sinonasal mucosa has been relatively poorly studied. The authors aimed to investigate the distributional and quantitative changes of the lymphatic vessels in inflammatory sinus mucosa and nasal polyps in comparison with healthy sinus mucosa using D2-40 antibody. METHODS: Immunohistochemistry and Western blotting with D2-40 antibody were applied to normal and edematous ethmoid sinus mucosa and nasal polyps. The number, size, and length densities of lymphatic vessels were evaluated using tissue sections and whole mount preparations. RESULTS: Most lymphatic vessels in normal and edematous ethmoid sinus mucosa were distributed in the subepithelial layer. Some of these vessels were dilated, whereas others were compressed and had a slit-like lumen. No D2-40 positive vessels were found in samples of nasal polyps. Lymphatic vessels showed no statistically significant difference in their number, size, or length density between normal and edematous ethmoid sinus mucosa. Western blot also showed no differences in their expression levels. CONCLUSION: These findings indicate that lymphangiogenesis does not occur in edematous ethmoid sinus mucosa, which may not reuptake interstitial fluid efficiently in inflammatory conditions, resulting in the formation of mucosal edema in chronic inflammation.     

水通道蛋白-4在人鼻息肉组织中的表达及意义

目的 研究水通道蛋白-4(aquaporin4, AQP-4)在鼻息肉组织中的分布并探讨其在鼻息肉形成过程中的机制和作用。方法 采用免疫组织化学方法检测60例新鲜鼻息肉标本和30例肥大下鼻甲黏膜中AQP-4的表达及分布水平,应用两独立样本t检验对检测结果进行对比分析。结果 鼻息肉和下鼻甲黏膜的上皮细胞、固有层腺体细胞、血管及血窦内皮中均可检测到AQP-4分布;鼻息肉上皮细胞、血管及血窦内皮中阳性细胞数均高于下鼻甲黏膜,且差异有统计学意义。结论 AQP-4在鼻息肉上皮细胞和血管及血窦内皮细胞中表达水平明显增高,提示AQP-4在鼻息肉组织中的异常分布可能是鼻黏膜水肿的形成机制之一。     

Choanal polyps: an evaluation of 53 cases

BACKGROUND: The aim of this study was to evaluate our experience on the diagnosis and treatment of choanal polyps (CP). METHODS: This study consists of 53 patients with CP diagnosed by means of rhinoscopy, nasal endoscopy, computerized tomography, surgical, and histologic findings between 1996 and 2005. RESULTS: The origins of the CPs were the unilateral maxillary sinus in 47 patients, simultaneously bilateral maxillary sinus in 2 patients, septum in 2 patients, sphenoid sinus in I patient, anterior ethmoid sinus in 1 patient. The most common presenting symptoms were unilateral nasal obstruction, snoring, and rhinorrhea. In the cases of the antrochoanal polyps, the most common preoperative radiological finding was the total opacification of the maxillary sinus. CONCLUSION: Endoscopic approach for complete removal of the CPs is an extremely safe and effective procedure. It should be focused on the detection of the exact origin and the extent of the polyp to prevent recurrence.     

后鼻孔息肉的临床类型和诊断及鼻内镜手术

目的探讨后鼻孔息肉的临床类型、诊断及鼻内镜手术的方法和效果。方法总结1998年1月至2005年12月收治的34例后鼻孔息肉患者的临床资料，分析其发病方式、来源、临床表现、与鼻窦的关系以及鼻内镜手术技巧和疗效。结果①18例发病源于鼻窦囊肿或息肉，其中上颌窦17例，后筛窦1例；②5例发病分别源于鼻囟门或蝶筛隐窝、蝶窦口黏膜，同侧上颌窦或蝶窦积脓或黏膜水肿；③11例发病分别源于中鼻甲、钩突、嗅沟鼻中隔和筛泡前壁黏膜，邻近的鼻窦正常；④全部病例均行鼻内镜手术切除后鼻孔息肉及相应鼻窦开放，术后无复发。结论①建议诊断后鼻孔息肉应分为窦内型、鼻窦阻塞型和单纯型三种临床类型，遵循以临床类型为依据的手术原则，选择合理的术式和范围；②鼻内镜和鼻一鼻窦CT检查可以在术前明确后鼻孔息肉的诊断和临床类型；③鼻内镜手术治疗后鼻孔息肉准确、微创，彻底切除息肉蒂基部，防止复发。     

来源于后组筛窦的后鼻孔息肉的诊断和治疗

目的:探讨后组筛窦的后鼻孔息肉(CP)的临床特征、诊断以及鼻内镜下手术方法.方法:总结2002年1月～2007年6月收治的11例后组筛窦的CP患者的临床资料,分析其临床表现、鼻腔及鼻窦内病变情况、鼻内镜手术方法及注意要点以及临床疗效.结果:11例均在鼻内镜下完成手术.术中见11例CP根部均来自后组筛窦开口处.后组筛窦内3例(27.3%)伴有囊肿,5例(45.4%)窦内有明显息肉,3例(27.3%)表现为窦内黏膜水肿息肉样变.术中无明显并发症,术后随访6个月～3年,平均1.2年,无息肉复发者.结论:后组筛窦的CP多来自后筛窦口,可能由窦内囊肿演变而成.鼻内镜下切除息肉同时需开放后组筛窦清除窦内病变,彻底清除病变后不易复发.     

Mucin gene expression in nasal polyps

CONCLUSIONS: A large set of mucin genes is expressed in nasal polyps. The expression pattern is complex and may reflect the wide spectrum of variables involved in polyp formation and progression. Prospective studies including subgroups of nasal polyps and involving substantial numbers of cases in each subgroup will be required to elucidate these variables and to understand how they affect mucus secretion. OBJECTIVE: At present, 15 of the 19 known mucin genes are expressed in the human airways. Nasal polyps might be expected to have a mucin expression pattern comparable to that of the airways. The aim of this study was to investigate mucin expression in nasal polyps. MATERIAL AND METHODS: Nasal polyp samples were obtained from 20 patients during functional endoscopic sinus surgery. Normal (control) sphenoid sinus mucosa was obtained from patients undergoing trans-sphenoid hypophysectomy. The expression of eight mucin genes (MUC1-4, -5AC, -5B, -6 and -7) was studied by in situ hybridization utilizing digoxigenin-labelled oligonucleotide probes. RESULTS: MUC6 and -7 were not expressed in sphenoid sinus mucosa, while all the studied mucin genes were expressed in nasal polyps. Expression patterns varied widely between individual polyps. The predominant epithelial mucin genes were MUC4, -5AC and -3, while MUC5B and -7 were mainly of glandular origin. MUC1, -2 and -6 were weakly expressed. The major alteration in gene expression in nasal polyps was found in the submucosal glands. MUC4 and -5AC represent a major component of both submucosal glands and epithelial cells in nasal polyps.     

Experimentally Induced Polyps in the Sinus Mucosa

To document polyp formation in the sinus mucosa, the authors of this study subjected New Zealand white rabbits to different modes of manipulation intended to induce inflammation of the maxillary sinus. These manipulations included a combination of bacterial infection and mechanical trauma, the deposition of agarose into the sinus cavity, and the deposition of N-formyl-methionyl-leucyl-phenylalanine, a chemotactic peptide, into the sinus cavity. A majority of animals developed polyps, which were examined by light and electron microscopy. Polyp formation appears to involve epithelial disruption and the migration of immature branching epithelium. While part of the migrating epithelium eventually covers the mucosal defect, other branches spread into the underlying connective tissue, where intraepithelial microcavities with a differentiated, ciliated lining are formed. Fusing cavities separate the developing polyp body from the adjacent mucosa. With the described method, mucosal polyps can be induced with high reproducibility.     

The antrochoanal polyp

Antrochoanal polyps (ACP) are benign lesions that arise from the mucosa of the maxillary sinus, grow into the maxillary sinus and reach the choana, and nasal obstruction being their main symptom. It is an interesting model to compare the pathophysiological mechanisms with those of bilateral nasal polyposis (NP). There is a lack of research in some areas of ACP, which have to become the main aims for future investigations of this disease. In comparison to NP, ACPs are usually unilateral and appear in younger patients. Macroscopically, they have a cystic intramaxillary portion and a solid intranasal portion. Microscopically, they are similar to a maxillary cyst of the mucosa. Nasal endoscopy, computed tomography and magnetic resonance are the main diagnostic techniques. Surgery is the indicated treatment for ACP, with endoscopic resection the most recommended. Simple avulsion of the polyp has a high rate of recurrence, whereas the Caldwell-Luc procedure is associated with damage of the maxillary and dental growth centres. More research is needed to establish the relationship between chronic sinusitis and ACP. Further work is also needed to investigate the role of inflammatory mediators (histamine, IgE, adhesion molecules, PAF), as well as metalloproteases and nasal remodelling, and tumour marker expression in A CP.     

慢性鼻及鼻窦炎伴鼻息肉患者鼻窦黏膜中三叶因子3的表达

目的探讨慢性鼻及鼻窦炎伴鼻息肉（chronicrhinosinusitis with nasal polyps,CRSwNP）患者鼻窦黏膜中三叶因子3（trefoil factor 3,TFF3）的表达及临床意义。方法采用免疫组化方法（非生物素二步法）检测正常钩突黏膜和CRSwNP患者鼻窦黏膜中TFF3表达,同时对HE染色组织切片进行观察,判断上皮损伤程度,比较两组间TFF3表达差异及其与上皮损伤程度的关系。结果①TFF3在CRSwNP患者鼻窦黏膜中表达较正常钩突黏膜降低（Z=-3.807,P=0.02）,血清总IgE水平升高组更明显（Z=-2.629,P=0.033）;②CRSwNP患者鼻窦黏膜中TFF3表达与上皮损伤分期存在负相关关系（r=-0.388,P=0.016）。结论 TFF3在CRSwNP患者鼻窦黏膜中表达降低可能在CRSwNP的发病机制中起到作用。     

嗜酸性粒细胞浸润对鼻息肉术后鼻腔黏膜转归及疗效的影响

目的：探讨嗜酸性粒细胞（eosinophils, EOS）浸润对鼻息肉术后鼻腔黏膜转归及疗效影响的因素。方法：对于50例鼻息肉患者术中及部分术后复发的鼻息肉组织和上颌窦口周边水肿组织采用Chromotrope 2R特染,检测以上标本中嗜酸性粒细胞在功能性鼻窦内窥镜术后术腔黏膜恢复过程中的表达水平,并进行相关分析。结果：鼻息肉组织中EOS水平明显高于中鼻甲黏膜组织,且随时间呈现不同的变化规律（P＜0.01）;EOS浸润程度越深,鼻腔黏膜恢复越慢,鼻息肉复发越快。结论：EOS浸润在鼻息肉的形成和发展中起重要作用,提示其可能参与延迟鼻窦、鼻腔黏膜上皮化的进程,可作为疗效判断的指标之一。     

PCR analysis of nasal polyps,chronic sinusitis,and hypertrophied turbinates for DNA encoding bacterial 16S rRNA

BACKGROUND: Nasal polyps are considered to result from chronic inflammation, but the initial or persisting stimulus for the inflammation is not known. A variety of bacteria and fungi have been cultured from nasal polyps, but approximately 35% have sterile cultures. Previously, Mycoplasma pneumoniae-specific DNA was detected in human nasal polyps using polymerase chain reaction (PCR) techniques, suggesting M. pneumoniae as a causative agent in the etiology of nasal polyps. METHODS: In this study, we tested for the presence of bacterial DNA in nasal polyps resected from 40 patients, in nasal mucosa membrane from 9 patients undergoing turbinectomy for hypertrophy, and in sinus mucosa membrane from 6 patients undergoing endoscopic surgery for chronic sinusitis. Tissue DNA was extracted and analyzed by PCR using M. pneumoniae specific primers for DNA that encode the 16S rRNA gene in 41 specimens (31 polyps, 6 turbinates, and 4 sinus), and by consensus sequence-based PCR using broad range primers for most eubacterial DNA encoding the 16S rRNA gene in 38 specimens (26 polyps, 7 turbinates, and 5 sinuses). RESULTS: Only two samples were positive for bacterial DNA encoding 16S rRNA: Streptococcus sp. DNA was isolatedfrom one polyp specimen and Pseudomonas aeruginosa DNA was isolated in one maxillary sinusitis specimen. No evidence of M. pneumoniae-specific DNA encoding 16S rRNA was found in any of the tissues. CONCLUSIONS: This study suggests that chronic bacterial infection is not a major component of nasal polyp etiology.     

鼻内镜手术疗效综合评价

目的 探讨鼻内镜手术对慢性鼻窦炎及鼻息肉疗效的综合评价方法.方法 采用声反射鼻腔测量系统、前鼻测压计、T＆T嗅觉计定量检查法和术区黏膜评分法,对46例慢性鼻窦炎及鼻息肉患者鼻气道阻力、嗅觉、鼻腔术区黏膜形态进行测试.结果 鼻内镜手术后患者的鼻气道通气、嗅觉有明显好转;术后鼻腔、黏膜状况与功能恢复有显著相关性.结论 鼻气道阻力、嗅觉功能测试、鼻声反射检查、术区黏膜评分检测作为手术前后鼻功能的检测手段,可对术后疗效进行客观的综合评价.     

Expression of MUC5AC mRNA in the goblet cells of human nasal mucosa

OBJECTIVES/HYPOTHESIS: Mucus hypersecretion is a common feature in chronic sinusitis with polyps. Because mucus hypersecretion is commonly accompanied by goblet cell hyperplasia, it is important to identify which mucin gene mRNAs are expressed in the goblet cells of the surface epithelium in the human airway. This study aims to investigate the pattern of expression of MUC5AC messenger RNA (mRNA) in the goblet cells of human nasal mucosa. METHODS: Six nasal polyps, five inferior turbinate mucosa specimens, and three normal-appearing mucosa specimens of the posterior ethmoid sinus were obtained. Each of the specimens was cut into 10-microm-thick serial frozen sections, and in situ hybridization of MUC5AC mRNA was performed with an oligonucleotide probe. Alcian blue (pH 2.5)-periodic acid-Schiff (AB-PAS) staining was performed on the serial sections. RESULTS: In human nasal polyps, MUC5AC mRNA was expressed in the cytoplasm of most of the goblet cells. However, in the inferior turbinate, MUC5AC mRNA was expressed in only some of the goblet cells. On the contrary, in the normal-appearing mucosa of the posterior ethmoid sinus, MUC5AC mRNA was barely expressed in the goblet cells. Furthermore, MUC5AC mRNA was mainly expressed in some of the PAS-positive goblet cells. CONCLUSIONS: Only a portion of the goblet cells in the human nasal mucosa expressed MUC5AC mRNA. This result suggests that surface goblet cells might have other mucin genes, in addition to MUC2 and MUC5AC.     

Open-type congenital cholesteatoma: differential diagnosis for conductive hearing loss with a normal tympanic membrane

Conclusions

A large set of mucin genes is expressed in nasal polyps. The expression pattern is complex and may reflect the wide spectrum of variables involved in polyp formation and progression. Prospective studies including subgroups of nasal polyps and involving substantial numbers of cases in each subgroup will be required to elucidate these variables and to understand how they affect mucus secretion.

Objective

At present, 15 of the 19 known mucin genes are expressed in the human airways. Nasal polyps might be expected to have a mucin expression pattern comparable to that of the airways. The aim of this study was to investigate mucin expression in nasal polyps.

Material and methods

Nasal polyp samples were obtained from 20 patients during functional endoscopic sinus surgery. Normal (control) sphenoid sinus mucosa was obtained from patients undergoing trans-sphenoid hypophysectomy. The expression of eight mucin genes (MUC1–4, -5AC, -5B, -6 and -7) was studied by in situ hybridization utilizing digoxigenin-labelled oligonucleotide probes.

Results

MUC6 and -7 were not expressed in sphenoid sinus mucosa, while all the studied mucin genes were expressed in nasal polyps. Expression patterns varied widely between individual polyps. The predominant epithelial mucin genes were MUC4, -5AC and -3, while MUC5B and -7 were mainly of glandular origin. MUC1, -2 and -6 were weakly expressed. The major alteration in gene expression in nasal polyps was found in the submucosal glands. MUC4 and -5AC represent a major component of both submucosal glands and epithelial cells in nasal polyps.     

Nasal polyps in the olfactory cleft

Objectives: Nasal polyps frequently arise from the middle meatus in patients with nasal polyposis, but caution is required when polyps are seen protruding from the olfactory cleft. The purpose of this study was to evaluate a method to achieve effective and safe access to the olfactory cleft, and to determine the actual incidence of polyps arising from the olfactory cleft in patients with nasal polyposis. Patients: Eighty-four patients with bilateral or unilateral nasal polyps (n = 143) ranging in age from 16 to 72 years underwent endoscopic sinus surgery in the period from January 1994 to December 1996. Methods: To observe and gain access to the olfactory cleft, septoplasty combined with endoscopic sinus surgery was needed in patients with nasal polyposis. Results: The endoscopy during the combined septoplasty and endoscopic sinus surgery revealed that 36.4% (n = 52) of bilateral or unilateral nasal polyps (n = 143) arose from the olfactory cleft. Of 52 polyps of olfactory cleft origin, 45 (86.5%) arose from the superior turbinate and/or superior meatus, 32 (67.3%) from the medial side of the middle turbinate, 24 (46.2%) from the anterior face of the sphenoid sinus, and 17 (32.7%) from the mucosa of the nasal septum. Conclusions: These findings suggest that for surgeries of nasal polyposis an approach to the olfactory cleft as well as to the middle meatus is required.