喉癌喉全切除手术前后鼻腔黏膜形态和功能的比较

发布时间：2018-11-26 17:16

【摘要】：目的：观察喉癌(Laryngealcancer,LC)喉全切手术(Totallaryngectomy,TL)前后患者鼻腔黏膜形态和功能的变化。方法：①对20例LC患者喉全切除手术前、术后3月、术后18月分别进行鼻腔黏膜糖精实验。②对20例LC患者喉全切除手术前、术后3月、术后18月分别进行鼻腔电子鼻咽镜检查。③对15例LC患者喉全切除手术前、术后3月、术后18月分别进行鼻黏膜扫描电子显微镜及透射电子显微镜检查。结果：①糖精实验：术后3月与术前比较，纤毛传输时间的均值略显缩短，但其差异无统计学意义(P0.05)，纤毛传输时间术后18月比术前明显延长(P 0.05)。②鼻腔电子鼻咽镜检查：LC喉全切除术后3月检查与术前检查比较，鼻腔大体结构未见明显变化；术后18月鼻腔变得明显宽大，鼻腔各结构呈萎缩性改变，鼻甲变小，黏膜变薄，色泽变淡，，多为苍白色、青白色等，质地变硬，弹性变差，表面多有略呈白色的稀薄分泌物。③电子显微镜检查: LC喉全切除术后3月鼻黏膜纤毛、腺体等结构与术前比较，无明显差异,术后18月鼻黏膜纤毛较稀疏、局部纤毛脱落，存留的纤毛排列紊乱，摆动方向不一致，可见倒伏、黏连成簇状的纤毛；且黏膜固有层内腺细胞排列紊乱，部分腺细胞固缩，腺腔变小，部分甚至呈闭锁状态，其游离面微绒毛减少，腺腔内可见较少分泌物。结论：LC喉全切除术后鼻腔的大体结构和超微结构及黏液纤毛清除功能在术后3月内没有显著变化，但随着时间延长，至术后18月时，鼻腔的大体结构发生萎缩性改变，超微结构受到损伤，黏膜纤毛清除功能显著下降。
[Abstract]:Objective: to observe the morphology and function of nasal mucosa in patients with laryngeal carcinoma (Laryngealcancer,LC) before and after total laryngectomy (Totallaryngectomy,TL). Methods: before laryngectomy, 3 months and 18 months after laryngectomy, 20 patients with LC underwent nasal mucosal saccharin test, and 20 patients with LC underwent laryngectomy before and 3 months after laryngectomy. The nasal mucosa scanning electron microscope and transmission electron microscope were performed in 15 patients with LC before laryngectomy, 3 months after operation and 18 months after operation. Results: 1 saccharin experiment: the mean of ciliary transmission time was slightly shorter than that before operation 3 months after operation, but the difference was not statistically significant (P0.05). The time of ciliary transmission was significantly prolonged 18 months after operation than that before operation (P 0.05). 2 the nasal cavity gross structure did not change significantly after LC total laryngectomy 3 months after operation compared with preoperative examination. At 18 months after operation, the nasal cavity became obviously wide, the nasal cavity structure showed atrophic changes, the turbinate became smaller, the mucous membrane became thinner, the color became pale, mostly pale, green and white, the texture became hard, and the elasticity became poor. The surface of the nasal mucosal cilia and glandular structure were not significantly different from those before operation. The nasal mucosal cilia were sparse and the local ciliates were shedding at 18 months after LC's total laryngectomy. The remaining ciliates were disordered, the direction of wobble was not consistent, and the ciliates were lopsided, sticky and cluster-like; In the lamina propria mucous membrane, the gland cells were arranged in disorder, some gland cells were constricted, the glandular cavity became smaller, some of them were even atresia, the free microvilli decreased, and less secretions could be seen in the glandular cavity. Conclusion: the gross structure, ultrastructure and mucociliary clearance function of nasal cavity after total laryngectomy with LC showed no significant changes within 3 months after operation, but the gross structure of nasal cavity changed atrophic at 18 months after LC laryngectomy. The ultrastructure was damaged and the mucosal cilia clearance function was significantly decreased.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.65

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