【摘要】：目的：觀察喉癌(Laryngealcancer,LC)喉全切手術(shù)(Totallaryngectomy,TL)前后患者鼻腔黏膜形態(tài)和功能的變化。 方法：①對(duì)20例LC患者喉全切除手術(shù)前、術(shù)后3月、術(shù)后18月分別進(jìn)行鼻腔黏膜糖精實(shí)驗(yàn)。②對(duì)20例LC患者喉全切除手術(shù)前、術(shù)后3月、術(shù)后18月分別進(jìn)行鼻腔電子鼻咽鏡檢查。③對(duì)15例LC患者喉全切除手術(shù)前、術(shù)后3月、術(shù)后18月分別進(jìn)行鼻黏膜掃描電子顯微鏡及透射電子顯微鏡檢查。 結(jié)果：①糖精實(shí)驗(yàn)：術(shù)后3月與術(shù)前比較，纖毛傳輸時(shí)間的均值略顯縮短，但其差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)，纖毛傳輸時(shí)間術(shù)后18月比術(shù)前明顯延長(zhǎng)(P 0.05)。②鼻腔電子鼻咽鏡檢查：LC喉全切除術(shù)后3月檢查與術(shù)前檢查比較，鼻腔大體結(jié)構(gòu)未見明顯變化；術(shù)后18月鼻腔變得明顯寬大，鼻腔各結(jié)構(gòu)呈萎縮性改變，鼻甲變小，黏膜變薄，色澤變淡，，多為蒼白色、青白色等，質(zhì)地變硬，彈性變差，表面多有略呈白色的稀薄分泌物。③電子顯微鏡檢查: LC喉全切除術(shù)后3月鼻黏膜纖毛、腺體等結(jié)構(gòu)與術(shù)前比較，無(wú)明顯差異,術(shù)后18月鼻黏膜纖毛較稀疏、局部纖毛脫落，存留的纖毛排列紊亂，擺動(dòng)方向不一致，可見倒伏、黏連成簇狀的纖毛；且黏膜固有層內(nèi)腺細(xì)胞排列紊亂，部分腺細(xì)胞固縮，腺腔變小，部分甚至呈閉鎖狀態(tài)，其游離面微絨毛減少，腺腔內(nèi)可見較少分泌物。 結(jié)論：LC喉全切除術(shù)后鼻腔的大體結(jié)構(gòu)和超微結(jié)構(gòu)及黏液纖毛清除功能在術(shù)后3月內(nèi)沒(méi)有顯著變化，但隨著時(shí)間延長(zhǎng)，至術(shù)后18月時(shí)，鼻腔的大體結(jié)構(gòu)發(fā)生萎縮性改變，超微結(jié)構(gòu)受到損傷，黏膜纖毛清除功能顯著下降。
[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.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R739.65

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