Gindros George, Kantas Ilias, Balatsouras Dimitrios G, Kandiloros Dimitris, Manthos Anastasios K, Kaidoglou Aikaterini
ENT Department, G.Genimmatas General Hospital, Thessaloníki, Greece.
Eur Arch Otorhinolaryngol. 2009 Sep;266(9):1409-16. doi: 10.1007/s00405-009-0916-9. Epub 2009 Jan 30.
Chronic nasal obstruction owed to chronic hypertrophic rhinitis is one of the most common problems encountered in rhinology. Various forms of conservative therapy have been used, but these are often ineffective and surgical reduction techniques have been successfully applied. However, the issue of postoperative histological changes in the nasal mucosa has not been adequately addressed. The aim of the present study was to comparatively evaluate the effect of the methods of submucosal monopolar diathermy, radiofrequency coblation and ultrasounds on the nasal mucosa. Sixty patients with chronic hypertrophic rhinitis of nonallergic etiology underwent different surgical methods of turbinate reduction, divided into two groups: (1) 30 patients underwent tissue volume reduction of the inferior nasal turbinates using ultrasound procedure on the left side and monopolar diathermy on the right; (2) 30 patients underwent radiofrequency coblation technique on the left side and ultrasound reduction on the right. We studied 20 preoperative specimens of the inferior turbinate mucosa taken randomly from both groups of patients, 5 from each side of each group. Normal nasal mucosal specimens taken from ten healthy persons were used as controls. Specimens of the inferior turbinate were taken after 1, 3, and 6 months after surgery, from the same patients. All specimens were examined by electron microscopy. Preoperative observation revealed degeneration of epithelial cells, loss of cilia, disruption of intercellular connections, edema, nasal mucus overproduction and inflammatory infiltration in chorium. Postoperative observations revealed decrease of intercellular edema, reduction of mucus, overproduction of collagen and degeneration of the epithelium to flattened stratified. Only specimens after use of ultrasounds showed islands with normally organized epithelium of columnar ciliated cells. It may be concluded that epithelial changes owed to chronic hypertrophic rhinitis do not significantly improve postoperatively after turbinate tissue volume reduction. Only in several cases operated with ultrasounds, regeneration of epithelium occurs, resulting to anatomical and functional restoration of the nasal physiology.
慢性肥厚性鼻炎所致的慢性鼻阻塞是鼻科学中最常见的问题之一。人们已经采用了各种形式的保守治疗方法，但这些方法往往无效，而手术缩减技术已得到成功应用。然而，鼻黏膜术后组织学变化的问题尚未得到充分解决。本研究的目的是比较评估黏膜下单极透热疗法、射频消融术和超声对鼻黏膜的影响。60例非过敏性病因的慢性肥厚性鼻炎患者接受了不同的鼻甲缩小手术方法，分为两组：（1）30例患者左侧使用超声手术、右侧使用单极透热疗法进行下鼻甲组织体积缩减；（2）30例患者左侧采用射频消融技术、右侧采用超声缩减。我们研究了从两组患者中随机选取的20份术前下鼻甲黏膜标本，每组每侧各5份。从10名健康人身上获取的正常鼻黏膜标本用作对照。在术后1个月、3个月和6个月从同一患者身上获取下鼻甲标本。所有标本均通过电子显微镜检查。术前观察显示上皮细胞变性、纤毛丧失、细胞间连接破坏、水肿、鼻黏液分泌过多以及固有层炎症浸润。术后观察显示细胞间水肿减轻、黏液分泌减少、胶原蛋白生成过多以及上皮细胞退化为扁平复层。只有使用超声后的标本显示有柱状纤毛细胞正常组织化上皮的岛状结构。可以得出结论，慢性肥厚性鼻炎所致的上皮变化在鼻甲组织体积缩减术后并未显著改善。只有在几例采用超声手术的病例中，上皮发生再生，导致鼻生理功能的解剖学和功能恢复。
