中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2011年
7期
547-551
,共5页
尤慧华%诸葛盼%施海明%李栋%杜欢乐
尤慧華%諸葛盼%施海明%李棟%杜歡樂
우혜화%제갈반%시해명%리동%두환악
鼻窦炎%鼻息肉%生物膜%显微镜检查,电子%扫描%随访研究
鼻竇炎%鼻息肉%生物膜%顯微鏡檢查,電子%掃描%隨訪研究
비두염%비식육%생물막%현미경검사,전자%소묘%수방연구
Sinusitis%Nasal polyps%Biofilms%Microscopy,electron,scanning%Follow-up studies
目的 观察慢性鼻-鼻窦炎鼻息肉患者手术黏膜组织中细菌生物膜的形态特征,并分析其与临床因素、术后疗效的关系.方法 试验组获取72例慢性鼻-鼻窦炎鼻息肉患者手术中筛窦黏膜组织,对照组获取15例鼻中隔偏曲患者、10例鼻骨骨折患者钩突黏膜组织(患者均知情同意),所有组织标本均行扫描电镜检查.对两组患者进行术后随访,分别应用Lund-Kennedy鼻内镜检查、慢性鼻窦炎疗效评定标准(1997年,海口)评估患者病情改善程度.采用t检验分析细菌生物膜对术后Lund-Kennedy评分的影响;采用卡方检验分析细菌生物膜与内镜手术疗效的相关性,以P＜0.05为差异有统计学意义.结果 试验组72例慢性鼻-鼻窦炎鼻息肉患者中有3例患者失访,失访率为4.2%.69例慢性鼻-鼻窦炎鼻息肉患者的细菌生物膜阳性率71.0%(49/69),并且可以观察到黏膜组织纤毛不同程度的损伤.对照组未发现细菌生物膜,可以观察到黏膜纤毛较浓密,排列整齐.卡方检验结果显示,性别、慢性鼻-鼻窦炎鼻息肉类型、病程等因素在试验组细菌生物膜阴性组与阳性组间差异无统计学意义(P值均＞0.05).细菌生物膜阳性组患者术后6个月和12个月的Lund-Kennedy 评分(4.78 ±1.67;4.55 ±1.61)分别高于细菌生物膜阴性组患者(3.65 ±1.39;3.65 ±1.18),差异均有统计学意义(t=-2.654,P＜0.01;t=-2.264,P＜0.05);细菌生物膜阴性组术后6个月和12个月的疗效明显优于细菌生物膜阳性组,差异有统计学意义(x2值分别为18.014、22.063,P值均＜0.001).结论 慢性鼻.鼻窦炎鼻息肉患者手术黏膜组织中存在细菌生物膜的生命周期不同形态,细菌生物膜的存在与否,与慢性鼻-鼻窦炎鼻息肉的类型、性别、病程无明显相关.细菌生物膜可能对患者术后疗效产生不良的影响.
目的 觀察慢性鼻-鼻竇炎鼻息肉患者手術黏膜組織中細菌生物膜的形態特徵,併分析其與臨床因素、術後療效的關繫.方法 試驗組穫取72例慢性鼻-鼻竇炎鼻息肉患者手術中篩竇黏膜組織,對照組穫取15例鼻中隔偏麯患者、10例鼻骨骨摺患者鉤突黏膜組織(患者均知情同意),所有組織標本均行掃描電鏡檢查.對兩組患者進行術後隨訪,分彆應用Lund-Kennedy鼻內鏡檢查、慢性鼻竇炎療效評定標準(1997年,海口)評估患者病情改善程度.採用t檢驗分析細菌生物膜對術後Lund-Kennedy評分的影響;採用卡方檢驗分析細菌生物膜與內鏡手術療效的相關性,以P＜0.05為差異有統計學意義.結果 試驗組72例慢性鼻-鼻竇炎鼻息肉患者中有3例患者失訪,失訪率為4.2%.69例慢性鼻-鼻竇炎鼻息肉患者的細菌生物膜暘性率71.0%(49/69),併且可以觀察到黏膜組織纖毛不同程度的損傷.對照組未髮現細菌生物膜,可以觀察到黏膜纖毛較濃密,排列整齊.卡方檢驗結果顯示,性彆、慢性鼻-鼻竇炎鼻息肉類型、病程等因素在試驗組細菌生物膜陰性組與暘性組間差異無統計學意義(P值均＞0.05).細菌生物膜暘性組患者術後6箇月和12箇月的Lund-Kennedy 評分(4.78 ±1.67;4.55 ±1.61)分彆高于細菌生物膜陰性組患者(3.65 ±1.39;3.65 ±1.18),差異均有統計學意義(t=-2.654,P＜0.01;t=-2.264,P＜0.05);細菌生物膜陰性組術後6箇月和12箇月的療效明顯優于細菌生物膜暘性組,差異有統計學意義(x2值分彆為18.014、22.063,P值均＜0.001).結論 慢性鼻.鼻竇炎鼻息肉患者手術黏膜組織中存在細菌生物膜的生命週期不同形態,細菌生物膜的存在與否,與慢性鼻-鼻竇炎鼻息肉的類型、性彆、病程無明顯相關.細菌生物膜可能對患者術後療效產生不良的影響.
목적 관찰만성비-비두염비식육환자수술점막조직중세균생물막적형태특정,병분석기여림상인소、술후료효적관계.방법 시험조획취72례만성비-비두염비식육환자수술중사두점막조직,대조조획취15례비중격편곡환자、10례비골골절환자구돌점막조직(환자균지정동의),소유조직표본균행소묘전경검사.대량조환자진행술후수방,분별응용Lund-Kennedy비내경검사、만성비두염료효평정표준(1997년,해구)평고환자병정개선정도.채용t검험분석세균생물막대술후Lund-Kennedy평분적영향;채용잡방검험분석세균생물막여내경수술료효적상관성,이P＜0.05위차이유통계학의의.결과 시험조72례만성비-비두염비식육환자중유3례환자실방,실방솔위4.2%.69례만성비-비두염비식육환자적세균생물막양성솔71.0%(49/69),병차가이관찰도점막조직섬모불동정도적손상.대조조미발현세균생물막,가이관찰도점막섬모교농밀,배렬정제.잡방검험결과현시,성별、만성비-비두염비식육류형、병정등인소재시험조세균생물막음성조여양성조간차이무통계학의의(P치균＞0.05).세균생물막양성조환자술후6개월화12개월적Lund-Kennedy 평분(4.78 ±1.67;4.55 ±1.61)분별고우세균생물막음성조환자(3.65 ±1.39;3.65 ±1.18),차이균유통계학의의(t=-2.654,P＜0.01;t=-2.264,P＜0.05);세균생물막음성조술후6개월화12개월적료효명현우우세균생물막양성조,차이유통계학의의(x2치분별위18.014、22.063,P치균＜0.001).결론 만성비.비두염비식육환자수술점막조직중존재세균생물막적생명주기불동형태,세균생물막적존재여부,여만성비-비두염비식육적류형、성별、병정무명현상관.세균생물막가능대환자술후료효산생불량적영향.
Objective To explore the presence of bacterial biofilms(BF) in patients with CRS and the effect of BF on clinical symptoms and postoperative outcomes.Methods Seventy-two patients with chronic sinusitis were enrolled in this study.The control group included 15 patients with deviation of the nasal septum and 10 patients had a fracture of the nasal bone.Mucosa of the uncinate process or ethmoid near the ostium of the maxillary sinus was obtained during endoscopic sinus surgery.The specimens were subjected to scanning electron microscopy.Patients were followed for 1 year and observed by the LundKennedy endoscopy,and the Haikou standard classification (ESS-1997).Statistical analysis was performed by t-test or chi-square test Results Three patients were lost to follow-up.The scanning electron microscopy analysis showed bacterial biofilms in 49 of the 69 patients with chronic sinusitis.A marked destruction of the epithelium and cilia was observed in samples positive for bacterial biofilms.No bacterial biofilms were detected in the control group,and scanning electron microscopy showed normal epithelium and cilia in those specimens.There was no significant difference in gender,classification or duration of disease between the BF(-) and BF( + ) groups.At six months and one year postoperative,the Lund-Kennedy endoscopy scores for CRS patients with BF(4.78 ± 1.67 ;4.55 ± 1.61) were significantly higher than those without BF(3.65 ±1.39;3.65 ±1.18) (t =-2.654,P＜0.01;l =-2.264,P＜0.05).Based on the Haikou standard classification,there was a significantly difference between patients with BF and those without BF( x2 = 18.014,22.063 ,P ＜ 0.001,respectively).Conclusions Different life stages of bacterial biofilms were demonstrated to be present in CRS.Gender,classification or duration of disease did not affect the presence of bacterial biofilms in patients with CRS.There is a correlation between bacterial biofilms and an unfavorable outcome in patients with CRS after ESS.
