内镜下额窦球囊扩张术治疗慢性额窦炎的临床和基础研究

发布时间：2018-04-16 17:17

本文选题：鼻窦炎/外科学 + 额窦粘膜/病理学　；参考：《安徽医科大学》2011年硕士论文

【摘要】：背景和目的:慢性额窦炎手术治疗方法的进步经过了一个漫长的摸索过程。额窦手术最早开始于1750年,历经二百多年的时间,涌现出许多手术方式,但理想的手术方式一直未被认可。对于慢性鼻及鼻窦炎(chronic rhinosinusitis,CRS)患者,被目前公认的治疗CRS的经典手术:功能性内镜鼻窦手术(functional endoscopic sinus surgery ,FESS)。但FESS并没有达到真正意义上的“功能性”鼻窦开放。备受国际及国内鼻科医生和学者推崇的鼻窦球囊扩张术(Ballon Sinuplasty)是一项技术革新,具有明显的优势:最大程度的保留鼻窦的正常结构,创伤更小,粘膜破坏更小,恢复快。但手术成本扩大,费用高,也是其不足之处。考虑到目前的球囊扩张术费用高,基层医院难以推广,本文利用Foley导尿管球囊扩张额窦口治疗慢性额窦炎,以探讨额窦球囊扩张术治疗慢性额窦炎的疗效及可行性。方法:选取28例慢性鼻窦炎(均含有额窦炎)患者,均为2009年8月至2010年6月在我科住院接受额窦球囊扩张术联合FESS手术并且术后定期随访(随访3个月)。按海口标准进行分型分期,I型1期12例,I型2期6例,I型3期3例,II型1期3例,II型2期4例。均无鼻窦手术史。其中慢性额窦炎15例(单侧12例,双侧3例),术中仅对31侧额窦口进行球囊扩张。取术中、术后1个月和3个月额窦口处粘膜标本;观察术后1个月和3个月患者症状、额窦口情况。以无鼻窦炎病史的20例鼻中隔偏曲患者作对照,于鼻中隔矫正术中取其钩突粘膜标本;均行光镜观察,IL-2、TNF-a的免疫组化染色。结果:1.患者术后症状改变:15例慢性额窦炎患者额窦球囊扩张术后3个月症状消失。2.28例鼻窦炎患者额窦球囊扩张术后3个月内镜检查31侧额窦恢复良好。3.28例慢性鼻窦炎患者额窦球囊扩张术后1个月和3个月内镜检查测量31侧额窦口情况:29侧额窦口开放良好,2侧额窦口稍狭窄,无1例闭锁。4.光镜观察:额窦球囊扩张术后1个月额窦粘膜上皮有21侧(67.7%)为鳞柱交界上皮,10侧(32.3%)为假复层柱状纤毛上皮;术后3个月31侧额窦粘膜基本恢复为假复层柱状纤毛上皮。5.免疫组化染色结果:额窦球囊扩张术中组、术后1个月组,IL-2,TNF-a阳性细胞数明显高于健康对照组,P0.01,有显著统计学意义;额窦球囊扩张术后3个月,IL-2,TNF-a阳性细胞数与健康对照组比较,P0.05,无统计学意义;额窦球囊扩张术中组、术后1个月组与术后3个月组比较,P0.05,有统计学意义。结论:1.利用Foley导尿管球囊扩张额窦口治疗慢性额窦炎的疗效好,具有可行性,值得在基层医院推广。2.术后随访很重要,应大于3个月或更长时间。术后及时应用糖皮质激素对预防复发有重要意义。
[Abstract]:Background and objective: the surgical treatment of chronic frontal sinusitis has undergone a long groping process.Frontal sinus surgery began in 1750, after more than 200 years, many surgical methods have emerged, but the ideal operation has not been recognized.For patients with chronic rhinosinusitis (CRS), functional endoscopic sinus surgery (functional endoscopic sinus surgery) is widely recognized as a classic procedure for the treatment of CRS.However, FESS did not achieve the true "functional" sinus opening.Ballon Sinuplasty, which is highly praised by international and domestic nasal doctors and scholars, is a technological innovation with obvious advantages: preserving the normal structure of paranasal sinus to the greatest extent, less trauma, less mucosal damage and faster recovery.But the cost of the operation is enlarged and the cost is high, which is also its deficiency.In view of the high cost of balloon dilatation and the difficulty in popularizing primary hospitals, Foley catheter balloon dilatation of frontal sinus orifice was used to treat chronic frontal sinusitis in order to explore the efficacy and feasibility of frontal sinus balloon dilatation in treating chronic frontal sinusitis.Methods: Twenty-eight patients with chronic sinusitis (including frontal sinusitis) were treated with balloon dilation of frontal sinus combined with FESS operation from August 2009 to June 2010.According to Haikou standard, 12 cases of type I 1, 6 cases of type I, 3 cases of type I, 3 cases of type 1, 3 cases of type II and 4 cases of type 2 were classified.There was no history of sinus surgery.There were 15 cases of chronic frontal sinusitis (unilateral 12 cases, bilateral 3 cases). Only 31 sides of frontal sinus orifice were balloon dilated during operation.The mucosal specimens at the orifice of the frontal sinus were taken 1 and 3 months after operation, and the symptoms and the ostium of the frontal sinus were observed 1 and 3 months after operation.Twenty cases of nasal septum deviation without history of sinusitis were used as control group. The mucous membrane of uncinate process was collected during nasal septum correction, and the immunohistochemical staining of IL-2 and TNF-a was performed under light microscope.The result is 1: 1.Symptoms of 15 patients with chronic frontal sinusitis disappeared 3 months after balloon dilatation of frontal sinusitis. 2. 28 patients with sinusitis patients with frontal sinus balloon dilatation 3 months after endoscopic examination 31 frontal sinus recovery. 3.28 cases of chronic sinusitis31 cases of frontal sinus orifice were examined by endoscopy 1 month and 3 months after balloon dilation of frontal sinus. 29 sides of frontal sinus orifice opened well and 2 sides had slight stenosis of frontal sinus orifice.No atresia. 4.Under light microscope, 21 sides of frontal sinus mucosal epithelium were found to be pseudostratified columnar ciliated epithelium at 1 month after balloon dilatation, and 31 sides of frontal sinus mucosal epithelium returned to pseudostratified columnar ciliated epithelium at 3 months after operation.The results of immunohistochemical staining showed that the number of TNF-a positive cells in the frontal sinus balloon dilatation group was significantly higher than that in the healthy control group (P 0.01), and the number of TNF-a positive cells in the first month after operation was significantly higher than that in the healthy control group (P 0.01).There was no significant difference in the number of IL-2TNF-a positive cells between the frontal sinus balloon dilatation group and the healthy control group 3 months after balloon dilatation, and there was significant difference between the frontal sinus balloon dilatation group and the postoperation 3 months group in the frontal sinus balloon dilatation group (P 0.05).Conclusion 1.The use of Foley catheter balloon dilation of frontal sinus orifice in the treatment of chronic frontal sinusitis is effective and feasible, and is worth popularizing in basic hospitals.Postoperative follow-up is important and should be longer than 3 months or more.The application of glucocorticoid in time after operation is of great significance in preventing recurrence.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R765.4

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