Liu B, Wan J B, Zhang G A
Department of Burns, Beijing Jishuitan Hospital, the Fourth Clinical Medical College of Peking University, Beijing 100035, China.
Zhonghua Shao Shang Za Zhi. 2018 Aug 20;34(8):549-555. doi: 10.3760/cma.j.issn.1009-2587.2018.08.013.
To investigate the morphological and pathological changes of the larynx after severe laryngeal burn in dogs and their relationship with laryngostenosis. Eighteen healthy, male beagle dogs were assigned into control group, immediately after injury group, and 2, 4, 6, and 8 weeks after injury groups according to the random number table, with 3 dogs in each group. Dogs of injury group inhaled saturated steam through mouth for 5 seconds to reproduce severe laryngeal burn. Tracheotomy and intubation were performed immediately after injury, and 400 000 U/d penicillin was intravenously infused for 1 week. The feeding, activity, and vocalization of dogs in each group after injury were observed until they were sacrificed. Immediately after injury and 2, 4, 6, and 8 weeks after injury, the laryngeal morphology of the dogs in corresponding time point groups were observed by endoscope. After the observation, the dogs in each injury group were sacrificed, and the laryngeal tissue was taken. The epiglottis, glottis, and cricoid cartilage were collected to make full-thickness tissue slice, respectively, and their pathological changes were observed with hematoxylin and eosin staining. The dogs of control group were not specially treated, and their life activities, laryngeal morphological and pathological changes were observed. (1) The dogs of control group had normal feeding, activities, and vocalization. All the dogs in injury group survived until they were sacrificed, and their feeding, activities, and vocalization were obviously reduced after injury compared with those of control group. The dogs of 2, 4, 6 and 8 weeks after injury groups ate and moved normally 2 weeks after injury but vocalized abnormally in frequency and volume compared with those of control group, which lasted until they were sacrificed. (2) The dog's laryngeal mucosa in control group was complete and pink, without obvious exudation. The laryngeal mucosa of the dog in immediately after injury group was pale and edematous, with obvious exudation, local ulceration, necrosis, and exfoliation, and dilated microvessels on the surface. The laryngeal mucosa of the dogs in 2 weeks after injury group was pale, edematous, and oozed less than that of immediately after injury group, and the glottis was blocked by an obviously extruding mass. The paleness and edema of laryngeal mucosa were significantly reduced in the dogs of 4 weeks after injury group compared with those of 2 weeks after injury group, without dilated microvessel, and the glottic extruding mass was obviously smaller than that of 2 weeks after injury group. The sizes of glottic mass were similar between the dogs of 6 and 8 weeks after injury groups, which were obviously smaller than that in 4 weeks after injury group. (3) In the dogs of control group, the epithelial cells of epiglottis, glottis, and cricoid cartilage were normal in morphology, the proper glands were visible in the intrinsic layer, and the muscle fibers and the chondrocytes were normal in morphology. In the dogs of immediately after injury group, large sheets of epiglottis epidermis exfoliated, the epithelial cells were swollen and necrotic, the intrinsic glands were atrophic and necrotic, and the chondrocytes were degenerated and necrotic. The epidermis of the glottis partially exfoliated, the epithelial cells were swollen and necrotic, the intrinsic glands were atrophic and necrotic, the muscle fibers were partially atrophic and fractured, and the vacuolar chondrocytes were visible. The cricoid cartilage epidermis was ablated, the epithelial cells were swollen, the intrinsic layer and submucosal layer were slightly edematous, and the morphological structure of glands, chondrocytes, and muscle fibers were normal. In the dogs of 2 weeks after injury group, the epiglottis epidermis was completely restored, a small amount of glands in the intrinsic layer were repaired, and obsolete necrotic chondrocytes and new chondrocytes could be seen. A large number of fibroblasts, new capillaries, and inflammatory cells infiltration were observed in the epidermis of glottis, and intrinsic layer glands were repaired. The cricoid cartilage epidermis was repaired intactly, and there was no edema in the intrinsic layer. In the dogs of 4 weeks after injury group, the epiglottis intrinsic layer glands were further repaired compared with those of 2 weeks after injury group, and new chondrocytes were seen in the submucosa of the glottis. The condition of cricoid cartilage was consistent with that of control group. The dog's epiglottis, glottis, and cricoid cartilage were similar between the 6 and 8 weeks after injury groups, and no significant change was observed compared with those of 4 weeks after injury group. The morphological changes of larynx after severe laryngeal burn in dogs include mucosa detachment and necrosis, and mass blocking glottis. Pathological changes include epidermis shedding and necrosis, gland atrophy and necrosis, vascular congestion and embolism, chondrocytes degeneration, necrosis and proliferation, even local granulation tissue formation and cartilaginous metaplasia. These results may be the cause of laryngostenosis after laryngeal burn.
探讨犬重度喉烧伤后喉部的形态学及病理学变化及其与喉狭窄的关系。将18只健康雄性比格犬按随机数字表法分为对照组、伤后即刻组、伤后2、4、6、8周组,每组3只。伤后组犬经口吸入饱和蒸汽5秒造成重度喉烧伤。伤后立即行气管切开及插管,并静脉输注青霉素40万U/d,共1周。观察各组犬伤后的进食、活动及发声情况,直至处死。伤后即刻及伤后2、4、6、8周,分别观察相应时间点组犬的喉部形态。观察结束后,处死各伤后组犬,取喉部组织。分别取会厌、声门及环状软骨制作全层组织切片,苏木精-伊红染色观察其病理变化。对照组犬不做特殊处理,观察其生活活动、喉部形态及病理变化。(1)对照组犬进食、活动及发声正常。伤后组犬均存活至处死,伤后进食、活动及发声较对照组明显减少。伤后2、4、6、8周组犬伤后2周进食及活动正常,但发声频率及音量较对照组异常,持续至处死。(2)对照组犬喉黏膜完整,呈粉红色,无明显渗出。伤后即刻组犬喉黏膜苍白、水肿,有明显渗出,局部溃疡、坏死及脱落,表面微血管扩张。伤后2周组犬喉黏膜苍白、水肿,渗出较伤后即刻组少,声门被一明显突出肿物阻塞。伤后4周组犬喉黏膜苍白及水肿较伤后2周组明显减轻,无微血管扩张,声门突出肿物明显小于伤后2周组。伤后6、8周组犬声门肿物大小相似,明显小于伤后4周组。(3)对照组犬会厌、声门及环状软骨上皮细胞形态正常,固有层可见正常腺体,肌纤维及软骨细胞形态正常。伤后即刻组犬会厌大片表皮脱落,上皮细胞肿胀、坏死,固有腺体萎缩、坏死,软骨细胞变性、坏死。声门表皮部分脱落,上皮细胞肿胀、坏死,固有腺体萎缩、坏死,肌纤维部分萎缩、断裂,可见空泡状软骨细胞。环状软骨表皮剥脱,上皮细胞肿胀,固有层及黏膜下层轻度水肿,腺体、软骨细胞及肌纤维形态结构正常。伤后2周组犬会厌表皮完全修复,固有层少量腺体修复,可见陈旧性坏死软骨细胞及新生软骨细胞。声门表皮可见大量成纤维细胞、新生毛细血管及炎性细胞浸润,固有层腺体修复。环状软骨表皮完整修复,固有层无水肿。伤后4周组犬会厌固有层腺体较伤后2周组进一步修复,声门黏膜下层可见新生软骨细胞。环状软骨情况与对照组一致。伤后6、8周组犬会厌、声门及环状软骨情况相似,与伤后4周组相比无明显变化。犬重度喉烧伤后喉部形态学变化包括黏膜脱落、坏死及声门肿物阻塞;病理学变化包括表皮脱落、坏死,腺体萎缩、坏死,血管充血、栓塞,软骨细胞变性、坏死及增生,甚至局部肉芽组织形成及软骨化生。这些结果可能是喉烧伤后喉狭窄的原因。