真菌性鼻窦炎85例临床及影像学特征和手术方式探讨

Clinical analysis of fungal sinusitis in eighty-five patients

目的探讨真菌性鼻窦炎的影像学特征及手术方式,提高该病的治愈率。方法对2013-01~2015-12该院确诊真菌性鼻窦炎85例患者的影像学特征及手术方式进行回顾性分析。结果 85例患者中,单侧上颌窦发病63例,筛窦6例,蝶窦6例,额窦2例,上颌窦联合筛窦2例,筛窦联合蝶窦4例,筛窦联合额窦2例;其中涉及上颌窦真菌性鼻窦炎的65例患者中,采用鼻内镜上颌窦窦口开放入路41例,鼻内镜上颌窦窦口开放联合下鼻道开窗入路24例,所有患者术后随访6~12个月,鼻内镜上颌窦窦口开放入路患者治愈率为92.7%(38/41),3例患者出现鼻腔粘连,2例溢泪,2例面部麻痛;采用鼻内镜上颌窦窦口开放联合下鼻道开窗入路患者治愈率为100.0%,2例患者出现鼻腔粘连,无溢泪及面部麻木等并发症发生。结论鼻内镜上颌窦窦口开放联合下鼻道开窗入路是一种微创、安全、有效的治疗上颌窦真菌性鼻窦炎的手术方式。

Objective To evaluate the outcome and the surgical experience of treating fungal sinusitis. Methods The clinical data of 85 patients with fungal sinusitis diagnosed in our department from January 2013 to December 2015 were retrospectively analyzed. Results The lesions were located inmaxillary sinus in 63 cases, in ethmoidal cellules in 6 cases, in sphenoid sinus in 6 cases, and in frontal sinus in 2 cases. Of the 65 cases with fungal maxillary sinusitis, 41 patients were treated with endoscopic maxillary ostium surgery and 24 patients were treated with endoscopic maxillary ostium surgery combined with inferior meatus fenestration. All the patients were followed up for 6 to 12 months after the surgery. The curative rate was 92. 7% （38/41） in the patients who were treated with endoscopic maxillary ostium surgery, among whom three cases had nasal adhesion, two had epiphora, and two had facial numbness; The curative rate was 100. 00 in the patients who were treated with endoscopic maxillary ostium surgery combined with inferior meatus fenestration, among whom none of the compliations occurred except that two cases had nasal adhesion. Conclusion Endoscopic maxillary ostium surgery combined with inferior meatus fenestration is a minimally invasive, safe and effective approach for the surgical treatment of fungal maxillary sinusitis.