真菌球型蝶窦炎临床分析

The clinical analysis of fungus ball sphenoid sinusitis

目的提高对孤立性真菌球型蝶窦炎的认识,有利于早期诊断和治疗。方法回顾性分析10例孤立性真菌球型蝶窦炎的临床表现、影像学特点、鼻内镜手术方法及疗效。结果10例患者最主要的临床表现为头痛或/和涕中带血,主要影像学特征为单侧蝶窦内软组织影,骨壁増厚,中央常可见高密度钙化斑。全部患者鼻内镜下行蝶窦开放术,定期换药,随访3～18个月,全部治愈。结论孤立性真菌球型蝶窦炎临床表现无特异性,早期不易发现,CT扫描及鼻内镜检查有利于早期诊断,病理学检查可确诊,采用鼻内镜下蝶窦开放术具有创伤小、并发症少和术后恢复快等优点,值得推广。

OBJECTIVE To improve the knowledge on the early diagnosis and treatment of the isolated fungus ball sphenoid sinusitis. METHODS A retrospective study was made on 10 cases of isolated fungus ball sphenoid sinusitis to discuss the clinical manifestation, radiographic features and treatment with endoscopic sinus surgery. RESULTS The common symptoms in 10 cases were headache and/or bloody nasal discharge. Radiographic features of the disease were a soft tissue image occupying the sphenoid sinus with bones wall thickening. A soft tissue image with calcification in the sphenoid sinus was the feature of CT image. All the patients were treated by nasal endoscopic sinus surgery and cured after followed up for 3 to 18. CONCLUSION Isolated fungus ball sphenoid sinusitis was difficult to diagnose in early stage because of its non-specific symptoms. The nasal endoscopy and CT scan make the early diagnosis possible. The diagnosis can be definitely confirmed by pathological studies. Treatment with endoscopic sinus surgery is an effective method for fungus ball sphenoid sinusitis.