Lenz H, Preussler H
HNO. 1976 Mar;24(3):80-6.
The light microscopic findings of tonsillar tissues from nineteen patients (aged 13-51) with the clinical diagnosis of chronic tonsillitis are described at sequential intervals following cryosurgical treatment. The Cooper instrument was used, containing liquid nitrogen and capacity limited cryoprobes as well as probes of a flow system. Two consecutive freeze-thaw cycles were used during a single session in each patient, with freezing time varied from 30 seconds to three minutes. In addition to primary cryosurgical tissue changes such as hyperemia, edema, inflammation, necrosis, fibroplasia with capillary increase, collagenous fibrosis and reepithelialisation, the following could be found: 1. A different cryosensibility of the cells and fibers within the cryolesion: The tonsillar septae are much more resistant to cold than the lymphoid tissue. Of this latter tissue, the reticulin cells and the lymphoblasts are more sensitive to the cold changes than are the matured lymphocytes. In the epithelium the stratum basale is as sensitive to cold as the lymphoreticulum. The outer epithelial cells are more resistant to cold than the basal cells. 2. A quick proliferation in the periphery of the cryolesion is seen in the form of an acanthosis and papillomatosis which begins before slough of necrotic debris occurs. 3. Sharp demarcation and protracted sloughing of necrotic epithelium from the free tonsillar surface or crypts and lymphoid tissue can be seen. 4. Reepithelialization can first be seen following slough of the cryonecrosis twenty days following cryosurgery, after which total reepithelialization occurs.
描述了19例临床诊断为慢性扁桃体炎患者(年龄13 - 51岁)扁桃体组织在冷冻手术治疗后不同时间间隔的光镜检查结果。使用了库珀仪器,其包含液氮和容量受限的冷冻探头以及流动系统探头。每位患者在单次治疗中进行两个连续的冻融循环,冷冻时间从30秒到3分钟不等。除了冷冻手术引起的组织原发性变化,如充血、水肿、炎症、坏死、伴有毛细血管增生的纤维组织增生、胶原纤维化和再上皮化外,还可发现以下情况:1. 冷冻损伤区内细胞和纤维对冷冻的敏感性不同:扁桃体间隔比淋巴组织对寒冷的抵抗力更强。在后者组织中,网状细胞和成淋巴细胞比成熟淋巴细胞对寒冷变化更敏感。在上皮组织中,基底层对寒冷的敏感性与淋巴组织相同。外层上皮细胞比基底细胞对寒冷的抵抗力更强。2. 在坏死碎片脱落之前,冷冻损伤周边可见以棘皮症和乳头瘤病形式出现的快速增殖。3. 可见坏死上皮从游离扁桃体表面或隐窝及淋巴组织处明显分界并长期脱落。4. 冷冻手术后20天,冷冻坏死组织脱落后首先可见再上皮化,之后完全再上皮化。