功能性鼻内镜手术后鼻黏膜囊泡的形成机制及囊液成分分析:一项组织生化学研究  

Formation mechanism and cyst fluid composition analysis of nasal mucosal cysts after functional endoscopy sinus surgery

作　　者：侯静[1] 房高丽[1] 周兵[2] HOU Jing;FANG Gaoli;ZHOU Bing(Department of Otorhinolaryngology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Rhinology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学北京地坛医院耳鼻喉科,北京100015 [2]首都医科大学北京同仁医院鼻科,北京100730

出　　处：《山东大学耳鼻喉眼学报》2024年第5期1-5,12,共6页Journal of Otolaryngology and Ophthalmology of Shandong University

摘　　要：目的探讨功能性鼻内镜手术(functional endoscopy sinus surgery,FESS)后鼻腔内常见的鼻黏膜囊泡的形成因素和组织学特征,评估其对临床治疗的指导意义。方法收集10例经FESS治疗的慢性鼻窦炎患者鼻腔鼻黏膜囊泡,采用组织形态学分析和扫描电镜检测囊泡组织,采用分光光度法检测囊液成份。结果与正常黏膜相比,囊泡的上皮层增生(P=0.023)和炎症细胞的浸润程度(P=0.029)差异有统计学意义,黏膜腺体增生无显著差异(P=0.631)。囊泡液中乳酸脱氢酶(P<0.001)和谷丙转氨酶(P<0.001)水平明显高于血清含量,而天冬氨酸转氨基转移酶(P<0.001)和总蛋白(P=0.001)水平明显降低。结论FESS后发生的鼻黏膜囊泡是由高水肿的黏膜、局部炎症细胞浸润和组织渗出液组成,囊泡液中大量LDH及AST升高提示囊泡与手术创伤有关;对不阻塞术腔通气引流的囊泡无需处理;应强化术后随访综合治疗。Objective The objective of this study was to investigate the formatting factors and histological characteristics of nasal mucosal vesicles that commonly occurred in the nasal cavity after functional endoscopy sinus surgery(FESS).Methods We collected 10 cases of nasal mucosal vesicles from the nasal cavity of the patients with chronic rhinosinusitis after FESS.Vesicle tissues were assayed by histomorphological analysis and scanning electron microscope.The consistency of the liquid in the vesicles was examined by biochemistry analysis.Results Compared to normal mucosa,there were statistically significant differences in the proliferation of the epithelial layer(P=0.023)and the degree of infiltration of inflammatory cells(P=0.029)in the vesicles.At the same time,there was no statistically significant difference in the number of mucosal glands(P=0.631).The levels of lactate dehydrogenase(P<0.001)and alanine transaminase(P<0.001)in the vesicular fluid were significantly higher than their levels in the blood.As for aspartate transaminase(P<0.001)and total protein(P=0.001),there were statistically significant decreases.Conclusion Nasal mucosal cysts occurring after FESS are composed of edematous mucosa,local infiltration of inflammatory cells,and exudate.A large amount of LDH and the increased AST level in the vesicle fluid suggested that the vesicles were related to surgical trauma.The vesicles that do not obstruct the ventilation and drainage of the surgical cavity do not need to be treated.The postoperative comprehensive treatment should be strengthened.

关 键 词：鼻腔黏膜囊泡 功能性鼻内镜术后 囊液成份 组织渗出物 上皮层水肿 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]