综合治疗在慢性鼻及鼻窦炎黏膜炎症恢复中的作用

Combined therapy on chronic nasal-sinusitis

目的观察综合治疗在控制慢性鼻及鼻窦炎黏膜炎症过程中的作用。方法对30例慢性鼻及鼻窦炎进行功能性鼻内镜手术及围手术期治疗。分别于术后1、3和6个月随访并行鼻内镜检查取黏膜活检,比较患者临床症状、黏膜炎症的恢复情况。结果术后6个月,30例术腔黏膜上皮化,但10例(33%)术腔黏膜仍轻度肿胀,持续有黏液样分泌物。黏液纤毛输送速率(mucociliarytransportrate,MTR)术前(3.63±1.74)毫米/分钟,术后6个月(6.27±1.31)毫米/分钟,明显加快(P<0.01)。上颌窦黏膜炎性细胞浸润减少,水肿减轻。但杯状细胞数和黏膜下腺体无明显改善(P>0.05),表面超微结构未完全恢复正常。结论慢性鼻及鼻窦炎经综合治疗6个月,虽可达临床治愈,但黏膜炎症仍存在。

OBJECTIVE To evaluate the efficacy of combined therapy on chronic rhinosinusitis （CRS）. METHODS Thirty cases with CRS in stage Ⅱ -2 were treated by FESS. At 1, 3, 6-month after operation, endoscopy and nasal mucosa biopsy were performed and the clinic symptoms were reassessed. RESULTS Although fine mucosal epithelization was found in all cases at 6 month after operation, mild edema of mucosa and muciform secretion still existed in 10 cases. Mucociliary transport rate （MTR） was 3.63 ± 1.74 mm/min before operation, and was 6.27 ± 1.31 mm/min at 6-month after operation. Compared with that before operation, the MTR was significantly improved whereas it had not rehabilitated to normal status. The decrease of inflammatory cells and alleviation of submucosal edema were observed in the mucosa of maxillary sinus. Nevertheless, the number of goblet cells and submucosa glands did not improve significantly. The ultrastructure of the mucosa was not recovered completely at 6 month after operation. CONCLUSION With combined therapy on CRS for 6 months, clinical cure can be achieved, but mucosal inflammatory reaction is still existed.