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目的:探讨电动鼻窦切割钻(HUMMER)和微波切除部分下鼻甲对鼻黏膜纤毛清除系统的影响,为临床选择合理术式提供理论依据。方法:HUMMER切除部分下鼻甲组(HUMMER组)和微波切除部分下鼻甲组(微波组)各20例,无鼻腔疾病的健康对照组10例。每例患者分别于术前、术后3个月和术后6个月取材,健康对照组任选5例取材。每次取每个研究对象的下鼻甲黏膜,分别行光镜和扫描电镜观察。所有患者取材之前用糖精试验测定鼻黏膜纤毛输送率(MTR)。结果:①HUMMER组术前、术后3个月和术后6个月MTR分别为(3.63±0.57)、(3.76±0.43)、(6.09±1.19)mm/min,术后6个月与术前、术后3个月比较差异均有统计学意义(均P<0.01)。微波组术后3、6个月MTR分别为(3.96±0.40)和(3.95±0.32)mm/min,与健康对照组(6.20±0.68)mm/min比较差异均有统计学意义(均P<0.01)。微波组术后6个月与HUMMER组术后6个月MTR比较差异有统计学意义(P<0.01)。②光镜及扫描电镜观察:HUMMER组和微波组术前鼻黏膜上皮内杯状细胞增多,纤毛排列紊乱、缺失,粗细长短不一,部分黏膜上皮由假复层纤毛柱状上皮化生为单层立方上皮;HUMMER组术后鼻黏膜上皮再生为假复层纤毛柱状上皮,基本和正常黏膜纤毛系统表现一致。微波组术后鼻黏膜纤毛上皮很少再生,黏膜上皮化生为鳞状上皮,纤毛断裂缺失较重。结论:HUMMER切除部分下鼻甲术在保护和恢复鼻腔功能方面优势比较明显。
Objective: To investigate the effect of partial mastectomy of the inferior turbinate on nasal mucociliary clearance with HUMMER and microwave ablation, so as to provide a theoretical basis for clinical rational surgical selection. Methods: 20 cases of HUMMER resected part of inferior turbinate group (HUMMER group) and 20 cases of microwaved partial inferior turbinate group (microwave group), 10 cases of healthy control group without nasal cavity disease. Each patient was taken before surgery, 3 months after surgery and 6 months after surgery, and five healthy controls were selected. Each time we took the inferior turbinate mucosa, respectively, under light and scanning electron microscopy. Nasal mucociliary delivery (MTR) was measured by saccharin test before all patients were drawn. Results: ① The MTR of preoperative, postoperative 3 and postoperative 6 months in HUMMER group were (3.63 ± 0.57), (3.76 ± 0.43) and (6.09 ± 1.19) mm / min, respectively, , And the differences were statistically significant at 3 months after operation (all P <0.01). The MTR of the microwave group at 3 and 6 months after operation were (3.96 ± 0.40) and (3.95 ± 0.32) mm / min respectively, which were significantly different from those of the healthy control group (6.20 ± 0.68) mm / min (all P < 0.01). There was significant difference in MTR between microwave group 6 months after operation and HUMMER group 6 months after operation (P <0.01). ② The light microscopy and scanning electron microscopy: HUMMER group and microwave group preoperative nasal mucosa epithelial goblet cells increased, cilia arranged disorder, missing, varying in length, part of the mucosal epithelium pseudostratified ciliated columnar epithelial metaplasia into a single layer Cubic epithelium; HUMMER group postoperative nasal mucosa epithelial regeneration of pseudostratified ciliated columnar epithelium, basic and normal mucosal cilia system performance. In the microwave group, nasal mucosa epithelium rarely regenerated, mucosal epithelial metaplasia was squamous epithelium, and the cilia rupture was less severe. Conclusion: HUMMER resection part of the inferior turbinate surgery in the protection and recovery of nasal function more obvious advantages.