鼻内镜手术治疗真菌性鼻窦炎19例

Treatment of fungal rhinosinusitis with endoscopic sinus surgery: A report of 19 cases

目的探讨鼻内镜手术治疗真菌性鼻窦炎的疗效。方法2000年1月～2003年12月对19例真菌性鼻窦炎在鼻内镜下清理中鼻道息肉或肉芽,切除钩突,扩大各窦口,清除窦内病变。术中3%H2O2反复冲洗窦腔。中隔偏曲致病侧中鼻道狭窄影响窦口引流者,一期行鼻中隔矫正术。结果术后5例症状缓解,14例症状消失。19例随访6～48个月,平均14个月,17例未复发,2例复发,再次行Caldwell-Luc手术,无一例并发症发生。结论鼻内镜手术治疗非侵袭型真菌性鼻窦炎有较好的临床疗效,但对严重上颌窦真菌病仍不能替代Caldwell-Lucs手术。

Objective To evaluate the effect of endoscopic sinus surgery (ESS) for treating fungal rhinosinusitis. Methods A total of 19 patients with fungal rhinosinusitis were treated under endoscope in this hospital from January 2000 to December 2003. In operation, the polyps or granulations in the middle nasal meatus were cleared away. Then after the removal of the uncinate process, all sinus ostiums were enlarged to further get rid of pathological tissues in the sinus. During the surgery the sinus was repeatedly irrigated with 3% H_2O_2. If the drainage of the sinus ostium had been affected by the narrowing of the middle meatus resulted from a deviation of the nasal septum, a synchronal correction of the nasal septum was carried out. Results Symptoms remitted in 5 patients and disappeared in 14 postoperatively. Follow-up for 6~48 months (mean, 14 months) in 19 patients found 2 patients with recurrence, which was re-operated on with the Caldwell-Luc procedure. No complications were observed. Conclusions The ESS is effective in the treatment of non-invasive fungal rhinosinusitis. However, this technique cannot replace the Caldwell-Luc procedure in the management of serious fungal maxillary sinusitis.