真菌性鼻-鼻窦炎鼻内镜下治疗116例分析

Clinical features of fungal rhinosinusitis in 116 cases

目的探讨真菌性鼻-鼻窦炎恰当的诊断及治疗方法。方法回顾116例鼻内镜下手术治疗的真菌性鼻-鼻窦炎患者的临床资料、分析真菌性鼻-鼻窦炎的发生率、临床及病理学特点、诊断及治疗过程。结果鼻窦真菌感染占同期慢性鼻窦炎、鼻息肉病手术患者的5．6％（116／2089）。真菌培养及病理检查证实曲霉菌感染，占所有致病真菌的84．5％（98／116）。各类型真菌性鼻-鼻窦炎中，鼻窦真菌球最为常见，占79．3％（92／116），以上颌窦最为多见，术后2-8年复发率为2．2％（2／92）；变态反应真菌性鼻-鼻窦炎占12．9％（15／116），术后1-3年复发率为13．3％（2／15）；急性爆发性真菌性鼻一鼻窦炎占1．7％（2／116）；慢性侵袭性真菌性鼻．鼻窦炎占6．1％（7／116），随访2-5年均未见复发。结论真菌性鼻-鼻窦炎的诊断必须综合分析患者的病史、临床表现、影像学资料、术中观察、病理学及微生物学检查结果而得以确立，手术清除病灶是该病的主要治疗手段。

Objective To study the pathological and clinical features of fungal sinusitis and its diagnosis and treatment. Methods The clinical data of 116 patients with fungal rhinosinusitis were retrospectively reviewed. The inci-dence, the clinical and pathological features, diagnosis and treatment of fungal rhinosinusitis were analyzed. Results The incidence of fungal sinusitis in patients requiring surgery due to chronic sinusitis or nasal polyposis was 5.5% （ 116/2089）. The pathogenic microorganism in 84.5% （98/116） of all the fungal sinusitis was identified as aspergillus. According to the classification criteria, 79.3% （92/116） was fungus ball. Only 2 cases （2.2%） relapsed 2 to 8 years after intranasal endoscopic surgery. The ratio of allergic fungal rhinosinusitis was 12.9% （15/116）, with the post-opera- tive relapse incidence being 13.3% （2/15）. Only 2 cases （ 1.7% ） of acute fulminant fungal sinusitis were collected. Chronic invasive fungal sinusitis occupied 6.1% （7/116） of all fungal sinusitis. All 7 patients were prescribed intranasal glucocorticoid and rinsed locally with anti-fungal medicine after intranasal endoscopic surgery. None of them recurred 2 to 5 years postoperatively. Conclusions A complete diagnosis of fungal sinusitis should include routine history inquiry, clinical manifestation, precise sinus imaging studies, nasal endoscopy, morphological observation of mucus membrane and detained secretion during surgery, tissue and mucus sampling for pathology and micrology. Clearing up the infected focus by operation was the capital therapy.