蝶窦外侧隐窝真菌球的临床特征及手术治疗

Clinical features and endoscopic treatment of fungal ball in lateral recess of sphenoid sinus

目的探讨蝶窦外侧隐窝真菌球的临床特征及经鼻内镜下手术的疗效。方法回顾性分析2005年2月～2011年2月收治的21例蝶窦外侧隐窝真菌球患者的临床资料及手术后的随访结果。所有蝶窦外侧隐窝真菌球患者中，颞部头痛或眼外侧胀痛患者14例；涕中带血5例、视力下降2例。均行鼻内镜蝶窦开放手术，其中12例经嗅裂蝶窦开口处入路，5例经蝶窦前下壁开窗人路，4例经翼突根部入路。结果术中及术后所有患者均无并发症发生。术后随访12～24个月，21例患者临床症状均消失，术腔黏膜生长良好，蝶窦口开放良好，无复发病例。结论鼻窦CT检查有助于蝶窦外侧隐窝真菌球的诊断，鼻内镜手术具有微创和病灶获得彻底清除的优点，对于防止术后复发具有重要的意义。

Objective To discuss the clinical features of fungal ball in the lateral recess of sphenoid sinus, and to study the therapeutic effect of endoscopic surgery for the disease. Methods 21 patients with fungal ball in the lateral recess of sphenoid sinus received endoscopic surgery from Feb 2005 and Feb 2011. ,Clinical data of them was analyzed retrospectively. Results The clinical symptoms of this illness were temporal headache or eye pain with fullness （ n = 14 ） , bloody nasal discharge （ n = 5 ） , and diminution of vision （ n = 2 ）. The patients underwent endoscopic sphenoidostomy via olfactory sulcus approach （ n = 12 ）, inferior wall fenestration approach （ n = 5 ） or pterygoid process root approach （ n = 4 ）. No intraoperative or postoperative complications occurred. All patients were followed up for 12 to 24 mohths postoperatively. The clinical symptoms got relieved in all cases with excellent epithelization of sphenoid mucosa and patency of sphenoid aperture. None of them reoccurred. Conclusion The sinus CT examination is conducive to the diagnosis of fungal ball in the lateral recess of sphenoid sinus. With advantages of good therapeutic effect and minimal invasion, endoscopic sphenoidostomy plays an important role in preventing recurrence of fungal ball in sphenoid sinus lateral recess.