鼻内镜手术治疗霉菌性鼻-鼻窦炎分析

Clinical analysis of 31 cases with fungal rhino-sinusitis treated by endoscopic operation

目的探讨霉菌性鼻-鼻窦炎患者的临床表现及其诊断、治疗方法。方法总结同济大学附属东方医院耳鼻咽喉科2000年1月至2007年6月收治的31例霉菌性鼻-鼻窦炎患者的临床资料,分析其临床表现、CT资料及手术方法与疗效。结果 CT对霉菌性鼻-鼻窦炎的诊断和治疗有很高的价值,其特征性表现为病变窦腔密度不均匀增高,内有局灶性点状、絮状、砂粒状、小斑片状高密度影,可有窦壁骨质破坏。所有患者均行鼻内镜手术治疗,术后定期冲洗、清理术腔,随访12～18个月,均获治愈。结论霉菌性鼻-鼻窦炎以上颌窦多发,筛窦、蝶窦次之,其CT表现有特异性,鼻内镜手术可达到根治和微创的临床效果,关键是彻底清除病灶,建立足够的鼻腔鼻窦通气引流通道,从而避免或减少复发。

Objective To study the clinical manifestation of the patients with fungal rhino- sinusitis,and its diagnosis and treatment. Methods The clinical data and information of 31 cases with fungal rhino-sinusitis from January 2000 to June 2007 were summarized,and their clinical manifestation,CT features,operation methods and curative effects were analyzed. Results CT had a valuable method for diagnosis and treatment of fungal rhino-sinusitis. The major CT findings were heterogeneous density of sinusal cavity with small calcification appeared as spots,floccose,sand-like or patchy shadows ,and local bone destruction. All patients were treated with endoscopic technique and cured after 12-18 months followed-up. Conclusion Maxillary sinuses are damaged more often than ethmoid sinuses and sphenoid sinuses. It has characteristic findings on CT. Endoscopic nasal sinusoperation really achieve the goal of radical cure and mini-invasion. The key to avoid recurrence is to excise the focus thoroughly and to make a passage wide enough for acration of the sinus.