鼻内镜手术治疗真菌性鼻窦炎

Management of fungal sinusitis with endoscopic sinus surgery

目的探讨鼻内镜治疗真菌性鼻窦炎的临床效果及与鼻腔解剖异常之间的关系。方法回顾性分析经病理学确诊的31例真菌性鼻窦炎(fungal sinusitis,FS)的鼻内镜检查和CT扫描的病变特征、临床表现以及鼻内镜下鼻窦开放术式治疗真菌性鼻窦炎的效果。结果CT扫描或鼻内镜检查显示31例患者鼻腔均有不同程度的解剖异常或病变及窦腔内病灶;全部病例病理学检查均发现真菌孢子、菌丝和黏膜炎症,临床分型均属非侵袭性FS,其中5例为变应性真菌性鼻窦炎(allergic fungal sinusitis,AFS)。术后随访2～4年,治愈27例(87.1%),显效2例(6.5%),无效2例(6.5%)。结论鼻腔解剖异常及局部病变与FS关系密切。

OBJECTIVE To investigate the treating effects of endoscopic sinus surgery for fungal sinusitis and its relationship between the abnormality of anatomy and fungal sinusitis. METHODS The histopathological observation,clinical manifestation features,nasal sinus endoscopy examination and sinus CT scan characteristics of 31 cases with fungal sinusitis which confirmed by pathological examination were analyzed retrospectively. RESULTS All of the 31 cases were diagnosed as noninvasive fungal sinusitis by pathological examination and showed different extent abnormality of nasal anatomy. Five of 31 cases were finally diagnosed as allergic fungal sinusitis. All the patients were followed-up for 2 to 4 years. Twenty seven cases were cured （curative rate was 87.1%）and 2 cases showed apparent efficacy （6.5 %）,while 2 cases showed inefficacy （6.5 %）. CONCLUSION There were close relationship between nasal anatomy abnormality and the pathogenesis of fungal sinusitis. The endoscopic sinus surgery was the main method for management of fungal sinusitis.