本文選題：鼻竇炎/外科學 + 額竇粘膜/病理學��； 參考：《安徽醫(yī)科大學》2011年碩士論文

【摘要】：背景和目的:慢性額竇炎手術(shù)治療方法的進步經(jīng)過了一個漫長的摸索過程。額竇手術(shù)最早開始于1750年,歷經(jīng)二百多年的時間,涌現(xiàn)出許多手術(shù)方式,但理想的手術(shù)方式一直未被認可。對于慢性鼻及鼻竇炎(chronic rhinosinusitis,CRS)患者,被目前公認的治療CRS的經(jīng)典手術(shù):功能性內(nèi)鏡鼻竇手術(shù)(functional endoscopic sinus surgery ,FESS)。但FESS并沒有達到真正意義上的“功能性”鼻竇開放。備受國際及國內(nèi)鼻科醫(yī)生和學者推崇的鼻竇球囊擴張術(shù)(Ballon Sinuplasty)是一項技術(shù)革新,具有明顯的優(yōu)勢:最大程度的保留鼻竇的正常結(jié)構(gòu),創(chuàng)傷更小,粘膜破壞更小,恢復快。但手術(shù)成本擴大,費用高,也是其不足之處�？紤]到目前的球囊擴張術(shù)費用高,基層醫(yī)院難以推廣,本文利用Foley導尿管球囊擴張額竇口治療慢性額竇炎,以探討額竇球囊擴張術(shù)治療慢性額竇炎的療效及可行性。 方法:選取28例慢性鼻竇炎(均含有額竇炎)患者,均為2009年8月至2010年6月在我科住院接受額竇球囊擴張術(shù)聯(lián)合FESS手術(shù)并且術(shù)后定期隨訪(隨訪3個月)。按�？跇藴蔬M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。均無鼻竇手術(shù)史。其中慢性額竇炎15例(單側(cè)12例,雙側(cè)3例),術(shù)中僅對31側(cè)額竇口進行球囊擴張。取術(shù)中、術(shù)后1個月和3個月額竇口處粘膜標本;觀察術(shù)后1個月和3個月患者癥狀、額竇口情況。以無鼻竇炎病史的20例鼻中隔偏曲患者作對照,于鼻中隔矯正術(shù)中取其鉤突粘膜標本;均行光鏡觀察,IL-2、TNF-a的免疫組化染色。結(jié)果:1.患者術(shù)后癥狀改變:15例慢性額竇炎患者額竇球囊擴張術(shù)后3個月癥狀消失。2.28例鼻竇炎患者額竇球囊擴張術(shù)后3個月內(nèi)鏡檢查31側(cè)額竇恢復良好。3.28例慢性鼻竇炎患者額竇球囊擴張術(shù)后1個月和3個月內(nèi)鏡檢查測量31側(cè)額竇口情況:29側(cè)額竇口開放良好,2側(cè)額竇口稍狹窄,無1例閉鎖。4.光鏡觀察:額竇球囊擴張術(shù)后1個月額竇粘膜上皮有21側(cè)(67.7%)為鱗柱交界上皮,10側(cè)(32.3%)為假復層柱狀纖毛上皮;術(shù)后3個月31側(cè)額竇粘膜基本恢復為假復層柱狀纖毛上皮。5.免疫組化染色結(jié)果:額竇球囊擴張術(shù)中組、術(shù)后1個月組,IL-2,TNF-a陽性細胞數(shù)明顯高于健康對照組,P0.01,有顯著統(tǒng)計學意義;額竇球囊擴張術(shù)后3個月,IL-2,TNF-a陽性細胞數(shù)與健康對照組比較,P0.05,無統(tǒng)計學意義;額竇球囊擴張術(shù)中組、術(shù)后1個月組與術(shù)后3個月組比較,P0.05,有統(tǒng)計學意義。 結(jié)論:1.利用Foley導尿管球囊擴張額竇口治療慢性額竇炎的療效好,具有可行性,值得在基層醫(yī)院推廣。2.術(shù)后隨訪很重要,應(yīng)大于3個月或更長時間。術(shù)后及時應(yīng)用糖皮質(zhì)激素對預防復發(fā)有重要意義。
[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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R765.4

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