本文選題：超脈沖CO2激光 + 耳蝸��； 參考：《福建醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 【目的】 本試驗(yàn)以超脈沖CO2激光為輻射源,對活體豚鼠耳蝸底周骨壁進(jìn)行開窗,研究激光豚鼠耳蝸底周開窗對耳蝸形態(tài)的影響,并與正常對照組進(jìn)行比較,從而為激光在耳外科手術(shù)中的安全應(yīng)用提供實(shí)驗(yàn)性指導(dǎo)依據(jù)。 【方法】 分別以耳后入路和聽泡入路解剖4只豚鼠,了解其中耳解剖結(jié)構(gòu),確定暴露豚鼠耳蝸底周的最佳手術(shù)入路。將48只白色紅目豚鼠隨機(jī)分為4組,每組12只。其中3組以不同劑量的超脈沖C02激光對豚鼠耳蝸底周骨壁進(jìn)行開窗,隨后取被照耳作耳蝸基底膜鋪片硝酸銀染色光學(xué)顯微鏡檢查、掃描電鏡檢查及免疫組化染色檢測熱休克蛋白70(heat shock protein HSP70)的表達(dá),并與正常對照組進(jìn)行比較,進(jìn)而分析激光輻照對耳蝸超微結(jié)構(gòu)的影響,HSP70的表達(dá)及在豚鼠耳蝸超微結(jié)構(gòu)損傷機(jī)制中的作用。 【結(jié)果】 術(shù)后即刻,光鏡下觀察正常對照組豚鼠耳蝸底回基底膜硝酸銀染色未見明顯異常；1W、2W、3W組可觀察到硝酸銀濃染,外毛細(xì)胞腫脹,血管紋擴(kuò)張。術(shù)后即刻,正常組和1W組,掃描電鏡檢查底回毛細(xì)胞未見異常；2W、3W組可見底回第2、3排外毛細(xì)胞靜纖毛顯示部分不規(guī)則,但毛細(xì)胞未見明顯丟失。術(shù)后2周,2W組掃描電鏡檢查未見異常；3W組可見底回第2、3排外毛細(xì)胞部分排列紊亂、靜纖毛顯示部分倒伏,毛細(xì)胞未見明顯丟失,結(jié)果同術(shù)后即刻。 術(shù)后6小時(shí),正常對照組豚鼠耳蝸螺旋神經(jīng)節(jié)、基底膜及螺旋韌帶等部位HSP70的表達(dá)呈弱陽性,1W、2W、3W組豚鼠耳蝸螺旋神經(jīng)節(jié)、基底膜及螺旋韌帶等部位HSP70的表達(dá)呈陽性至強(qiáng)陽性,且隨激光劑量的增大,陽性細(xì)胞數(shù)及陽性細(xì)胞比例逐漸增高,激光3W組與其余組比較有統(tǒng)計(jì)學(xué)意義(p0.05)。 【結(jié)論】 1、直接聽泡入路手術(shù)過程簡單,易暴露耳蝸底周,術(shù)后并發(fā)癥少,為豚鼠耳蝸底周開窗的最佳手術(shù)入路。 2、低劑量超脈沖C02激光能有效消融耳蝸底周骨壁,且在限定的激光劑量下不會對內(nèi)耳結(jié)構(gòu)造成損傷,但對內(nèi)耳功能的影響有待進(jìn)一步研究。 3、激光豚鼠耳蝸底周開窗能誘發(fā)耳蝸熱休克反應(yīng),使HSP70表達(dá)增加,其表達(dá)程度與耳蝸超微結(jié)構(gòu)改變有關(guān),HSP70可能發(fā)揮保護(hù)耳蝸免受損傷的作用。
[Abstract]:[purpose]In this experiment, ultrapulse CO2 laser was used as the radiation source to open the bone wall around the cochlea of living guinea pig. The effect of the fenestration on the cochlea morphology was studied and compared with that of the normal control group.This provides experimental guidance for the safe application of laser in ear surgery.[methods]Four guinea pigs were dissected by posterior ear approach and auditory alveolar approach respectively. The anatomical structure of the middle ear was studied and the optimal operative approach for the exposure of cochlea was determined.Forty-eight white red guinea pigs were randomly divided into 4 groups with 12 in each group.Three groups of guinea pig cochlea were treated with different doses of superpulse CO2 laser to open the bone wall around the bottom of the cochlea, and then the irradiated ears were taken for silver nitrate staining optical microscopy of the basal membrane of the cochlea.The expression of heat shock protein (70(heat shock protein HSP70) was detected by scanning electron microscopy and immunohistochemical staining, and compared with that of normal control group.The effect of laser irradiation on the ultrastructure of cochlea and the expression of HSP70 in guinea pig cochlea were analyzed.[results]Immediately after operation, silver nitrate staining, swelling of outer hair cells and vasodilation in basal membrane of basal gyrus of normal guinea pigs were observed under light microscope.Immediately after operation, in normal group and 1W group, no abnormal hair cells were found in the bottom gyrus of the bottom gyrus. In the 2W 3W group, the static cilia of the 2nd third row of the bottom gyrus were irregular, but the hair cells were not significantly lost.2 weeks after operation, no abnormality was found in the scanning electron microscope in the 2W group. In the 3W group, there was a disorder in the arrangement of the outer hair cells in the 2nd row of the bottom gyrus. The static cilia showed partial lodging, and the hair cells were not obviously lost. The results were the same as immediately after the operation.Six hours after operation, the expression of HSP70 in cochlear spiral ganglion, basement membrane and spiral ligament of guinea pigs in normal control group was weakly positive. The expression of HSP70 in cochlear spiral ganglion, basement membrane and helical ligament of guinea pig cochlear spiral ganglion was strongly positive.With the increase of laser dose, the number of positive cells and the proportion of positive cells increased gradually. Compared with the other groups, the number of positive cells in the laser 3W group was significantly higher than that in the other groups.[conclusion]1. The procedure of direct auditory alveolar approach is simple, easy to expose cochlea fundus, and has less postoperative complications. It is the best operative approach for guinea pig cochlea fundus fenestration.2. Low-dose ultra-pulse CO2 laser can effectively ablation the bone wall around the bottom of cochlea, and the structure of the inner ear will not be damaged under the limited laser dose, but the effect on the function of the inner ear needs further study.3. Laser fenestration induced heat shock response and increased HSP70 expression in cochlea. HSP70 may play a role in protecting cochlea from injury due to the ultrastructural changes of cochlea.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R764

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本文編號：1761161