鼻中隔偏曲对中鼻甲形态和结构的影响

目的比较鼻中隔偏曲患者双侧中鼻甲形态结构的改变。方法选择单纯鼻中隔偏曲患者30例，术前行鼻窦冠状位CT扫描，在CT片上直接测量并计算出双侧中鼻甲实际的宽度和高度。于中鼻甲的前端切取标本， 光镜、透射电镜观察其组织结构的改变。结果从鼻窦CT片中观察到，偏曲对侧中鼻甲的高度和宽度与同侧比较，差异有统计学意义(P<0.01)。光镜结果：偏曲对侧中鼻甲与同侧比较，黏膜上皮细胞个数增多或体积增大，基底膜增厚，间质血管增生、扩张，间质纤维组织增生。电镜结果：偏曲对侧中鼻甲与同侧比较，黏膜固有层的结缔组织胶原纤维增生明显，毛细血管的内膜具有窗格样空隙，小静脉内皮基底膜变透明，间隙增大。结论在鼻中隔偏曲患者中，偏曲两侧的中鼻甲形态和结构差异有统计学意义。骨质的增生和黏膜的肥厚是其主要原因。

Shape and structure of the middle turbinate of patients with a deviated nasal septum

ObjectiveTo explore the changes of shape and structure of the middle turbinate in two nostrils with a deviated nasal septum. Methods30 cases of a simple deviated nasal septum were enrolled in this study and nasal sinus coronal CT pictures were taken before the operations. The height and width of the middle turbinate were determined. Then mucosa samples of the middle turbinate were taken from its former end and their pathological performances were observed under an optical microscope and a transmission electron microscope. ResultsThere were significant differences of the width and height of the middle turbinate between the two nostrils as observed by CT scanning.(P<0.01). Results of optic microscopy: compared with the other side, the mucosa epithelium of the middle turbinate was proliferated and hypertrophic, the basal lamina was incrassated, the blood vessel had proliferation and dilatation in the mesenchyma, and fibrous tissues had obvious proliferation in the opposite side of the nasal septum deviation. Results of transmission electron microscopy: compared with the other side, the mucosa of the middle turbinate in the opposite side of the nasal septum had an obvious deviation, and the collagenous fibers in the lamina propria also had obvious proliferation. Fenestrated capillaries were seen under the subepithelia vascular layers and around the gland. The basal lamian of the small vein had limpidity and the space was increased. ConclusionsDifferences of shape and structure of the middle turbinate between two nostrils in patients with nasal septum deviation are significant, which contribute to hypertrophy of the middle turbinate and proliferation of the mucous membrane on the opposite side of the nasal septum deviation.