非侵袭性真菌性额窦炎的诊治

Diagnosis and treatment of noninvasiveness fungal frontal sinusitis

目的探讨非侵袭性真菌性额窦炎的发病原因、诊断和治疗。方法11例非侵袭性真菌性额窦炎患者,在局麻或全麻控制性降压下行鼻内镜手术治疗,开放额窦,对鼻腔结构异常者亦行相关处理,彻底去除额窦内异常分泌物,清除病变组织,尽可能保留窦内正常黏膜。结果术后8～10周术腔逐渐上皮化,治愈9例,症状明显减轻2例。随访6个月～2年,未见复发,全部病例经病理及真菌涂片、培养证实为额窦黏膜非侵袭性真菌感染。结论本病主要病因为局部因素,术前诊断的主要依据大部分来自高质量的CT,鼻内镜手术是治疗非侵袭性真菌性额窦炎较为理想的手术方式。

OBJECTIVE To discuss the pathogenesis, diagnosis and treatment of noninvasiveness fungal frontal sinusitis. METHODS Eleven patients with noninvasiveness fungal frontal sinusitis were included in this study. There were 3 males and 8 females with age ranged from 27 to 56 years（average 39 years）. All the patients were operated on under local or general anesthesia with nasal endoscope. During operation, the frontal sinus was opened, abnormal secretion in the frontal sinuses was eliminated, the pathological tissue was removed, and the normal mucosa was preserved. The postoperative treatment included cleaning operative cavity, nasal iwigation, using the antibiotics, steroids and immune regulators, etc. RESULTS No postoperative complications occurred. The operative cavity became epidermidalization gradually in 8 to 10 weeks. Nine cases were cured and 2 cases were improved. The patients were followed up for 6 months to 2 years. No recurrence occurred. Fungi were identified on culture and pathology. CONCLUSION The preoperative diagnosis of noninvasiveness fungal frontal sinusitis is main on high quality CT scan. Nasal endoscopic sinus surgery is a ideal method for this disease.