作者：肖二彬，高荣先， 田从哲， 杜锦朵
【摘要】 目的 通过观察慢性鼻窦炎伴嗅觉障碍患者行功能性鼻内窥镜手术前、后嗅觉功能改变，探讨慢性鼻窦炎嗅觉功能与鼻内窥镜手术的关系；并用透射电镜观察手术对嗅区黏膜超微结构的影响。为临床治疗慢性鼻窦炎患者的嗅觉障碍提供理论依据。方法 对慢性鼻窦炎伴嗅觉障碍患者行功能性鼻内窥镜手术，于术前及术后6个月时观察嗅觉功能变化并切取嗅区黏膜于透射电镜下观察超微结构改变。结果 嗅觉也可不同程度改善，主观嗅觉改善率97%；嗅上皮的超微结构不同程度恢复，超微结构显著改变由术前的100%降为20%。结论 炎症导致嗅上皮细胞由表及里各层的超微结构异常程度与嗅觉功能减退程度有关。慢性鼻窦炎伴嗅觉障碍患者经功能性鼻内窥镜手术，解决其鼻腔通气障碍及嗅黏膜炎性反应消除后，嗅上皮超微结构可有不同程度恢复，嗅觉也可以有不同程度改善。
【关键词】 功能性鼻内窥镜手术；嗅觉障碍；电子显微镜；嗅上皮；超微结构
【Abstract】 Objective To study the influences of olfactory area cilia before and after functional endoscopic sinus surgery for chronic sinusitis accompanying with olfactory sensation disorders， providing theoretical foundation for the clinical treatment of chronic sinusitis. Methods Olfactory area membrane of nasal septum was cut by small sickle through endoscope before operation via the olfactory superior nasal concha， observing ultramicrostructure of olfactory epithelium of the patients of chronic sinusitis accompanying with disorders of olfactory sensation， then FESS after 6months，we recheck it at the same position ，obtaining the same tissue，using the same methods.Observing the changes of ultramicrostructure of olfactory area compared with the changes of that before the operation through transmission electron microscope. Results Observation the patients of chronic sinusitis accompanying with disorders of olfactory sensation， and through FESS by transmission electron microscope， the ultramicrostructure of olfactory epithelium can be recovered at certain circumstances.The ultramicrostructure of olfactory epithelium cell with chronic sinusitis patients shows that：the consequences of inflammation shows that there is a positive influence between abnormal degree of ultramicrostructure of olfactory epithelium and atrophy degree of olfactory epithelium.Conclusion For the patients of chronic sinusitis accompanying with disorders of olfactory sensation， through functional endoscopic sinus surgery， after solving the disorder of ventilation of nasal cavity and diminishing the inflammation of olfactory membrane， the ultra microstructure of olfactory epithelium can be recovered at certain circumstances and sensation can be improved at certain degree as well.
【Key words】 functional endoscopic sinus surgery；disorder of olfactory sensation； electronic microscope； olfactory epithelium； ultramicrostructure
慢性鼻窦炎常常伴有嗅觉减退，功能性鼻内窥镜鼻窦手术(FESS)治疗慢性鼻窦炎、鼻息肉的效果肯定，而术后鼻腔黏膜在形态学、组织学和功能上能否恢复正常状态是目前关注的热点。对于FESS对鼻腔纤毛运动的影响的研究多为对鼻窦内黏膜纤毛运动的研究，对中鼻甲内侧面黏膜，采用透射电镜观察研究，我国尚无报道。本研究用T&T嗅觉方法检查慢性鼻窦炎伴嗅觉障碍患者经功能性鼻内窥镜手术后嗅觉功能的改善程度，探讨慢性鼻窦炎患者嗅觉功能恢复与功能性鼻内窥镜手术的关系；采用透射电镜观察患者术前及术后嗅区黏膜超微结构的变化，为临床应用FESS改善慢性鼻窦炎患者的嗅觉障碍提供有力的理论依据。
1 资料与方法
1.1 一般资料 2004年于我科住院的慢性鼻窦炎伴嗅觉障碍行功能性鼻内窥镜手术患者共30例，男19例，女11例；年龄16～53岁，平均36岁；病史0.5～2年。按慢性鼻窦炎鼻息肉临床分型分期及内