發(fā)布時(shí)間：2018-07-23 14:35

【摘要】：目的闡明鼻內(nèi)鏡下鼻腔翼管、篩前神經(jīng)集區(qū)射頻熱凝治療變應(yīng)性鼻炎(Allergic Rhinitis,AR)對(duì)鼻腔通氣功能、鼻粘膜纖毛傳輸功能以及鼻粘膜纖毛超微結(jié)構(gòu)的影響,為臨床應(yīng)用提供理論依據(jù)。 方法隨機(jī)選擇2008年5月至2009年5月在我科門診就診接受鼻腔翼管、篩前神經(jīng)集區(qū)射頻熱凝治療的變應(yīng)性鼻炎患者36例為實(shí)驗(yàn)組,隨機(jī)選擇30例正常健康人為對(duì)照組,對(duì)實(shí)驗(yàn)組術(shù)前、術(shù)后6個(gè)月及健康對(duì)照組分別進(jìn)行鼻聲(Acoustic Rhinometry,AR)/鼻氣道阻力(Nasal Airway Resistance,NAR)測試、糖精試驗(yàn)(Saccharin Test,ST),將實(shí)驗(yàn)組術(shù)前、術(shù)后進(jìn)行對(duì)比及將實(shí)驗(yàn)組術(shù)前與對(duì)照組進(jìn)行對(duì)比。本研究還對(duì)接受雙側(cè)翼管、篩前神經(jīng)叢集區(qū)射頻熱凝術(shù)的常年性變應(yīng)性鼻炎患者下鼻甲粘膜術(shù)前及術(shù)后6個(gè)月行透射電鏡檢查,另外,在對(duì)照組中隨機(jī)選擇2例正常人取下鼻甲粘膜行透射電鏡檢查。 結(jié)果糖精實(shí)驗(yàn)顯示:實(shí)驗(yàn)組術(shù)前、術(shù)后鼻粘膜纖毛輸送率(Nasal Mucociliary Transport Rate,MTR ,mm·min~(-1))分別為6.2083±1.87728、9.9669±1.73760,對(duì)照組鼻粘膜纖毛輸送率為9.8973±1.58762。鼻聲(AR)/鼻氣道阻力(NAR)結(jié)果顯示:實(shí)驗(yàn)組術(shù)前、術(shù)后鼻腔最小截面積(Nasal Minimal Cross-sectional Area,NMCA,cm~2)為0.7050±0.09142、0.9767±0.18025,對(duì)照組鼻腔最小截面積為0.9963±0.18037;實(shí)驗(yàn)組術(shù)前、術(shù)后鼻腔0-5cm容積(Nasal Cavity Volume from 0-5cm,NCV0-5,cm~3)為7.9094±1.01176、11.2167±1.75845,對(duì)照組鼻腔0-5cm容積為11.5880±2.00104;實(shí)驗(yàn)組術(shù)前、術(shù)后鼻吸氣總阻力(Nasal Inspiration Total Resistance,NITR, Kpa/L·S)為0.3743±0.06093、0.2130±0.04319,對(duì)照組鼻吸氣總阻力為0.2250±0.05082;實(shí)驗(yàn)組術(shù)前、術(shù)后鼻呼氣總阻力(Nasal Expiration Total Resistance,NETR,Kpa/L·S)為0.3183±0.05907、0.1811±0.03783,對(duì)照組鼻呼氣總阻力為0.1885±0.04641。上述實(shí)驗(yàn)組組間及實(shí)驗(yàn)組術(shù)前與對(duì)照組對(duì)比均有顯著差異(P0.05)。實(shí)驗(yàn)組術(shù)前透射電鏡下觀察示:粘膜柱狀上皮細(xì)胞表面微絨毛、纖毛脫失,長短纖毛交錯(cuò)存在,有纖毛區(qū)、無纖毛區(qū)交替分布;上皮細(xì)胞間隙擴(kuò)大,柱狀上皮細(xì)胞胞漿水腫,柱狀上皮細(xì)胞線粒體水腫,細(xì)胞粘集;基底膜暴露、增厚,部分區(qū)域粘膜脫落,粘膜下層有嗜酸性、淋巴細(xì)胞浸潤,粘液腺腺、漿液腺分泌顆粒豐富。對(duì)照組與實(shí)驗(yàn)組術(shù)后6個(gè)月透射電鏡下觀察存在一致性:柱狀上皮纖毛排列整齊,方向較一致,粗細(xì)較均勻,長短一致,無纖毛脫落、倒伏,柱狀上皮“9+2”微管結(jié)構(gòu)清晰,線粒體狹長致密。 結(jié)論鼻內(nèi)鏡下翼管、篩前神經(jīng)集區(qū)射頻熱凝治療變應(yīng)性鼻炎能提高鼻粘膜纖毛輸送率(MTR),改善鼻粘膜纖毛傳輸功能;能使鼻腔的通氣功能得到改善;該手術(shù)不損傷鼻粘膜,并且可以使已經(jīng)受到損傷的鼻粘膜纖毛系統(tǒng)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 鹵1.877289.9669 鹵1.73760, and that of the control group was 9.8973 鹵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 鹵0.09142 鹵0.9767 鹵0.18025 before and after operation, and the minimum area of nasal cavity in the control group was 0.9963 鹵0.18037. The nasal cavity 0-5cm volume (Nasal Cavity Volume from 0-5 cm) was 7.9094 鹵1.01176 鹵11.2167 鹵1.75845, and that of the control group was 11.5880 鹵2.00104. Before and after operation, the total nasal inspiratory resistance (Nasal Inspiration Total resilience, Kpa/L S) was 0.3743 鹵0.060930.2130 鹵0.04319 in the experimental group and 0.2250 鹵0.05082 in the control group. The total nasal expiratory resistance (Nasal Expiration Total) was 0.3183 鹵0.059070.1811 鹵0.03783, and the total nasal expiratory resistance was 0.1885 鹵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.
【學(xué)位授予單位】：桂林醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R765.21

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