刘小飞 庐健

[摘要] 目的 探讨鼻内镜治疗慢性鼻窦炎前后患者鼻黏膜形态与功能的变化。 方法 选择我院2013年1月～2015年3月收治的慢性鼻窦炎患者200例，随机将其分为两组，各100例，观察组使用鼻内镜治疗，对照组给予静脉用克拉霉素联合庆大霉素鼻腔冲洗，比较两组治疗前后活组织标本光学显微镜下鼻黏膜形态及鼻息肉、黏膜水肿及脓性分泌物情况，统计治疗前后糖精试验时间。 结果 两组治疗后存在炎性细胞浸润、病理性腺体增生、纤毛细胞减少、鼻息肉、黏膜水肿及脓性分泌物比例均低于治疗前（P<0.05），且观察组低于对照组（P<0.05）；治疗后观察组糖精试验时间短于对照组（P<0.05），显微镜检查结果基本恢复正常。 结论 采用鼻内镜手术治疗术后3个月，鼻黏膜的结构与功能基本恢复正常，鼻腔内纤毛运动功能显著恢复。

[关键词] 鼻内镜；慢性鼻窦炎；鼻黏膜；形态；功能

[中图分类号] R765.41 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0104-04

[Abstract] Objective To evaluate morphology and function of nasal mucosa in patients with chronic sinusitis before and after nasal endoscopic treatment. Methods From January 2013 to March 2015，200 patients with chronic sinusitis admitted into our hospital were selected and evenly divided into two groups in random with 100 cases in each group.In observation group，nasal endoscope was applied，while in control group，clarithromycin combining with gentamicin for intravenous was used to rinse nasal cavity.The morphology of nasal mucosa，nasal polyp，edema of mucosa，and purulent secretion from living tissue under optical microscope before and after treatment were compared in both groups.Saccharin test time before and after therapy in the two groups was calculated. Results Proportions of inflammatory cell infiltration，pathological microglandular hyperplasia，ciliated cell decreased，percentages of nasal polyp，edema of mucosa，and purulent secretion after treatment were lower both in the observation group and control group in comparison with those before treatment （P<0.05）.In the observation group，those indexes were lower than those in the control group after therapy （P<0.05）.In comparison with the control group after treatment，saccharin test time was shorter （P<0.05）.In the observation group，examined outcomes were almost normal by microscope after treatment. Conclusion By nasal endoscopic treatment，structure and function of nasal mucosa are basically returned to be normal 3 months after surgery as well as remarkable recovery of mucociliary movement in nasal cavity.

[Key words] Nasal endoscope；Chronic sinusitis；Nasal mucosa；Morphology；Function

慢性鼻窦炎主要因鼻窦的慢性化脓性感染所致，其以多个鼻旁窦同时受累为特征，病程较长，临床症状加重时可导致头痛颅内压升高、视物模糊、眼内压升高及肺部感染等严重并发症，其病程较为反复，久治不愈，严重影响患者的生活质量及其生存质量[1]。鼻内镜下鼻窦手术是近年来广泛开展的手术，具有手术创伤小、术后恢复快、术中可尽量减少对鼻腔-鼻窦生理结构破坏且能在直视下对鼻腔病理组织进行清除等优点[2]。虽然其手术疗效显著，但仍存在术后复发可能[3]。本研究从微观和生理结构入手分析，探讨鼻内镜手术对慢性鼻窦炎患者鼻黏膜结构及功能的影响，以更好地改进治疗方法，结合合理的术后处理方式促进患者早日康复。

1 资料与方法

1.1一般……