鼻窦真菌球的CT影像学特征和治疗

CT characteristics and clinical therapy of fungus ball in paranasal sinus

目的探讨鼻窦真菌球的CT影像学特征及临床治疗,提高该病的术前诊断率和疗效。方法选择1999年1月至2005年6月经手术、病理证实并且随访6个月以上的鼻窦真菌球32例,回顾性分析这些患者的鼻窦CT及临床资料。结果CT表现为多为单窦发病,以上颌窦最多见,22例,蝶窦次之,7例,累及上颌窦和筛窦1例,上颌窦和蝶窦1例,同时累及上颌窦、筛窦和额窦1例。所有病变窦腔密度不均匀增高,27例软组织密度团块影内见点状、絮状、斑片状不规则高密度钙化影,类似金属异物影。上颌窦内侧壁骨质破坏吸收13例,残存骨端伴有骨质硬化;上颌窦内壁明显向鼻腔膨胀2例。治愈30例,2例好转。结论鼻窦真菌球CT具特征的表现为,单窦发病,以上颌窦为主,蝶窦次之;窦腔内密度不均匀增高,软组织密度团块影内见点状、絮状、斑片状不规则高密度钙化影及上颌窦内侧壁破坏吸收。术前鼻窦CT结合鼻内镜检查是提高本病术前诊断率的有效便捷的方法。鼻内镜下充分开放病变鼻窦窦口,完全清理出病灶,同时保留窦腔黏膜完整是目前最有效的治疗方法。

Objective To evaluate CT characteristics and clinical therapy of fungus ball in paranasal sinus, to elevate preoperative diagnosis and recovery rate. Methods Thirty-two patients with fungal ball arising from the paranasal sinuses from January 1999 to June 2005 certified by histopathology and surgery were followed up over 6 months. CT results and clinical data of these patients were analyzed retrospectively. Results On CT images only one single sinus was involved in the majority of 32 patients, maxillary sinus was the most commonly infested（22 cases）. Seven cases were infected in sphenoid sinus, one case in maxillary sinus and ethmoid sinus, one case in maxillary sinus and sphenoid sinus and one case in maxillary sinus 、 ethmoid sinus and sphenoid sinus. Uneven high-density soft tissue image were observed in all affected paranasal sinuses. Punctiform、 flocculation、 or irregularly lamellar calcified soft tissue mass were demonstrated in 27 cases. The medial wall of the maxillary sinus was absorbed and destroyed in 13 cases and was distent to nasal cavity in 2 cases. Thirty cases were cured and 2 cases improved. Conclusion The characteristics of CT of fungus ball in paranasal sinus were single sinus affected, uneven high-density soft tissue images which may have punctiform ,flocculation ,or irregularly lamellar calcified image. Preoperative CT and nasal endoscopy are the effective and convenient method of improving preoperative diagnosis. It is the most effective therapeutic method to open ostium completely, clean sinus affected and retain the affected tunica mucosa of sinus integriated.