鼻内镜手术治疗非侵袭性真菌性鼻窦炎

Management of non-invasive fungal sinusitis with endoscopic sinus surgery

目的探讨非侵袭性真菌性鼻及鼻窦炎(noninvasive fungal rhino-sinusitis,NIFRS)的临床特点和疗效,加深对这一疾病的认识,提高临床诊疗效果。方法回顾性分析47例NIFRS患者的临床表现、鼻内镜检查和CT扫描的病变特征、以及鼻内镜下手术治疗的效果。结果 47例中大部分为真菌球性真菌性鼻及鼻窦炎(40/47),7例为变应性真菌性鼻及鼻窦炎,7例鼻窦内均发现典型的变应性黏蛋白蓄积。CT显示NIFRS影像学有特殊表现。47例患者均治愈,随访1～10年,复发率6.4%(3/47),3例伴糖尿病,经再次治疗后痊愈。结论 NIFRS临床症状不具特异性,鼻内镜检查和CT扫描对诊断有特殊价值,鼻内镜手术疗效确切,术后鼻内镜复查、鼻腔冲洗及药物治疗可有效预防疾病复发。

OBJECTIVE To study the clinical features and therapeutic efficacy of non-invasive fungal sinusitis.METHODS The clinical data of 47 patients with non-invasive fungal sinusitis were retrospectively studied.RESULTS Most of the cases were coccic fungal sinusitis（40/47）.The other 7 cases were allergic fungal sinusitis（AFS）,which had classic allergic mucin accumulation in nasal sinus.Computed tomography showed that coccic fungal sinusitis and AFS had special characters.All the patients underwent endoscopic sinus surgery.Three cases recurred,and received revision endoscopic sinus surgery.At last,all the patients were cured after follow up for 1-10 years.CONCLUSION Non-invasive fungal sinusitis does not have specific clinical manifestation.Nasal endoscopy and computed tomography are of great value for diagnosis of non-invasive fungal sinusitis.Endoscopic sinus surgery is an effective method for non-invasive fungal sinusitis.