鼻及鼻窦的霉菌性疾病

Fungal sinusitis

鼻窦的霉菌性感染由于不同的病理、生理过程可以表现出不同的类型 ,其诊断、预后尤其是治疗也各不相同。霉菌性鼻窦炎完整的诊断除术前常规的病史、体检及影像学检查外 ,还应包括术中对患病局部组织形态学了解 ,组织病理学检查 ,微生物学检查 ,血清学检查等。不同类型的霉菌性鼻窦炎治疗原则也有很大的区别 ,霉菌球性者完全靠手术治疗 ,而变态反应性和慢性侵袭性霉菌性鼻窦炎除手术治疗外 ,则应分别配合全身及局部的皮质激素治疗及抗霉菌药物治疗 ,急性爆发性霉菌性鼻窦炎的治疗则首先在治疗全身原发疾病的基础上应用抗霉菌药物 ,局部组织的清创或扩大范围的手术亦是非常重要的。

Due to the different pathophysiological process,fungal infection in nasal sinus cavity was showed different features with their types on diagnosis,prognosis and especially treatment.Beside the routine history record,precise sinus image (CT or MRI) before surgery,characteristic mucus membrane and detained secretion on the involved area observed during surgery,biopsy,microorganism examination,serum immunology should all be included in a complete diagnose.Apparent differences exist in the treatment principles for different type of fungal sinusitis.For mycetoma,endoscopic surgery alone has shown very effective,but for allergic fungal sinusitis and chronic invasive fungal sinusitis,besides thorough surgery a course of steroid and anti fungus medicine respectively seems more important,while for acute fulminante fungal sinusitis,thorough debriding of the affected sinus would be effective only on the condition that the original disease be treated and the anti fungus medicine be prescribed.A panorama knowledge on fungal infection is criticaly important for clinicians.