摘要
目的通过比较3种下鼻甲手术方式手术前、后下鼻甲黏膜组织形态和超微结构变化以及鼻腔黏膜黏液纤毛传输功能和3种术式特点,探讨下鼻甲的最佳手术方式。方法86例慢性肥厚性鼻炎患者随机分为3组,30例鼻内镜下鼻甲黏膜下成形术(A组),26例下鼻甲部分切除术(B组),30例鼻内镜下低温等离子双极射频消融下鼻甲减容术(C组)。术后随访3～6个月,分别比较A、B、C 3组治疗的有效率、手术特点和术前及术后3～6个月鼻腔黏膜纤毛输送率(mucociliary transport rate,MTR)、下鼻甲黏膜组织形态和超微结构特征。结果A、B、C 3组手术有效率分别为100%、100%、96.3%,差异无显著性(P>0.05),A、C组鼻腔解剖结构和生理功能保护好,手术便捷、创面愈合快。比较手术前和手术后3～6个月鼻腔黏膜MTR和下鼻甲组织形态和超微结构变化,A、C组鼻腔黏膜MTR值术前与术后差异无统计学意义(P>0.05),B组鼻腔黏膜MTR值手术前后差异有统计学意义(P<0.01)。A、C组术后6个月下鼻甲黏膜光镜见假复层纤毛柱状上皮基本完整,B组黏膜上皮脱落,纤维组织增生。下鼻甲电镜超微结构观察,A、C组术后6个月纤毛结构大部分存在,B组纤毛结构消失,纤维组织大量增生。提示A、C组术式术后下鼻甲黏膜上皮基本完整,纤毛结构保存相对完好,鼻腔黏膜黏液清除功能维护好,B组术式可损伤下鼻甲黏膜及其表面的纤毛结构,影响鼻腔生理功能。结论鼻内镜下鼻甲黏膜下成形术和鼻内镜下低温等离子双极射频消融下鼻甲减容术是治疗慢性肥厚性鼻炎较好的手术方式,下鼻甲黏膜下微创术是治疗慢性肥厚性鼻炎值得推荐的手术方法。
OBJECTIVE To study the best surgical technique for treatment of chronic hypertrophic rhinitis （HR）. METHODS Eighty six cases with HR were divided randomly into 3 groups. Thirty cases were treated by transnasal endoscopic submucous inferior turbinate resection （group A）, 26 cases by partial inferior turbinectomy （group B） and 30 cases by bipolar radiofrequency ablation （group C）. The epithelium of the inferior turbinate of the every case in 3 groups was examined with histomorphology and ultrastructure techniques at 6 months after operation. The efficacy and the features of in the 3 groups were compared. The MTR was determined in the patients of the 3 groups. The histomorphology and ultrastructure of the inferior turbinate were observed at 6 months after operation. RESULTS All the cases with HR in 3 groups were followed up for 3 to 6 months after operation. Effective rates of group A, group B and group C were 100 %, 100 % and 96.3 % respectively, while there was no significant difference among the three groups. Compared to the group B, surgical techniques applied in Group A and group C have more advantages because ultrastructure of inferior turbinate mucosal cilia and nasal mucociliary transport function were nearly normal at 3 to 6 months after operation. The advantages include operating easily, wound healing up fast. MTR between pre-and post-operation was significant difference in group B. Epithelial tissue remained intact in group A and group C, while epithelial tissue in group B was instead of fiber tissue at 6 months after operation. The ultrastructure of inferior turbinate mucosal cilia in group A and group C remained intact at 6 months after operation. CONCLUSION The transnasal endoscopic submucous inferior turbinate resection and bipolar radiofrequency ablation for treatment of chronic hypertrophy rhinitis are effective. Submucous minimally invasive surgery of the inferior turbinate deserves to be recommended.
出处
《中国耳鼻咽喉头颈外科》
北大核心
2008年第8期461-464,共4页
Chinese Archives of Otolaryngology-Head and Neck Surgery
基金
上海市科学技术委员会基金(034119936)
关键词
鼻炎
鼻甲
耳鼻喉外科手术
组织学
显微镜检查
Rhinitis
Turbinates
Otorhinolaryn- gologic Surgical Procedures
Histology
Microscopy
