霉菌性鼻窦炎的诊治体会

Diagnosis and treatment of fungal sinusitis

目的:探讨霉菌性鼻窦炎的临床特点及诊治方法。方法:回顾分析1999至2 0 0 3年4 8例霉菌性鼻窦炎的临床资料。结果:4 8例中霉菌球性鼻窦炎4 4例,变态反应性霉菌性鼻窦炎(AFS) 2例,急性暴发型侵袭性霉菌性鼻窦炎(AFFS) 2例;12例行改良上颌窦根治术,36例行鼻内镜手术;2例AFFS死亡1例,1例存活,右眼视力丧失,余4 6例临床症状消失,术腔上皮化良好,引流通畅,随访3个月无复发。结论:霉菌性鼻窦炎以霉菌球型最为常见。侵袭性霉菌性鼻窦炎病情危重,预后差,临床应予以足够的重视。鼻窦CT是早期诊断的有效方法。手术彻底清除病窦内病变组织,建立通畅的长期引流通道是治疗的关键。

Objective:To investigate the clinical characters and treatment of fungal sinusitis. Method:Forty-eight cases of fungal sinusitis from 1999 to 2003 were analyzed retrospectively.Results:There were 44 cases of mycetoma,2 cases of allergic fungal sinusitis(AFS) and 2 cases of acute fulminant fungal sinusitis(AFFS).All the cases were performed modified Caldwell-Luc operation or endoscopic sinus surgery. Of the AFFS, 1 died and the other survived with the eyesight lost;the rest 46 patients were cured without recurrence in a follow-up of 3 months.Conclusion: Mycetoma is the most ordinary type of fungal sinusitis.The invasive fungal sinusitis is dangerous and has a bad outcome,thus should be payed great importance. CT scan is a valuable method for diagnosing fungal sinusitis. The key of treatment is to debride all the infected tissues and to make a permanent passage in the infected sinus.