鼻用糖皮质激素治疗兔急性细菌性上颌窦炎的细菌培养观察

目的探讨鼻用糖皮质激素喷雾剂布地奈德(budesonide)对兔急性细菌性上颌窦炎的细菌学的影响。方法健康成年新西兰白兔48只,采用鼻腔置入Merocel高分子膨胀海绵并注入肺炎链球菌的方法建立急性细菌性上颌窦炎模型,10 d后取出鼻腔膨胀海绵,随机分成抗生素治疗组(A组)、抗生素加鼻用激素治疗组(B组)、鼻用激素治疗组(C组)及对照组(D组),每组各12只。分别于治疗2周及4周后每组各处死6只动物,获取上颌窦腔分泌物作普通细菌培养。结果细菌培养结果显示治疗2周后,虽然A、B组上颌窦分泌物细菌培养阳性率低于C、D组,但组间差异无统计学意义(P>0.05)。治疗4周后,A、B组细菌培养阳性率明显低于C、D组,差异有统计学意义(P<0.05),A、B组间差异无统计学意义(P>0.05)。结论鼻用糖皮质激素合并抗生素治疗兔急性细菌性上颌窦炎时,未见影响抗生素的抗菌效果。     

慢性筛窦炎黏膜超微结构变化

目的观察慢性筛窦炎（chronic ethmoiditis）患者筛窦黏膜的超微结构。方法15例慢性筛窦炎患者和4例单纯鼻中隔偏曲患者在接受鼻内镜手术时钳取筛窦黏膜,通过扫描电镜、透射电镜观察其黏膜表面形态及炎细胞浸润的超微结构改变。结果慢性筛窦炎患者筛窦黏膜可观察到黏液颗粒呈串珠样或团片状附着在残存纤毛上：纤毛稀疏、排列凌乱、缠结：细胞连接分离,细胞间隙增宽;基底细胞受损：肥大细胞、嗜酸性粒细胞颗粒释放,浆细胞粗面内质网扩张等超微结构的改变。结论慢性筛窦炎患者筛窦黏膜超微结构的改变是筛窦炎慢性迁延的病理学基础。     

二甲胺四环素对嗅感觉神经元凋亡的保护作用

目的：观察二甲胺四环素对慢性鼻窦炎大鼠嗅感觉神经元（OSNs）凋亡的保护作用。方法：将大鼠随机分为对照组（A组）、鼻窭炎造模组（B组）和鼻窦炎加二甲胺四环素组（C组）,于不同时间取材,用苏木精-伊红染色观察嗅上皮厚度及上颌窦黏膜病理变化,用免疫组织化学染色检测Caspase-3表达阳性细胞。结果：苏木精-伊红染色镜检发现上颌窦黏膜病理学改变：A组明显轻于B组和C组,B、C两组嗅上皮厚度差异有统计学意义（P〈0．05）,免疫组织化学镜检发现B、C两组Caspase-3阳性细胞表达差异有统计学意义（P〈0．05）。结论：二甲胺四环素能抑制鼻窦炎大鼠模型Caspaser-3的表达,可能成为治疗嗅觉障碍的有效药物。     

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。     

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。     

3种术式治疗非侵袭性真菌性上颌窦炎的临床分析

目的：回顾分析3种不同入路鼻内镜手术治疗非侵袭性真菌性上颌窦炎的临床效果。方法：根据不同术式,将32例分为3组：A组9例,行鼻内镜鼻内、外双径路上颌窦病灶清除术;B组：15例,行鼻内镜鼻内中、下鼻道双径路术;C组：8例,行单纯鼻内镜手术。结果：A组9例,治愈率100％;B组15例,复发1例,治愈率93％;C组8例,治愈率100％。3组病理检查均未见窦腔黏膜内有真菌生长。结论：治疗非侵袭性真菌性上颌窦炎,不论采取何种术式,都要达到既微创又彻底去除病灶,使鼻窦引流通畅和通气的目的。     

辛夷注射液窦腔灌注治疗家兔慢性上颌窦炎

目的建立家兔慢性上颌窦炎模型,观察自制辛夷注射液对慢性上颌窦炎的治疗效果.方法家兔28只,分为4组,其中实验组24只,再分为3组.在全麻下打开上颌窦前壁裂隙植入明胶海绵并注入金黄色葡萄球菌5周后制成慢性上颌窦炎模型.①空白组窦腔内灌注生理盐水2ml;②阳性对照组窦腔灌注庆大霉素2ml(8万U);③治疗组窦腔灌注辛夷注射液2ml.并于第3、5、7天分别以同样方法重复灌注.第10天处死动物做细菌培养和病理学检查.结果治疗组共有3个窦腔培养结果为阳性,对照组13个窦腔培养结果为阳性,空白组共14个窦腔分泌物有细菌生长.1、2、3组动物所有鼻窦黏膜均有炎症表现,但轻重程度不同.治疗组黏膜基本正常,对照组和空白组黏膜上皮排列不整齐,部分变性、坏死、脱落,有小溃疡形成,黏膜充血水肿明显并有炎细胞浸润.结论辛夷注射液窦腔内灌注对慢性上颌窦炎有很好的治疗作用.     

中鼻甲在维持上颌窦口通畅中的作用

目的观察中鼻甲对上颌窦口通畅度维持状况的影响。方法根据鼻内镜术中中鼻甲的保留情况，将466例（570侧）鼻内镜下行上颌窦手术的慢性鼻窦炎患者分为A、B、C三组。A组保留完整中鼻甲，B组保留部分中鼻甲，C组去除中鼻甲。术后随访12月以上，观察各组患者的上颌窦口通畅程度，分析其与中鼻甲保留程度的相关性。结果三组患者术后上颌窦开口的通畅率分别为72．13％、71．24％和40．35％，前两组之间上颌窦口通畅率差异无统计学意义（P〉0．05），均明显高于切除中鼻甲组（P〈0．01）。结论保留或部分保留中鼻甲可以提高鼻内镜手术后上颌窦开口的通畅率，从而减少上颌窦炎的复发。     

上颌窦穿刺中药液灌洗并置管治疗儿童慢性化脓性上颌窦炎疗效观察

目的:观察上颌窦穿剌中药液灌洗并置管治疗儿童慢性化脓性上颌窦炎的疗效。方法:将能合作穿刺治疗的268例儿童慢性化脓性上颌窦炎随机分成A、B两组。A组168例用中药液灌洗并置管冲洗;B组用生理盐水冲洗后注入庆大加地塞米松。两组疗效进行比较,结果中药液灌洗组总有效率97%,B组总有效率91%,经X2检验显示两组间疗效差异有显著意义(P<0.05)。结论:上颌窦穿剌中药液灌洗并置管治疗儿童慢性化脓性上颌窦炎有较好疗效,有利于儿童鼻及鼻窦生理功能的维护和改善。     

慢性肥厚性鼻炎4种术式特点及下鼻甲黏膜的超微结构观察

目的：探讨治疗慢性肥厚性鼻炎4种不同术式的手术特点及下鼻甲黏膜超微结构的变化。方法：88例慢性肥厚性鼻炎患者行鼻内镜下鼻甲黏膜下成形术（A组），30例行下鼻甲部分切除术（B组），36例行射频消融下鼻甲减容术（C组），10例行下鼻甲硬化剂注射术（D组）。分别比较A、B、C3组术式治疗慢性肥厚性鼻炎的有效率、手术特点及术前、术后下鼻甲黏膜超微结构特征。结果：术后随访4～6个月，A、B、C3组的有效率分别为97．4％、100．0％和93．4％，差异无统计学意义（均P〉0．05）。A组和C组术式优点突出，下鼻甲黏膜纤毛结构保存较好。结论：鼻内镜下鼻甲黏膜下成形术和射频消融下鼻甲减容术是治疗慢性肥厚性鼻炎较好的手术方法。     

淋巴细胞在慢性鼻-鼻窦炎组织中的表达及意义

目的：探讨B淋巴细胞（CD20）和T淋巴细胞亚群（CD4、CD8）在慢性鼻-鼻窦炎（CRs）中的表达及在炎症反应中的作用。方法：采用免疫组织化学技术检测B淋巴细胞（CD20）和辅助性T细胞（CD4）、细胞毒性T细胞（CD8）在实验组[分为15例CRS不伴鼻息肉（CRSsNP）组、12例CRS伴鼻息肉（CRSwNP）组、7例复发性CRSwNP组]和对照组（13例下鼻甲黏膜对照）中的表达。采用Mann-WhitneyU检验分析实验组和对照组B淋巴细胞、T淋巴细胞亚群的表达情况,实验组组间淋巴细胞浸润比较用单因素方差分析One—WayANOVA。结果：与对照组相比,实验组有明届的13淋巴细胞（CD20）和T淋巴细胞亚群（CD4、CD8）浸润（P〈0．05）：T淋巴细胞、亚群（CD4、CD8）在CRSwNP组和复发性CRSwNP组病变中的表达明显高于CRSsNP组（P〈0．05）;CD4在复发性CRSwNP组中的表达明显高于CRSwNP和CRSsNP组（P〈0．01）。结论：实验组鼻腔黏膜中B淋巴细胞、辅助性T细胞和细胞毒性T细胞高表达,均参与炎症的形成,其炎症匣应与T淋巴细胞浸润密切相关。     

Mucociliary activity and histopathology of sinus mucosa in experimental maxillary sinusitis: A comparison of systemic administration of antibiotic and antibiotic delivery by polylactic acid polymer

To evaluate the efficacy of antibiotic delivered by polyactic acid (PLA) polymer in sinusitis, we induced maxillary sinusitis in 32 New Zealand white rabbits by occluding the sinus ostium and inoculating the sinus cavity with Streptococcus pneumoniae. The rabbits were divided into three groups consisting of group 1 (control group, 8 rabbits), which was treated only by reopening the ostium; group 2, which was treated by both reopening the ostium and injecting ampicillin intramuscularly (40 mg/kg/day in three divided doses, 12 rabbits); and group 3 (12 rabbits) in which a piece of PLA-polymer ampicillin (0.326 mg) sheet (1.5 × 1.5 cm) was placed within the sinus after re-establishing ostial patency. The light microscopic findings such as epithelial ulceration, loss of cilia, infiltration of inflammatory cells, and edema were less pronounced in group 2 and minimal in group 3. The electron microscopic findings such as swelling of mitochondria and endoplasmic reticulum and protruded cytoplasm were severest in the control group, followed by groups 2 and 3. The mucociliary transport speed measured at the medial wall of the maxillary sinus was highest in group 3. The results of this study suggest that treatment with PLA-polymer ampicillin may have a better efficacy in maxillary sinusitis than that with systemic administration of ampicillin.     

不同浓度SEB对兔上颌窦GATA-3及Th1/Th2细胞因子表达的影响

目的：探讨向兔上颌窦腔注入不同浓度金黄色葡萄球菌肠毒素B（SEB）对上颌窦黏膜组织中Th2特异性转录因子GATA-3及Th1与Th2细胞因子表达的影响。方法：48只兔随机分成low-dose SEB组和highdose SEB组,每组24只。造模后每天向low-dose SEB组和high-dose SEB组兔左上颌窦腔分别注入0.3μg/L SEB（0.6ng）及30μg/L SEB（60ng）各2ml。2组兔右上颌窦腔每天注入2ml生理盐水作为对照组。造模后3、7、14及28d每组随机选6只兔处死并获取双侧上颌窦黏膜标本进行检测。用ABC-ELISA法检测IFN-γ、IL-2、IL-4和IL-5的含量;采用Real-time PCR和免疫组织化学法检测GATA-3的表达。结果：在造模后7、14及28d,high-dose SEB组左上颌窦黏膜组织中IFN-γ和IL-2的水平均高于low-dose SEB组及对照组（均P〈0.05）。造模后14、28dlow-dose SEB组左上颌窦黏膜组织中IL-4和IL-5的水平均高于high-dose SEB组和对照组（均P〈0.05）。Real-time PCR结果显示,low-dose SEB组转录因子GATA-3mRNA的相对表达水平较high-dose SEB组和对照组均明显升高（均P〈0.05）。免疫组织化学结果显示,low-dose SEB组GATA-3表达的阳性细胞数高于high-dose SEB组和对照组（均P〈0.05）。结论：高浓度SEB促进Th1细胞因子分泌,而低浓度SEB增强Th2细胞因子表达及Th2型免疫反应。     

单纯滴鼻致敏豚鼠上下气道病理改变

目的观察单纯滴鼻致敏豚鼠上下气道的症状及病理改变。方法健康Hartley豚鼠随机分为单纯滴鼻组（实验组,15只）及空白对照组（对照组,10只）。实验组及对照组经基础致敏和激发后,对其喷嚏、抓鼻、鼻腔分泌物、咳嗽及呼吸频率改变做动态症状学观察,观察鼻腔和肺组织的病理改变。结果抗原激发后,实验组均出现典型的鼻部症状和呼吸频率改变,但呼吸困难及咳嗽症状并不明显。对照组鼻、肺部均无明显改变,鼻腔和肺部支气管黏膜嗜酸性粒细胞浸润及杯状细胞分布较对照组有统计学意义（P〈0．05）。此外实验组还可以观察到鼻、肺黏膜下小血管扩张、腺体增生等病理改变。结论单纯滴鼻致敏的豚鼠具有明显的鼻部症状,肺部症状不明显,但上下气道的病理改变具有一致性。     

Experimental model of fungal sinusitis: a pilot study in rabbits

We have established an experimental model of fungal sinusitis in rabbits to analyze the chronology and the pathogenesis of the development of noninvasive fungal sinusitis due to Aspergillus fumigatus. Thirty-four Pasteurella-free New Zealand white rabbits divided into three groups were included in this study. In the first group (10 rabbits), A fumigatus was inoculated into the maxillary sinus. In the second group (10 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a wound in the mucosa. In the third group (14 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a blocked ostium. On days 15 and 30, endoscopic, histopathologic, bacterial, and mycological examinations of both maxillary cavities and mucous membrane were performed. The rabbits were painlessly sacrificed 30 days after inoculation; mucosal and bone biopsies of the maxillary sinus cavities were performed for histopathologic studies. We found that noninvasive fungal sinusitis had been induced in 2 rabbits of the second group and 8 rabbits of the third group. We conclude that introduction of fungi into a sinus with a blocked ostium induces fungal sinusitis. The present model of experimental fungal sinusitis seems to be reproducible and suitable for further studies of the development of fungal sinusitis.     

The effect of high single dose parenteral vitamin A in addition to antibiotic therapy on healing of maxillary sinusitis in experimental acute sinusitis

OBJECTIVE: The aim of this study is to investigate the therapeutic role of vitamin A in addition to standard antibiotic treatment on healing of experimental acute maxillary sinusitis. MATERIAL AND METHODS: Experimental maxillary sinusitis in rabbits was induced by blocking the left noses and direct inoculation of Staphylococcus aureus into the left maxillary sinuse cavities. Right maxillary sinuses were exposed to serum physiologic as the control group. Animals were divided into two groups. Forty-eight hours after the inoculation, Group A received only parenteral ampicilline-sulbactam (50 mg/kg), Group B were treated with same antibiotic regimen and parenteral a dose of 100.000 IU vitamin A in palmitate form. Animals were killed at 10th day and mucosas of each sinuses were examined histopathologically. Inflammation and sinus epithelium integrity were assessed. Groups were compared with using Mann-Whitney U test. RESULTS: All of the infected sinuses displayed various degrees of inflammation but there was no statistically significant difference between the study and control groups. Although epithelium integrity was slightly better in Group B but the difference was not meaningful. CONCLUSION: The adjuctive therapeutic role of vitamin A in acute sinusitis was found doubtful but this topic is worth to investigate more comprehensively.     

Xylitol enhances bacterial killing in the rabbit maxillary sinus

OBJECTIVES: Factors that alter airway surface liquid (ASL) ionic concentrations may influence the course of sinusitis. Xylitol has been shown to effect ASL ionic composition in vitro and to reduce nasal bacterial carriage, otitis media, and dental caries in vivo. We examined the effect of xylitol on experimental sinusitis in the rabbit model. STUDY DESIGN: Prospective randomized controlled study of xylitol, saline, and Pseudomonas aeruginosa administration to the rabbit maxillary sinus. METHODS: P. aeruginosa was administered to the sinuses of 26 New Zealand white rabbits. Saline was placed in the left maxillary sinus and xylitol in the right. The rabbits were randomly assigned to one of three groups: one, simultaneous administration of bacteria and solutions with bacterial analysis at 20 minutes, 11 rabbits; two, preadministration of solutions 1 hour before bacterial infection with analysis at 20 minutes, 11 rabbits; three, established sinusitis, 4 rabbits had daily injections of solutions for 5 days starting 7 days after P. aeruginosa administration. RESULTS: In group 1, 6.96% of injected bacteria were retrieved on the left (saline), whereas 0.095% were retrieved on the right (xylitol) (P = .034). In group 2, 5.64% of inoculum was recovered from the left and 2.89% from the right (P = .188). Group 3 demonstrated evidence of sinusitis with recovery of noninoculate bacteria. with no difference between right and left. CONCLUSIONS: Xylitol reduces experimental sinusitis when administered simultaneously with bacteria. Its effect in established sinusitis is less clear. A role may exist for xylitol in nasal irrigation fluid in human disease.     

上颌窦口开放联合泪前隐窝入路治疗真菌性上颌窦炎

目的：观察鼻内镜下上颌窦口开放联合泪前隐窝入路治疗真菌性上颌窦炎的疗效。方法真菌性上颌窦炎61例,27例行鼻内镜下上颌窦口开放联合泪前隐窝入路术式（观察组）,34例行鼻内镜下单纯上颌窦口开放术式（对照组）,术后随访1～2年,比较2种手术径路对真菌性上颌窦炎的疗效。结果治疗组治愈率为81.5%（22/27）,好转率为11.1%（3/27）,无效率为7.4%（2/27）;对照组治愈率58.8%（20/34）,好转率为14.7%（5/34）,无效率26.5%（9/34）,组间疗效差异有统计学意义（P＜0.05）。结论鼻内镜下上颌窦口开放联合泪前隐窝入路术式视野清晰,能全方位暴露上颌窦窦腔各死角,有利于清除病变组织,提高治愈率。