喉癌手术前后鼻腔黏膜形态和功能比较

Comparison of morphology and mucosa functions of nasal cavity before and after total laryngectomy

目的观察喉癌全切除手术前后鼻腔黏膜的形态及功能的变化。方法收集2009年7月～2 0 1 0年7月诊治并有完整随访资料的喉癌喉全切除术患者2 0例,所有患者手术前后鼻腔黏膜进行糖精试验和电子鼻咽镜检查,其中15例喉癌患者手术前后进行鼻腔黏膜扫描电镜检查。观察比较手术前后患者的鼻腔结构和纤毛传输时间。结果①鼻腔电子鼻咽镜检查术后3个月与术前比较,鼻腔大体结构未见明显变化;术后18个月鼻腔变得明显宽大,鼻腔各结构相对萎缩,鼻甲变小、黏膜变薄、色泽变苍白、质地变硬、弹性变差,表面多有略呈白色的稀薄分泌物;②纤毛传输时间术后3个月与术前比较,纤毛传输时间的均值略显缩短,但其差异无统计学意义(P>0.05);术后18个月比术前明显延长,差异具有统计学意义(P<0.05);③电子显微镜检查术后3个月患者鼻腔黏膜纤毛等超微结构无明显破坏,术后18个月鼻腔黏膜的纤毛较稀疏、局部纤毛脱落,存留的纤毛排列紊乱,方向不一致,可见倒伏、粘连成簇状的纤毛。结论喉癌喉全切术后鼻腔的大体结构和超微结构及黏液纤毛清除功能在术后3个月内无明显变化,但随着时间延长,鼻腔的大体结构逐渐发生明显萎缩性改变,超微结构受到破坏,黏膜纤毛清除功能显著下降。

Objective To study the changes of morphology and mucosa functions of nasal cavity after total laryngectomy in patients suffering from laryngeal carcinoma.Methods 20 patients suffering from laryngeal carcinoma and treated with total laryngectomy from Jul.2009 to Jul.2000 were enrolled.Before and after total laryngectomy,all patients received saccharin test and electron nasopharyngoscope examination,meanwhile 15 of them received scanning electron microscopy of the nasal mucosa.Results ① Electron nasopharyngoscope examination demonstrated relative wide nasal cavity with unchanged general structures 3 months after surgery,atrophic structures,thin,rigid and pale mucosa with watery secretion 18 months postoperatively.② The saccharin test showed that the ciliary transmission time at 3 months after surgery was slightly shorter than that of pre-operation without statistically significant difference,while that at 18 months after surgery was much longer than the preoperative one（P0.05）.③ The examination of electron microscope demonstrated that the ultrastructures of nasal mucosa and cilia kept undamaged at 3 months after surgery;and at 18 months after operation,the ultrastructure of nasal mucosa was impaired,characterized by sparseness and loss of cilia,disordered cilia array with different and inverse orientation,cilia dumping and clustering.Conclusion In patients after total laryngectomy,the general structure,ultrastructure and mucociliary clearance function of nasal cavity keep normal within 3 months after surgery.With the prolongation of postoperative duration,atrophic change of the general structure,ultrastructure impairment and prominent decline of mucociliary clearance function will occur.