98例真菌球型鼻窦炎的临床特点和鼻声反射分析

The clinical characters and acoustic rhinometry analyses of 98 cases fugal ball sinusitis

目的:提高对真菌球型鼻窦炎的正确诊断和治疗。方法:对98例真菌球型鼻窦炎患者的首发症状、鼻声反射结果、CT表现、手术方式进行回顾性分析。结果:鼻窦真菌球型鼻窦炎患者首发症状包括涕中带血、鼻塞、头面部疼痛、鼻腔异味、溢泪及无症状。术前鼻镜检查43.9%无明显异常,13.3%鼻中隔明显偏曲,41.8%鼻腔有新生物,25.5%鼻腔有分泌物。鼻窦真菌球型鼻窦炎患者鼻气道通气阻力、鼻腔总容积、鼻腔最小截面积与同性别正常人比较均差异有统计学意义(均P<0.01)。CT表现多为单侧鼻窦受累,不均匀或均匀不透光改变。术前CT诊断为真菌球型鼻窦炎与术后病理诊断的符合率为65.3%,真菌球以上颌窦发病率最高(54.1%),次为蝶窦(11.2%)、筛窦(5.1%)、额窦(2.0%),多窦受累及占32.7%。所有患者行功能性鼻内镜手术,结合不同角度内镜彻底清理病变。结论:真菌球型鼻窦炎临床症状不典型,鼻声反射检测提示鼻气道通气阻力增加,鼻腔总容积、鼻腔最小截面积缩小,可能成为影响鼻腔通气导致条件致病真菌感染的原因;术前CT检查对真菌病的诊断大有帮助,功能性鼻内镜手术是治疗真菌球型鼻窦炎的有效手段。

Objective：To improve the cognition of fungal ball sinusitis（FB） for diagnosing and treatting it rightly,we retrospectively analyzed the hospitalization cases.Method：We analyzed 98 cases FB patients＇ first symptom,acoustic rhinometry,CT manifestation,operation fashion.Result：The first symptoms of FB include： 47.2% nosebleed,38.8% snuffle,28.6% headache and face-ache,4.0% nasal peculiar smell,2.0% excessive tear,4.0% no symptom.Anterior nasoscope inspection include： 43.9% no significant abnormity,13.3% nasoseptal deviation,41.8% nasal cavity neoplasm（nasal polyp,nasoturbinal polyp,nasal meatus fugal ball etc）,25.5% secretion in nasal cavity.The parameters that conclude the nasal airway resistance（NAR）,nasal cavity volume（NCV） and nasal minimal cross-section area（NMCA） have extremely difference（P0.01） between FB and normal volunteers（NV）： the NAR increase,but NCV and NMCA decrease;the Distance of the Minimal cross-sectional area from the nostril（DCAN） appear moving backword compared with NV.The CT manifestation： almost unilateral lesions,involved paranasal sinuses present asymmetric or symmetrical opacification： 60.2% with calcified area,25.5% with local bone erosion,74.5% with sinus wall sclerosis.65.3% of the CT diagnoses as FB are accord with pathology diagnoses.The incidence of FB involve maxillary sinus most（54.1%）,then sphenoid sinus（11.2%） and ethmoid sinus（5.1%）,frontal sinus（2.0%）,multi-sinus（32.7%）.All cases operated functional endoscopy surgery： 13 cases with nasoseptal diorthosis,4 cases with inferior meatus opening,2 case with canine fossa opening;we clean up the fungal pathogen with different degree endoscope through different path.Conclusion：The clinical symptom of FB is not representative;the acoustic rhinometry show that NAR increasing but NCV and NMCA decreasing maybe the reason of fungal infection;the CT examine is helpful for FB diagnosis;the functional endoscopy surgery is efficient therapy for FB.