鼻内镜下射频热凝治疗变应性鼻炎的客观评价
发布时间：2018-07-23 14:35
【摘要】：目的阐明鼻内镜下鼻腔翼管、筛前神经集区射频热凝治疗变应性鼻炎(Allergic Rhinitis,AR)对鼻腔通气功能、鼻粘膜纤毛传输功能以及鼻粘膜纤毛超微结构的影响,为临床应用提供理论依据。 方法随机选择2008年5月至2009年5月在我科门诊就诊接受鼻腔翼管、筛前神经集区射频热凝治疗的变应性鼻炎患者36例为实验组,随机选择30例正常健康人为对照组,对实验组术前、术后6个月及健康对照组分别进行鼻声(Acoustic Rhinometry,AR)/鼻气道阻力(Nasal Airway Resistance,NAR)测试、糖精试验(Saccharin Test,ST),将实验组术前、术后进行对比及将实验组术前与对照组进行对比。本研究还对接受双侧翼管、筛前神经丛集区射频热凝术的常年性变应性鼻炎患者下鼻甲粘膜术前及术后6个月行透射电镜检查,另外,在对照组中随机选择2例正常人取下鼻甲粘膜行透射电镜检查。 结果糖精实验显示:实验组术前、术后鼻粘膜纤毛输送率(Nasal Mucociliary Transport Rate,MTR ,mm·min~(-1))分别为6.2083±1.87728、9.9669±1.73760,对照组鼻粘膜纤毛输送率为9.8973±1.58762。鼻声(AR)/鼻气道阻力(NAR)结果显示:实验组术前、术后鼻腔最小截面积(Nasal Minimal Cross-sectional Area,NMCA,cm~2)为0.7050±0.09142、0.9767±0.18025,对照组鼻腔最小截面积为0.9963±0.18037;实验组术前、术后鼻腔0-5cm容积(Nasal Cavity Volume from 0-5cm,NCV0-5,cm~3)为7.9094±1.01176、11.2167±1.75845,对照组鼻腔0-5cm容积为11.5880±2.00104;实验组术前、术后鼻吸气总阻力(Nasal Inspiration Total Resistance,NITR, Kpa/L·S)为0.3743±0.06093、0.2130±0.04319,对照组鼻吸气总阻力为0.2250±0.05082;实验组术前、术后鼻呼气总阻力(Nasal Expiration Total Resistance,NETR,Kpa/L·S)为0.3183±0.05907、0.1811±0.03783,对照组鼻呼气总阻力为0.1885±0.04641。上述实验组组间及实验组术前与对照组对比均有显著差异(P0.05)。实验组术前透射电镜下观察示:粘膜柱状上皮细胞表面微绒毛、纤毛脱失,长短纤毛交错存在,有纤毛区、无纤毛区交替分布;上皮细胞间隙扩大,柱状上皮细胞胞浆水肿,柱状上皮细胞线粒体水肿,细胞粘集;基底膜暴露、增厚,部分区域粘膜脱落,粘膜下层有嗜酸性、淋巴细胞浸润,粘液腺腺、浆液腺分泌颗粒丰富。对照组与实验组术后6个月透射电镜下观察存在一致性:柱状上皮纤毛排列整齐,方向较一致,粗细较均匀,长短一致,无纤毛脱落、倒伏,柱状上皮“9+2”微管结构清晰,线粒体狭长致密。 结论鼻内镜下翼管、筛前神经集区射频热凝治疗变应性鼻炎能提高鼻粘膜纤毛输送率(MTR),改善鼻粘膜纤毛传输功能;能使鼻腔的通气功能得到改善;该手术不损伤鼻粘膜,并且可以使已经受到损伤的鼻粘膜纤毛系统得到改善。
[Abstract]:Objective to elucidate the effects of nasal cavity pterygoid canal and anterior ethmoidal nerve collecting area radiofrequency thermocoagulation on nasal ventilation function, nasal mucosal cilia transmission function and nasal mucosal cilium ultrastructure under nasal endoscope, and to provide theoretical basis for clinical application. Methods from May 2008 to May 2009, 36 patients with allergic rhinitis treated with radiofrequency thermocoagulation in anterior ethmoidal nerve region were randomly selected as experimental group and 30 healthy persons as control group. Before operation, 6 months after operation and 6 months after operation, the experimental group were tested with Acoustic hinometry AR / nasal airway resistance (Nasal Airway resilience test (Saccharin test St), the experimental group was compared before and after operation, and the control group was compared before and after operation. This study also examined the mucosa of inferior turbinate in patients with perennial allergic rhinitis who underwent radiofrequency thermocoagulation with double flanking canal and anterior ethmoidal nerve cluster area before and 6 months after operation. The mucosa of inferior turbinate was taken from 2 normal persons in control group and examined by transmission electron microscope. Results the results of saccharin test showed that before and after operation, the nasal mucosal cilia transport rate of the experimental group was 6.2083 卤1.877289.9669 卤1.73760, and that of the control group was 9.8973 卤1.58762. The results of nasal acoustic (AR) / nasal airway resistance (NAR) showed that the minimum area of nasal cavity in the experimental group was 0.7050 卤0.09142 卤0.9767 卤0.18025 before and after operation, and the minimum area of nasal cavity in the control group was 0.9963 卤0.18037. The nasal cavity 0-5cm volume (Nasal Cavity Volume from 0-5 cm) was 7.9094 卤1.01176 卤11.2167 卤1.75845, and that of the control group was 11.5880 卤2.00104. Before and after operation, the total nasal inspiratory resistance (Nasal Inspiration Total resilience, Kpa/L S) was 0.3743 卤0.060930.2130 卤0.04319 in the experimental group and 0.2250 卤0.05082 in the control group. The total nasal expiratory resistance (Nasal Expiration Total) was 0.3183 卤0.059070.1811 卤0.03783, and the total nasal expiratory resistance was 0.1885 卤0.04641 in the control group. There were significant differences between the above experimental groups and the control group before operation (P0.05). The microvilli on the surface of columnar epithelial cells in the experimental group were observed by transmission electron microscope before operation. The mucosal columnar epithelial cells were characterized by microvilli, loss of cilia, long and short cilia interlaced, ciliated areas and non-ciliated areas alternately distributed, the epithelial cell space was enlarged, and the cytoplasmic edema of columnar epithelial cells was observed. Columnar epithelial cell mitochondria edema, cell aggregation, basement membrane exposure, thickening, partial mucosal abscission, submucous eosinophilic, lymphocytic infiltration, mucous gland, serous gland secretion granules. The results showed that the columnar epithelium cilia were arranged neatly, the direction was uniform, the thickness was uniform, the length was the same, the cilia were not shed, lying down, and the columnar epithelium "9.2" microtubule structure was clear. Mitochondria are narrow and dense. Conclusion the treatment of allergic rhinitis by radiofrequency thermocoagulation in pterygoid canal and anterior ethmoidal nerve gathering area under nasal endoscope can improve the rate of ciliary transport of nasal mucosa, improve the function of nasal cilia transmission, improve the ventilation function of nasal cavity, and do not damage nasal mucosa. It can also improve the nasal mucosal ciliated system that has been damaged.
【学位授予单位】：桂林医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.21
本文编号：2139714
[Abstract]:Objective to elucidate the effects of nasal cavity pterygoid canal and anterior ethmoidal nerve collecting area radiofrequency thermocoagulation on nasal ventilation function, nasal mucosal cilia transmission function and nasal mucosal cilium ultrastructure under nasal endoscope, and to provide theoretical basis for clinical application. Methods from May 2008 to May 2009, 36 patients with allergic rhinitis treated with radiofrequency thermocoagulation in anterior ethmoidal nerve region were randomly selected as experimental group and 30 healthy persons as control group. Before operation, 6 months after operation and 6 months after operation, the experimental group were tested with Acoustic hinometry AR / nasal airway resistance (Nasal Airway resilience test (Saccharin test St), the experimental group was compared before and after operation, and the control group was compared before and after operation. This study also examined the mucosa of inferior turbinate in patients with perennial allergic rhinitis who underwent radiofrequency thermocoagulation with double flanking canal and anterior ethmoidal nerve cluster area before and 6 months after operation. The mucosa of inferior turbinate was taken from 2 normal persons in control group and examined by transmission electron microscope. Results the results of saccharin test showed that before and after operation, the nasal mucosal cilia transport rate of the experimental group was 6.2083 卤1.877289.9669 卤1.73760, and that of the control group was 9.8973 卤1.58762. The results of nasal acoustic (AR) / nasal airway resistance (NAR) showed that the minimum area of nasal cavity in the experimental group was 0.7050 卤0.09142 卤0.9767 卤0.18025 before and after operation, and the minimum area of nasal cavity in the control group was 0.9963 卤0.18037. The nasal cavity 0-5cm volume (Nasal Cavity Volume from 0-5 cm) was 7.9094 卤1.01176 卤11.2167 卤1.75845, and that of the control group was 11.5880 卤2.00104. Before and after operation, the total nasal inspiratory resistance (Nasal Inspiration Total resilience, Kpa/L S) was 0.3743 卤0.060930.2130 卤0.04319 in the experimental group and 0.2250 卤0.05082 in the control group. The total nasal expiratory resistance (Nasal Expiration Total) was 0.3183 卤0.059070.1811 卤0.03783, and the total nasal expiratory resistance was 0.1885 卤0.04641 in the control group. There were significant differences between the above experimental groups and the control group before operation (P0.05). The microvilli on the surface of columnar epithelial cells in the experimental group were observed by transmission electron microscope before operation. The mucosal columnar epithelial cells were characterized by microvilli, loss of cilia, long and short cilia interlaced, ciliated areas and non-ciliated areas alternately distributed, the epithelial cell space was enlarged, and the cytoplasmic edema of columnar epithelial cells was observed. Columnar epithelial cell mitochondria edema, cell aggregation, basement membrane exposure, thickening, partial mucosal abscission, submucous eosinophilic, lymphocytic infiltration, mucous gland, serous gland secretion granules. The results showed that the columnar epithelium cilia were arranged neatly, the direction was uniform, the thickness was uniform, the length was the same, the cilia were not shed, lying down, and the columnar epithelium "9.2" microtubule structure was clear. Mitochondria are narrow and dense. Conclusion the treatment of allergic rhinitis by radiofrequency thermocoagulation in pterygoid canal and anterior ethmoidal nerve gathering area under nasal endoscope can improve the rate of ciliary transport of nasal mucosa, improve the function of nasal cilia transmission, improve the ventilation function of nasal cavity, and do not damage nasal mucosa. It can also improve the nasal mucosal ciliated system that has been damaged.
【学位授予单位】：桂林医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.21
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