鼻咽癌放疗后鼻黏膜组织形态学的研究

目的:研究放疗对鼻咽癌患者鼻黏膜组织形态学的影响.方法:按患者纳入条件和剔除条件选择鼻咽癌患者47例,于放疗前后各取中鼻甲黏膜组织1块,采用常规苏木精-伊红染色及PAS染色,光镜下观察鼻咽癌放疗前后中鼻甲黏膜之上皮层的纤毛和细胞、基底层及固有层的腺体和腺细胞的改变;同时随机抽取6例用扫描电镜和透射电镜观察其上皮层的纤毛及纤毛柱状上皮细胞的变化.结果:放疗前,47例患者鼻黏膜组织形态均正常;放疗后,6例无明显变化,41例出现不同层次和不同程度改变.光学显微镜下见:上皮细胞及纤毛脱落,基底膜增厚,固有层的浆液腺减少,黏液腺增多,血管扩张、充血、增生,血管内皮细胞损伤等;扫描电镜下见:纤毛结构异常,出现脱落、粘连成簇状等现象;透射电镜下见:上皮细胞的细胞核形态不规则、固缩,细胞质出现空泡,细胞器明显减少等.结论:鼻咽癌放疗后鼻黏膜组织形态受到不同程度破坏,这可能是鼻咽癌放疗后并发鼻及鼻窦炎的病理学基础.

The histomorphological changes of the nasal mucosa in nasopharyngeal carcinoma patients postradiotherapy

Objective:To study the histomorphology of the nasal mucosa in the nasopharyngeal carcinoma(NPC) patients postradiotherapy.Method:Forty-seven specimens from the nasal mucosa of NPC patients postradiotherapy were observed under light microscope.The changes of the mucosal histomorphology include cells and cilia in epithelium,basal layer,glandular and glandular cells in lamina propria.Six specimens were observed under electron microscope,including the changes of the cilia and ciliated columnar epithelial cells in epithelium.Result: The histomorphology of the 47 specimens were normal before radiotherapy.In the 47 specimens,six specimens had no changes but 41 specimens were found various changes postradiotherapy.The mucosal changes of epithelium and cilia desquamating,basal layer thickening,decrease of the serous glands and increase of the mucous glands in lamina propria were observed under light microscope.We found the cilia structural abnormalities and the abnormal phenomena of the epithelium under scanning electron microscope(SEM) and transmission electron microscope(TEM) respectively.Conclusion:We found that the various extent of destruction of the nasal mucosa may be the pathological basis of complicating nasal or sinusitis in NPC patients postradiotherapy.