兔淚道置管術拔管后的臨床及病理變化

白蒙 胡文學 付新錄 姜健 莫莉

[摘要] 目的 觀察兔淚道置管術拔管后的鼻淚管組織的臨床病理變化，探討拔管后阻塞復發的機制。 方法 25只新西蘭大白兔，一側為實驗組，制作成鼻淚管阻塞的模型，另一側作為對照組。實驗組行鼻淚管置管，28 d后拔管，觀察鼻淚管阻塞的模型及拔管后的臨床表現，拔管當天（0 d），拔管后3、7、14、28 d時鼻淚管組織的病理變化。觀察實驗組與對照組的管壁相對厚度、黏膜下組織的成纖維細胞密度、成纖維細胞PCNA陽性率，計算實驗組與對照組之間上述指標差值的統計學意義。 結果 建模成功的實驗組，均有溢淚，淚道沖洗不通，但分泌物較少，拔管后淚道沖洗通暢，均無溢淚。實驗組鼻淚管組織中海綿狀血管組織相對較少，膠原纖維相對較多，以7 d最為明顯。對照組管壁厚度、成纖維細胞密度、成纖維細胞PCNA陽性率在不同時點均無明顯差異（均P > 0.05）。管壁厚度：拔管7 d時，實驗組明顯大于對照組（P < 0.05）。實驗組7 d時與0 d時比較，差異有統計學意義（P < 0.05）。成纖維細胞密度：拔管7 d時，實驗組明顯高于對照組（P < 0.05）。實驗組7 d時與0 、14 、28 d時比較，差異均有統計學意義（P < 0.05）。成纖維細胞PCNA陽性率：拔管3 、7 d時，實驗組與對照組比較，差異均有統計學意義（P < 0.05或P < 0.01）。實驗組3 d時與0 、14、28 d時比較，差異有高度統計學意義（P < 0.01）；7 d時與14 d時比較，差異有統計學意義（P < 0.05）。 結論 拔管早期存在成纖維細胞大量增殖現象，有必要適當應用抗增殖藥以減少復發的可能。

[關鍵詞] 淚道置管術；鼻淚管；增殖；病理學；兔

[中圖分類號] R332 [文獻標識碼] A [文章編號] 1673-7210（2015）06（a）-0033-05

Clinical and pathological change in lacrimal intubation of rabbit after extubation

BAI Meng1 HU Wenxue2 FU Xinlu3 JIANG Jian1 MO Li1

1.Department of Pathology， TCM Hospital of Futian District Shenzhen City， Guangdong Province， Shenzhen 518040， China； 2.Department of Ophthalmology， People's Hospital of Longgang District Shenzhen City， Guangdong Province， Shenzhen 518172， China； 3.Experimental Animal Center of Sun Yat-sen University， Guangdong Province， Guangzhou 510006， China

[Abstract] Objective To observe the clinical and pathological change in lacrimal intubation of rabbit after extubation， to probe the mechanism of recurrence obstruction after extubation. Methods 25 New Zealand white rabbits， one side of every rabbit was named as experimental group， was made for nasolacrimal duct obstruction model， the other side as control group. Nasolacrimal intubation performed in the experimental eye， with stent for 28 days before extubation. Clinical manifestation of the nasolacrimal duct obstruction model and pathological change of nasolacrimal duct tissue after extubation of 0 day （extubation day）， 3rd day， 7th day， 14th day， 28th day were observed. Relative thickness of the duct， fibroblast density submucosal tissue and PCNA positive rate of fibroblasts in experimental group and control group were observed， statistical differences of indexes which mentioned above were calculated between experimental group and control group. Results The successful of nasolacrimal duct obstruction model eyes were all tearing， syring showed obstruction， but less discharge， after extubation， they were all no tearing. Cavernous blood vessels in experimental nasolacrimal duct were relatively less， the collagen fibers in 7th day were more obvious. There was no significant difference about wall thickness， cell density and PCNA positive rate in control group. Wall thickness： there was significant difference between the two groups at 7 d （P < 0.05）， there was significant difference between 7 d and 0 d in experimental group （P < 0.05）. Cell density： there was significant difference between the two groups at 7 d （P < 0.05）， there was significant difference between 7 d and 0 d，14 d， 28 d in experimental group （P < 0.05）. PCNA positive rate： there was significant difference between the two groups at 3 d and 7 d （P < 0.05 or P < 0.01）， there was significant difference between 3 d and 0 d，14 d， 28 d in experimental group （P < 0.01）， there was significant difference between 7 d and 14 d in experimental group （P < 0.05）. Conclusion In the early stage after extubation， fibroblast proliferation is obviously， so it is necessary to apply appropriately antiproliferative drugs to reduce the recurrence after extubation.

[Key words] Lacrimal intubation； Nasolacrimal duct； Proliferation； Pathology； Rabbit

鼻淚管阻塞及淚囊炎多采用手術治療。淚道置管術操作較簡單，面部不留瘢痕，但拔管后存在一定的復發率[1-3]。拔管后復發的機制，拔管后抗瘢痕治療的時機和療程，臨床存在爭議[1-10]。本研究擬通過電灼損傷結合縫合法，制造兔鼻淚管阻塞的模型，對兔鼻淚管阻塞模型行淚道置管術2周，觀察拔管后鼻淚管組織的病理變化，探討拔管后復發的可能機制。

1 材料與方法

1.1 材料

實驗儀器、器材準備及試劑：WZC-Ⅲ淚道治療儀一套，選用1 mm探針，頭部刮出2 mm無絕緣層區，兔頭固定器，實驗用手術器械。普……