兔泪道置管术拔管后的临床及病理变化

Clinical and pathological change in lacrimal intubation of rabbit after extubation

目的观察兔泪道置管术拔管后的鼻泪管组织的临床病理变化,探讨拔管后阻塞复发的机制。方法 25只新西兰大白兔,一侧为实验组,制作成鼻泪管阻塞的模型,另一侧作为对照组。实验组行鼻泪管置管,28 d后拔管,观察鼻泪管阻塞的模型及拔管后的临床表现,拔管当天(0 d),拔管后3、7、14、28 d时鼻泪管组织的病理变化。观察实验组与对照组的管壁相对厚度、黏膜下组织的成纤维细胞密度、成纤维细胞PCNA阳性率,计算实验组与对照组之间上述指标差值的统计学意义。结果建模成功的实验组,均有溢泪,泪道冲洗不通,但分泌物较少,拔管后泪道冲洗通畅,均无溢泪。实验组鼻泪管组织中海绵状血管组织相对较少,胶原纤维相对较多,以7 d最为明显。对照组管壁厚度、成纤维细胞密度、成纤维细胞PCNA阳性率在不同时点均无明显差异(均P>0.05)。管壁厚度:拔管7 d时,实验组明显大于对照组(P<0.05)。实验组7 d时与0 d时比较,差异有统计学意义(P<0.05)。成纤维细胞密度:拔管7 d时,实验组明显高于对照组(P<0.05)。实验组7 d时与0、14、28 d时比较,差异均有统计学意义(P<0.05)。成纤维细胞PCNA阳性率:拔管3、7 d时,实验组与对照组比较,差异均有统计学意义(P<0.05或P<0.01)。实验组3 d时与0、14、28 d时比较,差异有高度统计学意义(P<0.01);7 d时与14 d时比较,差异有统计学意义(P<0.05)。结论拔管早期存在成纤维细胞大量增殖现象,有必要适当应用抗增殖药以减少复发的可能。

Objective To observe the clinical and pathological change in lacrimal intubation of rabbit after extubation, to probe the mechanism of recurrence obstruction after extubation. Methods 25 New Zealand white rabbits, one side of every rabbit was named as experimental group, was made for nasolacrimal duct obstruction model, the other side as control group. Nasolacrimal intubation performed in the experimental eye, with stent for 28 days before extubation. Clinical manifestation of the nasolacrimal duct obstruction model and pathological change of nasolacrimal duct tissue after extubation of 0 day （extubation day）, 3rd day, 7th day, 14th day, 28th day were observed. Relative thickness of the duct, fibroblast density submucosal tissue and PCNA positive rate of fibroblasts in experimental group and control group were observed, statistical differences of indexes which mentioned above were calculated between experimental group and control group. Results The successful of nasolacrimal duct obstruction model eyes were all tearing, syringshowed obstruction, but less discharge, after extubation, they were all no tearing. Cavernous blood vessels in experimental nasolacrimal duct were relatively less, the collagen fibers in 7th day were more obvious. There was no significant difference about wall thickness, cell densityand PCNA positive rate in control group. Wall thickness： there was significant difference between the two groups at 7 d （P 〈 0.05）, there was significant difference between 7 d and 0 d in experimental group （P 〈 0.05）. Cell density： there was significant difference between the two groups at 7 d （P 〈 0.05）, there was significant difference between 7 d and 0 d, 14 d, 28 d in experimental group （P 〈 0.05）. PCNA positive rate： there was significant difference between the two groups at 3 d and 7 d （P 〈 0.05 or P 〈 0.01）, there was significant difference between 3 d and 0 d,14 d, 28 d in experi- mental group （P 〈 0.01）, there was significant difference between 7 d and 14 d in experimental group （P 〈 0.05）. Conclusion In the early stage after extubation, fibroblast proliferation is obviously, so it is necessary to apply appropriately antiproliferative drugs to reduce the recurrence after extubation.