Tong Yi-Fen, Sun Xiu-Zhen, Li Da-Wei
Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian 116033, China.
Zhonghua Er Bi Yan Hou Ke Za Zhi. 2004 Jul;39(7):402-6.
To understand the restoration process of the mucosa through the continual endoscopic, microscopic, transmission electron microscopic and scanning electron microscopic observation of the nasal mucosa after endoscopic sinus surgery (ESS). This restoration process of mucosa can be used to appraise the effectiveness of the operation.
Thirty-one cases (53 sides) with chronic nasal sinusitis and nasal polyps were selected randomly, which had been undergone ESS operation during January to December, 2001. Biopsy of posterior frontanelle of the maxillary sinus were performed to observe the mucosa changes before the ESS and at 2-3 weeks, 8-11 weeks and 13-16 weeks after the ESS, respectively.
Epithelia shedding, proliferation, squamous metaplasia, glandular and fibrous tissue proliferation and lymphocytes infiltration were observed in all cases before the ESS. The microtubule abnormal and mitochondria diminishing and expanding existed in all cases. The morphological changes were not significant within 2-3 weeks after the ESS compared to the changes before the ESS. Eight-eleven weeks after the ESS, the nasal cavity turned clean and smooth. The number of pillar cells increased and the cilia swelling, short cilia, and many pillar cells with microvillus were seen. The number of goblet cells increased. Pathological glandular and fibrous proliferation were seen in all cases (53 sides). The operated cavity was clean and covered completely by epithelia (50 sides) 13-16 weeks after ESS. The length of cilia increased and arrangement of the cilia line was in the same direction. The structure of microtubules was clear. The mitochondria was elongated and became dense (49 sides). The pathological repairing was at work (3 sides).
After the ESS, the recovery of the mucus needs 3 months. Some pathological changes are irreversible and the cilia pathological change is related with its restoration. The more cilia reserved and timely local cleaned after ESS, the more helpful to the restoration of the cilia morphology and function. The effective of ESS can be evaluated through the histological-morphological changes. timely local cleaned after ESS, the more helpful to the restoration of the cilia morphology and function. The effective of ESS can be evaluated through the histological-morphological changes.
通过对鼻窦内窥镜手术（ESS）后鼻腔黏膜进行连续的内窥镜、显微镜、透射电子显微镜及扫描电子显微镜观察，了解黏膜的修复过程，以此评估手术效果。
随机选取2001年1月至12月期间行ESS手术的慢性鼻窦炎伴鼻息肉患者31例（53侧），分别于ESS术前及术后2 - 3周、8 - 11周、13 - 16周取上颌窦前囟处组织活检，观察黏膜变化。
ESS术前所有病例均见上皮脱落、增生、鳞状化生、腺性及纤维组织增生和淋巴细胞浸润，均存在微管异常及线粒体减少、肿胀。ESS术后2 - 3周与术前相比形态学改变不明显。ESS术后8 - 11周，鼻腔清洁、光滑，柱状细胞数量增多，可见纤毛肿胀、变短，许多柱状细胞有微绒毛，杯状细胞数量增多，所有病例（53侧）均见病理性腺性及纤维组织增生。ESS术后13 - 16周，术腔清洁，50侧完全被上皮覆盖，纤毛长度增加，纤毛排列成行且方向一致，微管结构清晰，49侧线粒体变长且致密，3侧有病理修复。
ESS术后，黏液恢复需3个月，部分病理改变不可逆，纤毛病理改变与其修复有关。ESS术后保留的纤毛越多且局部及时清理，越有助于纤毛形态及功能的恢复。ESS的效果可通过组织形态学改变进行评估。ESS术后局部及时清理，越有助于纤毛形态及功能的恢复。ESS的效果可通过组织形态学改变进行评估。
