兔实验性真菌性上颌窦炎模型的制备和手术疗效的研究

发布时间：2018-08-31 08:01

【摘要】： 【目的】真菌性鼻窦炎可分为“侵袭性”和“非侵袭性”两大类型。非侵袭性与侵袭性区别在于真菌菌丝是否侵入黏膜、黏膜下、血管、骨质等组织结构中,侵袭性真菌感染一旦发生,往往预后不佳,其死亡率和致残率均高。国内外对真菌性鼻窦炎的研究不多,真菌性鼻窦炎特别是侵袭性真菌性鼻窦炎的发病机制不明,动物模型的建立可以作为后期研究的基础,仅国外制成非侵袭性真菌性鼻窦炎动物模型,未见有侵袭性真菌性鼻窦炎动物模型制作成功报道。本实验探讨实验性真菌性鼻窦炎动物模型的制备方法尤其是侵袭性真菌性鼻窦炎动物模型的制备和非侵袭性真菌性鼻窦炎动物模型的手术疗效。为真菌性鼻窦炎的发病机制,病理生理,治疗及预后等研究提供良好的实验性模型。【方法】一非侵袭性真菌性鼻窦炎动物模型的制备一定量烟曲菌接种免疫功能正常兔的上颌窦,以上颌窦自然开口是否给予封闭及鼻窦黏膜是否给与划伤的不同处理方法为分组标准,以未有烟曲菌接种组给予相同上颌窦自然开口及鼻窦黏膜的处理方法为对照,分为空白对照组、假手术组、黏膜划伤组、窦口阻塞组、仅注入烟曲菌组、注入烟曲菌并给予黏膜划伤组、注入烟曲菌加窦口阻塞组7组。于接种后14天及28天观察各组实验动物的一般情况,上颌窦内情况,分泌物真菌培养,分泌物涂片及黏膜病理检查,以分泌物真菌培养、分泌物涂片及病理检查结果为判定标准,研究各组制模成功率。二侵袭性真菌性鼻窦炎动物模型的制备给予免疫抑制剂造成兔免疫功能低下,一定量烟曲菌接种已制成免疫功能低下兔的上颌窦,不同窦口处理方式及免疫抑制剂处理为分组标准,未有给予免疫抑制剂而给予相同上颌窦自然开口处理为对照,分为窦口开放组(环磷酰胺组、地塞米松组、对照组)3组,窦口封闭组(环磷酰胺组、地塞米松组、对照组)3组,共6组。于接种后28天观察各组实验动物的一般情况,上颌窦内情况,分泌物真菌培养、分泌物涂片、黏膜病理检查及影像学检查,以分泌物真菌培养、影像学检查、分泌物涂片及病理检查结果为判定标准,研究各组制模成功率。三非侵袭性真菌性鼻窦炎的动物模型手术疗效的研究制成非侵袭性真菌性鼻窦炎动物模型后,按扩大上颌窦自然开口和保持原窦口大小开放上颌窦自然口不同手术方式为分组标准,分为上颌窦自然口扩大组和上颌窦自然口开放组2组。以观察窦腔情况、窦口是否开放,是否有脓性分泌物、分泌物真菌培养、分泌物涂片及病理检查结果为判定标准,观察术后6周后两组术式的不同疗效。【结果】一非侵袭性真菌性鼻窦炎动物模型的制备实验动物接种烟曲菌14天后,注入烟曲菌加窦口阻塞组上颌窦分泌物烟曲菌培养阳性率88.9%(8/9侧),28天后注入烟曲菌加窦口阻塞组上颌窦分泌物烟曲菌培养阳性率77.8%(7/9侧)。所有病理结果均未显示烟曲菌侵袭上颌窦黏膜及组织,即未有侵袭性真菌性鼻窦炎发生。二侵袭性真菌性鼻窦炎动物模型的制备免疫抑制剂环磷酰胺加烟曲菌接种并上颌窦口阻塞组28天后上颌窦分泌物烟曲菌培养阳性率为100.0%(8/8侧);免疫抑制剂地塞米松加烟曲菌接种并上颌窦口阻塞组28天后上颌窦分泌物烟曲菌培养阳性率为100.0%(8/8侧);未给予免疫抑制剂接种烟曲菌并上颌窦阻塞组烟曲菌培养阳性率为87.5%(7/8侧);各组上颌窦黏膜PAS染色病理检查,均未见上颌窦黏膜及组织内烟曲菌侵袭,即未有侵袭性真菌性鼻窦炎发生。三非侵袭性真菌性鼻窦炎的动物模型手术疗效的研究非侵袭性真菌性上颌窦炎制模成功后,按扩大上颌窦自然开口和保持原窦口大小开放上颌窦自然口不同手术方式为分组标准,6周后观察窦口是否开放及窦腔内有无脓性分泌物,上颌窦内分泌物并真菌培养,黏膜组织送病理检查。扩大上颌窦自然开口对实验性真菌性上颌窦炎的有效率达83.3%(10/12侧),开放上颌寞窦口对实验性真菌性上颌窦炎的有效率达33.3%(4/12侧)。【结论】兔上颌窦注入一定量烟曲霉菌并给予上颌窦自然口阻塞可成功制成非侵袭性真菌性鼻窦炎动物模型。给予免疫抑制剂可造成兔免疫低下,在实验兔免疫功能低下状态下于上颌窦内接种一定量烟曲菌并给予上颌窦自然口阻塞未能制成侵袭性真菌性鼻窦炎动物模型,侵袭性真菌性鼻窦炎动物模型的制备方法有待探讨。上颌窦窦口扩大术对实验性真菌性上颌窦炎的疗效较上颌窦窦口开放术(保持原窦口大小)好。
[Abstract]:[Objective]
Fungal sinusitis can be divided into "invasive" and "non-invasive" types. The difference between non-invasive and invasive fungal mycelia is whether fungal mycelia invade the mucosa, submucosa, blood vessels, bone and other tissue structures. Once invasive fungal infection occurs, its prognosis is often poor, and its mortality and disability rate are high. The pathogenesis of fungal sinusitis, especially invasive fungal sinusitis, is unknown. Animal models can be used as the basis for later research. Only non-invasive fungal sinusitis animal models were made abroad, and no invasive fungal sinusitis animal models were successfully reported. The preparation of animal models of fungal sinusitis, especially the preparation of animal models of invasive fungal sinusitis and the surgical effect of non-invasive fungal sinusitis, provide a good experimental model for the pathogenesis, pathophysiology, treatment and prognosis of fungal sinusitis.
[method]
The maxillary sinuses of rabbits with normal immune function were inoculated with Aspergillus fumigatus. The maxillary sinuses were divided into two groups according to whether the natural ostium of maxillary sinus was sealed and whether the nasal sinus mucosa was scratched or not. The maxillary sinuses were inoculated with Aspergillus fumigatus and the nasal sinus mucosa without Aspergillus fumigatus. The control group was divided into seven groups: control group, sham operation group, mucosal scratch group, sinus ostium obstruction group, Aspergillus fumigatus group, Aspergillus fumigatus group and mucosal scratch group, Aspergillus fumigatus plus sinus ostium obstruction group. Secretory smears and Mucosal pathological examination were used to study the success rate of each group.
Immunosuppressive agents were given to the rabbits to induce immunodeficiency. A certain amount of Aspergillus fumigatus was inoculated into the maxillary sinuses of the rabbits with immunodeficiency. Different treatments of ostium and immunosuppressive agents were used as grouping criteria. The same natural ostium of maxillary sinuses was given without immunosuppressive agents. They were divided into three groups: the open sinus ostium group (cyclophosphamide group, dexamethasone group, control group), the closed sinus ostium group (cyclophosphamide group, dexamethasone group, control group) and the closed sinus ostium group (cyclophosphamide group, dexamethasone group, control group). The success rate of mold making in each group was studied according to the results of secretion fungi culture, imaging examination, secretion smear and pathological examination.
The animal models of non-invasive fungal sinusitis were established and divided into maxillary sinus natural ostium enlargement group and maxillary sinus natural ostium enlargement group according to the different surgical methods of enlarging the natural ostium of maxillary sinus and keeping the size of the original ostium of maxillary sinus. Group A: To observe the sinus cavity, whether the ostium is open, whether there is purulent secretion, secretion fungus culture, secretion smear and pathological examination results as the judgment criteria, to observe the two groups after 6 weeks of different surgical effects.
[results]
The positive rate of Aspergillus fumigatus culture in maxillary sinus secretion was 88.9% (8/9 sides) in the Aspergillus fumigatus plus ostium obstruction group 14 days after inoculation. The positive rate of Aspergillus fumigatus culture in maxillary sinus secretion was 77.8% (7/9 sides) in the Aspergillus fumigatus plus ostium obstruction group 28 days after inoculation. No Aspergillus fumigatus invaded the mucosa and tissues of the maxillary sinus. No invasive fungal sinusitis occurred.
The positive rate of Aspergillus fumigatus culture in maxillary sinus secretion was 100.0% (8 / 8 sides) 28 days after inoculation with cyclophosphamide plus Aspergillus fumigatus and the positive rate of Aspergillus fumigatus culture in maxillary sinus secretion 28 days after inoculation with dexamethasone plus Aspergillus fumigatus and maxillary sinus ostium obstruction The positive rate was 100.0% (8/8 sides), the positive rate of Aspergillus culture was 87.5% (7/8 sides) in the group without immunosuppressive inoculation and maxillary sinus obstruction, and no invasive fungal sinusitis was found in maxillary sinus mucosa and tissue by PAS staining.
Study on the surgical effect of three non-invasive fungal sinusitis animal models The effective rate of enlarging the natural ostium of maxillary sinus for experimental fungal maxillary sinusitis was 83.3% (10/12 sides) and that of opening the ostium of maxillary sinus for experimental fungal maxillary sinusitis was 33.3% (4/12 sides).
[Conclusion]
Non-invasive fungal sinusitis animal models were successfully established by injecting a certain amount of Aspergillus fumigatus into the maxillary sinus and obstructing the natural mouth of the maxillary sinus.
Invasive fungal sinusitis animal model could not be established by inoculating a certain amount of Aspergillus fumigatus into maxillary sinus and obstructing the natural mouth of maxillary sinus in experimental rabbits. The preparation method of the animal model of invasive fungal sinusitis remains to be explored.
The effect of maxillary ostium enlargement on experimental fungal maxillary sinusitis is better than that of maxillary ostium enlargement.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R763;R-332

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