鼻内镜术后中鼻道黏膜变化及其临床意义

目的观察鼻内镜术后中鼻道黏膜变化及其临床意义。方法慢性鼻窦炎鼻息肉病人34例,FESS术后1个月和3个月取其前筛区黏膜标本;以鼻中隔偏曲病人30例(既往无鼻窦炎病史)作为对照,于鼻中隔矫正术中取其钩突黏膜标本;均行光镜观察,IL-2、TNF-α的免疫组化染色以及糖精试验。结果①光镜观察:FESS术后1个月前筛区黏膜上皮有26例(76%)为鳞-柱交界上皮,8例为假复层柱状纤毛上皮;术后3个月前筛区黏膜34例基本恢复为假复层柱状纤毛上皮。②糖精试验:FESS术后1个月与3个月比较、FESS术后1个月与正常对照组比较MTR之间均存在显著差异(P<0.05),FESS术后3个月与正常对照组间无显著差异。③免疫组化染色结果:FESS术后1个月IL-2、TNF-α阳性细胞数明显高于术后3个月组(P<0.05)及正常对照组(P<0.01);FESS术后3个月IL-2、TNF-α阳性细胞数与对照组无明显差异(P>0.05)。结论①鼻内镜术后中鼻道黏膜的恢复包括炎性反应和组织重塑。②术后及时应用糖皮质类固醇对预防复发非常重要。③术后随访应大于3个月或更长。

Patho-physiological changes of middle meatus mucosa after functional endoscopic sinus surgery and their clinical implications

Objective To investigate the patho-physiological changes of middle meatus mucosa after functional endoscopic sinus surgery(FESS) and their clinical implications.Methods Mucosa samples were taken at 1 and 3 months after FESS from 34 cases with chronic sinusitis,or during operation from 30 cases(as control) of nasal septum deviation,and examined by light microscopy and immunohistochemistry.Saccharin test was also performed on these cases.Results One month after FESS,26 cases showed squamous-columnar epithelium,and 8 cases had pseudostratified ciliated columnar epithelium,while all cases had pseudostratified ciliated columnar epithelium 3 months after FESS.Mucociliary transport rates(MTR) in patients at 1 month were significantly longer than that in patients at 3 months after FESS.There was no significant difference of MTR between controls and patients at 3 months after surgery.The inflammatory cell numbers in mucosa at 1 month were significantly higher than those at 3 month after FESS and those of healthy controls(P<(0.01)).Conclusion Inflammatory reaction and tissue remodeling happen after FESS.All patients should be followed up at least more than 3 months after surgery,and administration of glucocorticoid is necessary for preventing relapse.