侵袭性真菌性鼻-鼻窦炎扩大的鼻内镜鼻窦手术治疗的探讨

Endoscopic sinus surgery for the treatment of invasive fungal sinusitis

目的:探讨侵袭性真菌性鼻-鼻窦炎(IFRS)的早期诊断、治疗方法及预后。方法:总结确诊为IFRS的18例患者的临床资料、鼻窦CT/MRI、诊治经过、病理诊断与随访结果,分析IFRS的早期诊断与治疗方法。结果:急性IFRS患者5例,致病菌均为毛霉菌感染,其中3例因手术禁忌症未手术,均死于颅内并发症;慢性IFRS患者13例,其中曲霉菌9例,毛霉菌3例,另有1例培养阴性。合并糖尿病9例,强直性脊柱炎1例,低蛋白血症3例,器官移植1例,白血病1例。15例患者接受扩大的鼻腔鼻窦开放术及彻底的坏死病灶清除,术后给予抗真菌治疗。随访1~3年,复发3例,死亡1例。结论:FRS的诊断需要结合临床表现、影像学特点以及病理学检查。治疗需要手术彻底清除病变组织(扩大鼻窦开放术)结合抗真菌药物足量使用。

Objective：To explore the early diagnosis,the treatment and theprognosis of invasive fungal rhinosi-nusitis. Method：By summarizing the elinieal data of 18 patients, CT and MRI images, pathological diagnosis and follow-up results to analysis the early diagnosis and the treatment. Result：All 5 patients with invasive fungal sinus- itis were infected with mucor,3 of whom died of intracranial complications; Among 13 patients with chronic inva- sire fungal rhinosinusitis, 9 were aspergillus, 3 were mueor, and 1 were negative. There were 9 cases of diabetes, 1 cases of ankylosing spondylitis, 3 cases of hypoproteinemia, 1 cases of organ transplantation, and 1 cases of leu- kemia. There were 3 cases of death who unenforeed the operation, 15 patients reeeived enlarged endoscopic sur- gery, postoperative antifungal therapy. Followed up 1-3 years, relapse in 3 cases, 1 case of death. Conclusion： The diagnosis of FRS needs to be combined with clinical manifestations, imaging features and pathological findings. The treatment requires surgery to completely remove diseased tissue （enlarged sinus open surgery） combined with antifungal use in sufficient quantities.