真菌球型蝶窦炎的临床特点分析

Analysis of the clinical characteristics of fungus ball sphenoid sinusitis

目的:分析真菌球型蝶窦炎的临床特点及其与真菌球型上颌窦炎的差异。方法:回顾性分析50例经病理确诊的真菌球型蝶窦炎病例(病例组)及同期273例真菌球型上颌窦炎病例(对照组)的临床资料,比较其发病相关因素及临床特点。结果:真菌球型蝶窦炎多见于50岁左右女性,左侧较右侧常见,病程在半年内的患者约占40%;主要症状为头痛、鼻塞、涕中带血、异味涕、眼胀、鼻根胀痛、溢泪等。与真菌球型上颌窦炎相比,蝶窦炎头痛、眼胀、溢泪更常见(P<0.05)。CT表现为病变窦腔软组织影中有钙化影,可伴局部骨质的增厚、硬化、缺损。50例真菌性蝶窦炎中仅1例有二次手术史,手术治愈率高达98%。结论:真菌球型蝶窦炎临床症状多样,头痛、眼胀、溢泪具有相对特异性。CT诊断特异性较强,手术是最有效的治疗方法。

Objective：To analyze the clinical characteristics of fungus ball sphenoid sinusitis（FBSS）and its differences from fungus ball maxillary sinusitis（FBMS）.Method：A retrospective analysis was made for 50 patients with FBSS and 273 patients with FBMS in the corresponding period,which were confirmed by postoperative pathological diagnosis.And the related factors and clinical characteristics of them were analyzed.Result：FBSS were common disease in women around 50 years old.The left side FBSS was more common than the right side.About 40 percent of patients＇ disease course was less than half a year.FBSS had many presenting symptoms such as headache,nasal obstruction,nasal mucus with blood,smelly nasal secretions,eye ache bilges or nasion acheand tears spill.However,headache,eye ache bilges and tears spill were more common in FBSS compared with FBMS（P〈0.05）.The CT scan showed that there were calcification shadows in the diseased softtissue of sinus cavity.It could be accompanied by local bone thickening,sclerosis and coloboma.Only one case had a secondary surgery in 50 cases of FBSS.The surgery cure rate was as high as 98 percent.Conclusion：FBSS had various of clinical symptoms.Some presenting symptoms such as headache,eye ache bilges,and tears spill had relative specificity.CT diagnosis was more specific,and the endoscopic sphenoidotomy was the most effective treatment.