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目的:探讨慢性鼻窦炎鼻息肉鼻内镜术后术腔上皮阶段性修复的特点及规律,为改进鼻内镜术后处理措施提供依据。方法:对20例慢性鼻窦炎鼻息肉患者,在鼻内镜术后7~14 d取筛窦外侧壁、筛窦顶及上颌窦口处囊泡组织,分别进行光、电镜观察。结果:①内镜下见囊泡呈灰白色或淡黄色,半透明,有的含有囊液,有的为实质性。②光镜下见16例囊泡上皮为假复层纤毛柱状上皮,2例为复层鳞状上皮,2例在假复层纤毛柱状上皮中有节断性鳞状上皮组织转化;固有层水肿,上皮层及上皮下层有多量炎性细胞浸润,上皮下可见黏液腺、混合腺及其导管;小血管扩张充血。③电镜下见上皮为假复层纤毛柱状上皮,纤毛排列尚整齐,其间有微绒毛。多数纤毛横断面可见9+2型微管结构,有些中心微管缺如,有些仅有1个中心微管。上皮细胞中高尔基复合体发达,内质网扩张,线粒体多数呈明显凝集变性,有的线粒体呈1~2度肿胀,溶酶体增多。上皮内可见炎性细胞浸润,多数为中性粒细胞及淋巴细胞,也可见嗜酸粒细胞及浆细胞。结论:囊泡是鼻内镜术后术腔上皮再生反应活跃的表现,是术腔上皮化过程中的一个早期不平衡的再生过程,提示术后囊泡是类似鼻息肉组织病理学改变的早期局限性、病理性修复的现象。清除这种失衡的上皮化组织———囊泡,能有效遏制鼻息肉复发,使术腔上皮化均衡展开。
Objective: To investigate the characteristics and regularity of stage epithelial repair of chronic sinusitis and nasal polyps after endoscopic sinus surgery, and to provide evidence for the improvement of endoscopic sinus surgery. Methods: Twenty patients with chronic sinusitis and nasal polyps were enrolled in this study. The outer wall of ethmoid sinus, the top of ethmoid sinus and the maxillary sinus ostium at 7-14 days after endoscopic sinus surgery were observed by light and electron microscope. Results: ① Endoscopic vesicles were seen gray or pale yellow, translucent, and some contain cyst fluid, while others are substantial. ② In the light microscope, 16 cases of vesicle epithelium were pseudostratified ciliated columnar epithelium, 2 cases of stratified squamous epithelium, 2 cases of sectioned squamous epithelium in fake stratified ciliated columnar epithelium; , Epithelial and subepithelial inflammatory cells have a lot of infiltration, mucus gland seen under the epithelium, mixed gland and its catheter; small blood vessels dilatation and congestion. ③ electron microscope see epithelial pseudostratified ciliated columnar epithelium, cilia arranged neat, during which there is microvilli. Most of the cilia cross-section can be seen 9 +2 microtubule structure, some of the central microtubules lack, and some only one central microtubule. In the epithelial cells, the Golgi complex was developed, the endoplasmic reticulum was dilated, and most of the mitochondria showed obvious agglutination and degeneration. Some mitochondria were swollen by 1-2 degrees and lysosomes increased. Inflammatory cells can be seen within the epithelial infiltration, the majority of neutrophils and lymphocytes, but also eosinophils and plasma cells. Conclusions: The vesicles are active in epithelial cell regeneration after endoscopic sinus surgery and are an early unbalanced regenerative process in the process of epithelialization of the luminal cavity, suggesting that the vesicles are similar to the histopathological changes of nasal polyps Limitations, pathological repair of the phenomenon. Clear the imbalance of epithelial tissue --- vesicles, can effectively curb the recurrence of nasal polyps, the epithelialization of the chamber to start a balanced.