鼻腔中、下鼻甲微淋巴管密度研究

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1、中图分类号：R322.2+6；R765.25硕士学位论文鼻腔中、下鼻甲微淋巴管密度研究院（系）、所临床医学院研究生姓名石向阳学科、专业耳鼻咽喉科学导师姓名黄定强主任医师二Ο一二年四月目录1鼻腔中、下鼻甲微淋巴管密度研究„„„„„„„„„„11.1中文摘要„„„„„„„„„„„„„„„„„„„„„11.2英文摘要„„„„„„„„„„„„„„„„„„„„„31.3前言„„„„„„„„„„„„„„„„„„„„„„„61.4材料与方法„„„„„„„„„„„„„„„„„„„„71.5结果„„„„„„„„„„„„„„„„„„„„„„„111.6讨论„„„„„„„

2、„„„„„„„„„„„„„„„„151.7结论„„„„„„„„„„„„„„„„„„„„„„„271.8参考文献„„„„„„„„„„„„„„„„„„„„„291.9英汉缩略词对照表„„„„„„„„„„„„„„„„„332致谢„„„„„„„„„„„„„„„„„„„„„„„353微淋巴管及淋巴微循环研究进展(综述)„„„„„„„„37鼻腔中、下鼻甲微淋巴管密度研究摘要目的：采用D2-40标记法对比鼻腔中、下鼻甲黏膜中的微淋巴管密度（Lymphaticmicrovesselsdensity，LMVD），分析其与鼻息肉发生的关系。方法：此实验收集近两年来本院病

3、理科存档的27例鼻内镜手术中切下的中、下鼻甲组织石蜡标本及临床病例资料。纳入标准：选择在鼻中隔偏曲、鼻窦的良性肿瘤、囊肿、鼻外伤等鼻部手术中遗弃后所获取的正常中鼻甲、下鼻甲标本。需排除急慢性鼻窦炎、囊性纤维病、淋巴系统相关性疾病等。要求所有病例无鼻息肉病史及家族史，无过敏性鼻炎及鼻腔肿瘤病史。术前无任何放疗、化疗及生物治疗，特别是无鼻用激素治疗史。符合上述标准的病例共27例，男15例，女12例，患者平均年龄为33.1岁(13～69岁)。采用Envision方法在27例鼻腔中、下鼻甲组织标本中进行D2-40抗原表达的检测，计算D2-40阳性微淋巴管密度

4、。染色阳性淋巴管的特征是：环状棕黄色结构，组成多为单层内皮细胞,管腔形状可呈圆形、椭圆形、闭塞条索状等，且管壁薄，管腔内无红细胞，有的管腔内可见淋巴细胞。在淋巴管分布较多的区域选取热点区(hotspots)，每张切片选取3个热点区。3个热点区分别在图像采集系统高倍视野（×100）采集1幅图像。分别存储每张切片3张图像,计算每个标本3张图像微淋巴管的平均数，记为每个标本的微淋巴管密度。结果：27例共计54份中、下鼻甲黏膜组织的病理切片中D2-40阳性率为100％（54/54）。染色清楚，染色的淋巴管呈丛状分布于黏膜下层和固有层。中鼻甲黏膜组织中D2-4

5、0(+)淋巴管密度（LVD）为：3.42±1.67，下鼻甲黏膜组织中D2-40(+)淋巴管密度（LVD）为：3.25±1.36。使用SPSS19.0统计软件配对t检验，检验水准取0.05，中、下鼻甲淋巴管密度差异无统计学意义(P＞0.05)。结论：本实验可使我们认识到以下几点：①D2-40免疫组化法对于鼻腔黏膜淋巴管染色清晰，特异性好，取得了较好的实验效果，能清楚显示鼻腔淋巴管的结构。②通过对比中鼻甲与下鼻甲微淋巴管结构，发现微淋巴管大多位于黏膜上皮层下的固有层，成丛状排列。③初步发现中鼻甲黏膜组织中微淋巴管与下鼻甲组织中微淋巴管在数量上无显著差异。

6、由以上可初步认为中鼻甲较下鼻甲好发鼻息肉的原因不在于鼻腔黏膜淋巴管的数量差异。推测在于这些好发部位淋巴管的功能出现了异常，即无法保证黏膜中水分的引流，最终导致水肿的发生。在炎症的持续过程中，大量的炎症介质参与了这一过程。所有这些炎性物质使组织水肿的病理过程加重，最终炎性细胞浸润、组织重构息肉发生。关键词：鼻腔；淋巴系统；淋巴管StudyonLymphaticMicrovesselsDensityofMiddleandInferiorNasalConchaAbstract:Objective:Toinvestigatethelymphaticmicro

7、vesselsdensity（LMVD）labeledbyD2-40inmiddleandinferiornasalconchamucosaandstudyitsrelationshipwiththedevelopmentofNasalpolyps.Method:Thisstudyisbasedon27casesofparaffin-embeddedmiddleandinferiornasalconchatissuespecimenandclinicaldatacollectedfromendoscopicsinussurgeryofourPatho

8、logydepartmentinthepasttwoyears.Inclusioncriteria:sele