常年性变应性鼻炎手术前后鼻黏膜超微结构的变化

目的观察下鼻甲黏膜下部分切除术和鼻中隔矫正术治疗常年性变应性鼻炎前后下鼻甲超微结构的改变。方法 36例确诊为常年性变应性鼻炎患者,采用下鼻甲黏膜下部分切除术和鼻中隔矫正术,对其中6例进行术前、术后1年同侧下鼻甲前部鼻黏膜电子显微镜下观察,比较其组织病理学改变。结果常年性变应性鼻炎患者术前可见鼻黏膜上皮裸露、无纤毛,个别仅见少量微绒毛,固有层水肿,间质有较多嗜酸性粒细胞、嗜碱性粒细胞、浆细胞和肥大细胞浸润,并可见丰富的脱颗粒现象和胞质空泡化,腺体丰富,导管扩张、水肿、结构改变,有的腺细胞发生退变;术后可见鼻黏膜上皮仍裸露,纤毛未见修复仅有少量微绒毛,固有层水肿改善,间质罕见嗜酸性粒细胞,仍有嗜碱性粒细胞、浆细胞和肥大细胞浸润,其颗粒结构稳定、中心晶体清晰未见脱颗粒现象,腺体减少和组织结构趋向恢复,鼻黏膜呈慢性炎症改变。结论下鼻甲黏膜下部分切除术和鼻中隔矫正术治疗常年性变应性鼻炎手术前及手术后1年比较,下鼻甲黏膜组织超微结构发生了变化,由术前典型的变应性鼻炎组织病理转变为以嗜中性粒细胞、肥大细胞浸润为主的慢性炎症反应过程。

Ultrastructure Alternation in Nasal Mucosa on Perennial Allergic Rhinitis Cases After the Operations

Objective To identify the histopathologic changes of nasal mucosa after the operations in perennial allergic rhinitis（PAR） cases by transmission electronic microscope.Methods In 6 PAR cases undergone partial inferior turbinectomy and septoplasty treated,the changes of their sampled inferior turbinate mucosa were identified by transmission electron microscope and light microscope before and one later year of the operations.Results In 6 cases,it was shown that extensive edema and hyperplasia of the glands,cellular infiltration with EO、 MC,and the degranulation of EO and MC,abundant cytoplasm vacuolization,inconsistent density of granules with crystalloid lost,plus tissue edema and damage of collagen fibers were also dominat before the operations.Nevertheless in 6 cases,it was shown that edema and hyperplasia of the glands,cellular infiltration,and the degranulation of EO and MC、cytoplasm vacuolization were significantly reduced or disappeared after the operations,the density of EO granules with its crystalloid was consistent,and coupling with non degranulation of EO,but the epithelium cells were nude without cilia after the operations.Conclusion The ultrastructure of nasal mucosa was obviously different after the operations,and histopathology of nasal mucosa transformed to chronic inflammatroy modality with infiltration neutrophil and MC after the operations.