Baroody Fuad M
Section of Otolaryngology-Head and Neck Surgery, Departments of Surgery and Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
Clin Allergy Immunol. 2007;20:103-19.
In conclusion, this chapter provides a review of paranasal sinus anatomy and discusses the physiology of mucociliary transport and abnormalities observed in patients with CRS. Normal mucociliary transport is essential for the maintenance of healthy sinuses. This is well illustrated by PCD in which a congenital abnormality in ciliary function leads to, among other manifestations, CRS and bronchiectasis. A decrease in mucociliary clearance has been demonstrated in most studies of CRS, with the bulk of evidence suggesting that the decrease is secondary rather than a primary event. Mucostasis, hypoxia, microbial products, and mediators and toxic proteins generated during chronic inflammation probably all contribute to diminished mucociliary function. These factors decrease mucociliary function by direct toxic effects on cilia, ciliary loss, other ultrastructural alterations in the epithelium and changes in the viscoelastic properties of mucus. Studies of patients before and after surgical restoration of sinus ventilation have shown that mucociliary function improves gradually over 1-6 months postoperatively. The slower than normal rate of recovery of mucociliary clearance after surgery highlights the importance of careful postoperative medical and surgical management which is discussed in Chapters 19 and 20.
总之，本章回顾了鼻窦解剖结构，并讨论了黏液纤毛运输的生理学以及慢性鼻-鼻窦炎（CRS）患者中观察到的异常情况。正常的黏液纤毛运输对于维持鼻窦健康至关重要。这在原发性纤毛运动障碍（PCD）中得到了很好的体现，其中纤毛功能的先天性异常除了其他表现外，还会导致CRS和支气管扩张。在大多数CRS研究中都证实了黏液纤毛清除功能下降，大量证据表明这种下降是继发性的而非原发性事件。黏液停滞、缺氧、微生物产物以及慢性炎症期间产生的介质和毒性蛋白可能都导致黏液纤毛功能减弱。这些因素通过对纤毛的直接毒性作用、纤毛丧失、上皮细胞的其他超微结构改变以及黏液黏弹性特性的变化来降低黏液纤毛功能。对鼻窦通气手术恢复前后患者的研究表明，黏液纤毛功能在术后1至6个月逐渐改善。术后黏液纤毛清除功能恢复速度慢于正常情况，这突出了术后仔细的药物和手术管理的重要性，这将在第19章和第20章中进行讨论。
