非侵袭型真菌性鼻窦炎误诊误治探讨

Misdiagnosis Analysis of Non-Invasive Fungal Rhino-Sinusitis

目的分析非侵袭性真菌性鼻窦炎(noninvasive fungal rhino-sinusitis,NIFS)误诊的原因并提出防范措施。方法对我院1例NIFS误诊误治的临床资料进行回顾性分析。结果患者因反复发作鼻痒、喷嚏、流大量清涕在外院长期误诊为变应性鼻炎,结合鼻窦CT检查考虑NIFS,行鼻内窥镜手术治疗,术后病理检查明确诊断为NIFS并抗真菌治疗。随访5年未复发。结论 NIFS误诊的主要原因是临床表现不典型及临床医师先入为主的思维方式。提示出现疑似本病症状时,应详细询问病史、仔细查体并选择必要的医技检查,以及时诊断和治疗。

Objective To analyze the causes of misdiagnosis of noninvasive fungal rhino-sinusitis（NIFS） and propose preventive measures.Methods The clinical data of a patient with NIFS misdiagnosed in our hospital was retrospectively analyzed.Results The patient was misdiagnosed as having allergic rhinitis for having recurrent attacked rhinocnesmus,sneeze,and mass snot.Combined with paranasal sinuses CT detection,the patient was considered as having NIFS,and underwent endoscopic surgery.Pathology result confirmed the diagnosis of NIFS,and the patient received anti-fungi treatment without recurrence during a 5-year follow-up.Conclusion Misdiagnosis of NIFS is mainly due to atypical clinical manifestations and preconceived way of thinking by physicians.When the patient presents suspected symptoms of NIFS,the disease history should be collected thoroughly,and physical examination should be performed carefully for the purpose of timely diagnosis and treatment.