侵袭型真菌性鼻-鼻窦炎14例诊断和治疗临床分析

Clinical analyses of the diagnosis and treatment of invasive fungal rhinosinusitis： report of 14 cases

目的 通过回顾性分析14例侵袭型真菌性鼻-鼻窦炎（invasive fungal rhinosinusitis,IFRS）患者的临床资料,探讨其临床发病特点、诊断标准及治疗原则.方法 对2008年1月到2015年10月期间,入院确诊为IFRS的14例患者的临床特征、诊断依据、治疗方案及预后情况等进行回顾性分析.14例患者中急性IFRS 5例;慢性IFRS 9例;曲霉菌9例,毛霉菌4例,鼻脑接合菌病1例;13例伴有糖尿病,1例血糖正常.全部患者给予内镜下病变彻底清除及静脉滴注抗真菌药物治疗.结果 9例慢性IFRS患者中1例为毛霉菌感染、7例为曲霉菌感染、1例鼻脑接合菌,均治愈,但视力下降、复视、失明、硬腭穿孔未能恢复.5例急性IFRS患者中3例为毛霉菌感染,其中2例死亡,1例治愈;2例为曲霉菌感染,1例治愈,1例好转出院后未继续治疗,3d后死亡.结论 IFRS患者多伴有糖尿病,积极手术清除病变组织并全身应用抗真菌足量足疗程治疗可使得患者获益.毛霉菌所致IFRS较为凶险.

Objective Through the retrospective analysis of the clinical data in 14 cases of invasive fungal rhinosinusitis （ IFRS ） , the clinical characteristics, diagnosis and treatment of this disease were evaluated. Methods Fourteen clinically confirmed cases of IFRS since January 2008 to October 2015 were evaluated, collected, the clinical features, diagnosis, treatment and prognosis were analyzed to obtain a more comprehensive understanding for clinical reference. Fourteen patients were confirmed by pathological examination as IFRS, including 9 cases of aspergillus, 4 cases of mucor, and 1 case of rhinocerebral zygomycosis; including 5 cases of acute IFRS, 9 cases of chronic IFRS. All patients were treated with endoscopic surgery and intravenous antifungal therapy. Results Nine cases of chronic IFRS （including 1 case of mueor, 7 cases of aspergillus and 1 case of rhinocerebral zygomyeosis） were cured, but the vision loss, diplopia or blindness, hard palate perforation remained. Five cases of acute IFRS included 3 cases of mucor and 2 cases of aspergillus. Among the 3 cases of mucor, 2 cases were died and 1 case was cured. Among the 2 cases of aspergillns, 1 patient was cured and the other patient died of electrolyte disorder after discharge from hospital. Conclusions Patients with IFRS usually have diabetes. After the active surgical cleaning of lesion tissue and the systematic antifungal treatment with adequate dosage, these patients would have a better result. IFRS caused by mucor is ofen dangerous.