慢性鼻窦炎鼻息肉筛窦黏膜病理形态学研究  

Study of pathological morphology in chronic sinusitis

作　　者：何春燕[1] 刘红刚[1] 王先忠[2] 张盛忠[1] 

机构地区：[1]首都医科大学附属北京同仁医院病理科,北京100730 [2]首都医科大学附属北京同仁医院耳鼻咽喉-头颈外科,北京100730

出　　处：《中华耳鼻咽喉科杂志》2003年第2期89-91,I001,共4页Chinese Journal of Otorhinolaryngology

基　　金：北京市自然科学基金资助项目 (7992 0 18)

摘　　要：目的　探讨慢性鼻窦炎鼻息肉 (chronicsinusitisandnasalpolyps,CSNP)各型的病理变化特点和病变规律。方法　采用HE、VanGieson′s染色、阿尔辛蓝 过碘酸 雪夫等染色法观察并测量CSNP病变黏膜主要结构的改变。用透射电镜和扫描电镜重点观察黏膜上皮纤毛的改变。结果　光镜下黏膜上皮、纤维组织均有不同程度的增生 ,基底膜增厚 ,黏液腺体增多。其中Ⅰ型病变最轻 ,Ⅲ型病变最显著 ,而黏液腺体增多在Ⅱ型最明显。电镜观察 ,透视电镜下CSNP各型表现为纤毛结构异常 ,纤毛细胞减少 ,杯状细胞增多 ;扫描电镜下可见纤毛从排列稍乱 ,到紊乱、倒伏、大片脱落 ,被微绒毛所代替等病变逐渐加重的过程。结论　 3型CSNP筛窦黏膜病变和组织结构有明显的量和质的差别 ,海口标准 (1997)CSNP临床分型分期具有病理学基础 ,能代表CSNP发生发展及转归规律。Objective To study the pathological characteristics and regularity of chronic sinusitis (CS) in different clinical types, to estimate the reliability and feasibility of CS classification on the pathologic basis Methods HE, Van Gieson′s, alcian blue periodic acid schiff(AB PAS) staining was used to observe the changes of epithelium, to measure the thickness of basement membrance and the area of mucous glands The ultrastructural changes of pseudostratified ciliated columnar epithelium were observed under transmission electron microscope (TEM) and scanning electron microscope (SEM) Results The epithelial fiber tissue was increased, the basement membrane was thickened, and the mucous glands were obviously increased in CS under the light microscope Subepithelial fibrosis and thickened basement membrance were most obviously seen in type Ⅲ of CS and the hyperplasia of mucous glands was most distinct in type Ⅱ Under the TEM, abnormal structure of cilia, decrease of ciliated cells, increase of goblet cells were detected in all three CS types Under the SEM, the cilia of every types showed the ingravescenced process of pathological changes from slight cilium disorder, disorientation, to desquamation of most cilia and replacement of microvilli Conclusion There is significant distinction of mucous membrane structure among three types The Chinese classification of CS has pathological basis, it represents the occurrence, development and regularity of CS, and it can be used as basis in further study, communication and evaluation for surgical effect of CS

关 键 词：慢性鼻窦炎 鼻息肉 筛窦黏膜 病理形态学 临床分型 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]