鼻内镜手术对窦口鼻道复合体微生态的影响

目的:分析成人窦口鼻道复合体微生态系的构成及功能性内镜鼻窦手术对其影响。方法:选择慢性鼻窦炎患者200例(鼻窦炎组)及轻度鼻中隔偏曲,无慢性鼻窦炎症状、体征的患者20例(对照组);鼻窦炎组再按Ⅰ型与Ⅱ型分术前组、术后组;选择窦口鼻道复合体3个部位采集标本,同时进行需氧菌、厌氧菌及真菌培养,采用多个指标,综合分析其微生态状况及变化。结果:需氧菌共13属30种,厌氧菌共3种,主要真菌3种,多为致病力弱的菌种。Ⅰ型与Ⅱ型的微生态状况差异无统计学意义(P>0.05);在需氧菌方面,鼻窦炎组与对照组差异有统计学意义(P<0.01);术后组阳性率基本呈一致下降,与术前组之间差异无统计学意义(P>0.05),两组优势菌有差异;反映窦口鼻道复合体微生态一体化的3个部位需氧菌培养结果相同率:术前组与对照组、术后组之间差异均有统计学意义(均P<0.01);术后组与对照组之间差异无统计学意义(P>0.05)。真菌方面,上述各组之间差异无统计学意义(P>0.05)。各组厌氧菌均极少。结论:正常窦口鼻道复合体为相对较洁净的一体化微生态系;病变时则呈相互隔裂的多微生物存在状态;功能性内镜鼻窦手术对该微生态系的影响主要在于扭转被破坏的一体化微生态环境,从而促使其向正常状态转归。

Microecosystem of ostiomeatal complex and its changes via functional endoscopic sinus surgery

OBJECTIVE: To study the composition of microecosystem in ostiomeatal complex on adults and its changes via functional endoscopic sinus surgery. METHOD: Two hundred adults were grouped based on pre- or postoperation as well as its type of sinusitis. Swab speciemens were taken from three different sites of ostiomeatal complex in each individual, cultivations and identifications of aerobes, anaerobes and fungi were performed simultaneously; the microecosystem of OMC was analysesed. RESULT: All aerobes belonged to thirteen genera thirty species, anaerobes were three species and three major species of fungus were cultured, most of them have none or less virulence; statistically, none significance were shown between differences of type I and II (P > 0.05); as to aerobes, difference between preoperative group and control group had significance (P < 0.01); culture rate descended postoperatively while the difference had no significance compared to preoperative group (P > 0.05); difference of rate of same aerobic culture from three sites (RSAC) between preoperative and control group was significant (P < 0.01), while wasn't between postoperative group and control one (P > 0.05). Taking fungi into account, differences among all groups had no significance (P > 0.05); anaerobes were rare in all groups. CONCLUSION: Being a microecosystem under normal condition, ostiomeatal complex is relatively clean and exists as a whole space; while chronic inflammation separate different parts of which from each other with multimicrobial existence; FESS reverses the separation of the microecosystem in OMC and rebuild it as a whole again, thus promote the recovery.