慢性泪囊炎组织病理学特征及相关因素的研究

发布时间：2018-05-06 09:14

本文选题：经皮肤泪囊鼻腔吻合术 + 慢性泪囊炎　；参考：《辽宁医学院》2011年硕士论文

【摘要】：目的观察慢性泪囊炎患者泪囊粘膜的组织病理学改变,探索性别、年龄、手术前病程长短、脓液性状、急性发作史、手术与末次急性发作局部皮肤红肿消退的时间间隔等相关因素对泪囊粘膜慢性炎症以及纤维化的性质、程度的影响,探讨原发性获得性鼻泪管阻塞并慢性泪囊炎的病理机制及行经皮肤泪囊鼻腔吻合术干预的最佳手术时机。方法选取2009年7月到2010年7月在武警总医院确诊的原发性获得性鼻泪管阻塞所致慢性泪囊炎患者65例(65只眼),实行改良泪囊鼻腔吻合术,切取泪囊和鼻泪管连接处上方泪囊内侧壁的泪囊粘膜组织,采用HE染色、Masson三色染色和PAS染色方法对其进行组织病理学分析。收集患者的临床资料,包括性别、年龄、手术前病程长短、脓液性状、急性发作史、手术与末次急性发作局部皮肤红肿消退的时间间隔等,对65例病例样本的组织病理学特征进行总结,用非参数检验方法分析这些相关因素对原发性获得性鼻泪管阻塞所致慢性泪囊炎患者泪囊粘膜的组织病理学特征影响的差异性。结果本研究中慢性泪囊炎患者65例(65只眼)。镜下所有的泪囊粘膜标本全部有慢性炎症的表现,主要包含大量淋巴细胞和浆细胞浸润。其中,轻度炎症者34例,中度者20例,重度者11例。2例样本可见淋巴细胞成团,形成结节。上皮下的纤维化在42例样本中观察到,其中轻度纤维化度者29例,中度者6例,重度者7例。泪囊上皮表现为局部溃疡者18例,鳞化和增生者分别为3例和4例。发生杯状细胞融合31例,3例可以看到典型的多形核白细胞,2例还可以看到嗜酸性粒细胞。不同性别、年龄对慢性泪囊炎泪囊粘膜的炎症及纤维化程度影响的分析方面(Kruskal-Wallis test):无统计学意义,p0.05。手术前不同病程时间对慢性泪囊炎泪囊粘膜的炎症影响差异性分析(Kruskal-Wallis test):无统计学意义,p0.05。手术前不同病程时间对慢性泪囊炎泪囊粘膜的纤维化影响差异性分析(Kruskal-Wallis test):有显著性差异,p0.01。病程持续的时间越长,纤维化的严重程度就越明显。脓液性状对慢性泪囊炎泪囊粘膜的炎症影响差异性分析(Kruskal-Wallis test):无统计学意义,p0.05。脓液性状对慢性泪囊炎泪囊粘膜的纤维化影响差异性分析(Kruskal-Wallis test):有显著性差异,p0.05。患者手术前的脓液性状越浓稠,泪囊粘膜纤维化的严重程度越明显。急性发作史对慢性泪囊炎组织病理学特征的影响差异性分析(X2 test):有显著性差异,p0.01。有急性发作史的病例,泪囊粘膜的炎症以及纤维化的程度越明显。手术与末次急性发作局部皮肤红肿消退的时间间隔对慢性泪囊炎泪囊粘膜的炎症影响差异性分析(Kruskal-Wallis test):在时间间隔为1周与1～2周,有显著性差异,p0.05。手术与末次急性发作的时间间隔越短,粘膜的炎症越明显。在时间间隔为1～2周与2周以后,无统计学意义,p0.05。结论研究表明慢性泪囊炎的组织病理学特征主要表现为粘膜的炎症以及纤维化,其严重程度与患者病程长短、脓液性状、急性发作史、手术与末次急性发作局部皮肤红肿消退的时间间隔有关。慢性泪囊炎急性发作患者行经皮肤泪囊鼻腔吻合术的最佳手术时机应当选在局部皮肤红肿消退后1～2周内。
[Abstract]:Purpose

To observe the histopathological changes of the lacrimal sac mucosa in patients with chronic lacrimal sac inflammation , to explore the influence of sex , age , duration of pre - operative duration , characteristic of pus liquid , the history of acute attack , the time interval between the operation and the late acute attack local skin red swelling and regression on the nature and degree of chronic inflammation and fibrosis of the lacrimal sac mucosa , and to discuss the pathological mechanism of primary acquired nasolacrimal duct obstruction and chronic lacrimal sac inflammation and the optimal time of operation of the percutaneous lacrimal sac nasal anastomosis .

method

Methods Sixty - five cases ( 65 eyes ) of patients with chronic lacrimal sac caused by primary acquired nasolacrimal obstruction were selected from July 2009 to July 2010 .

Results

In this study , there were 65 cases ( 65 eyes ) of chronic lacrimal sac inflammation , all of which had chronic inflammation , mainly including large number of lymphocytes and plasma cell infiltration .

Conclusion

The results showed that the histopathological characteristics of chronic lacrimal sac inflammation were mainly the inflammation and fibrosis of the mucosa , the severity of which was related to the duration of the patient ' s disease course , the characteristics of the pus , the history of acute attack , the time interval between the operation and the local skin red swelling in the last time .

【学位授予单位】：辽宁医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R777

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