非侵袭性真菌性鼻-鼻窦炎患者鼻窦骨质改变的CT评估

Evaluation of bony change in noninvasive fungal sinusitis with computed tomography

目的评价非侵袭性真菌性鼻-鼻窦炎骨质改变的发生率,提高真菌性鼻-鼻窦炎的诊断精确性。方法回顾性分析2010~2017年就诊于我院行鼻内镜手术的152例患者的CT扫描结果,包括真菌球135例,变应性真菌性鼻-鼻窦炎17例,分别记录窦腔骨质改变的形式及部位。结果 135例真菌球患者中,134例(99%)发生骨质增厚,101例(74.8%)发生骨吸收。在17例变应性真菌性鼻-鼻窦炎中,2例(11.7%)上颌窦外侧骨壁出现轻微骨质增生,10例(58.8%)筛窦、蝶窦骨壁及颅底骨质吸收,6例(35.3%)患者中鼻甲、下鼻甲骨质吸收,1例(5.9%)出现额窦骨质吸收。结论非侵袭性真菌性鼻-鼻窦炎患者中骨增生及骨吸收发生率均较高,其中骨质吸收应注意与肿瘤性骨破坏相鉴别。

OBJECTIVE To evaluate the occur rence rate of bony changes in pat ients with noninvasive fungal sinusitis and to improve the accuracy of preoperative diagnosis. METHODS The clinical data of 152 patients with non-invasive fungal sinusitis were retrospectively analyzed. All of the patients were confirmed by postoperative pathologic diagnosis from January 2010 to January 2017. Every patient was performed both CT examination and nasal endoscopy preoperatively.All patients underwent endoscopic sinus surgery and the lesions in sinus were cleared and proved fungal infection pathologically. The type and location of bony change in sinuses were recorded. RESULTS In 135 cases with fungus ball sinusitis, 134 cases（99%） showed sinonasal bony thickening, 101 cases（74.8%） showed bony resorption. In 17 cases with allergic fugal sinusitis, 2 cases（11.7%） showed slight bony thickening in lateral maxillary sinus wall, 10 cases（58.8%） showed bony erosion in front wall of sphenoid sinus and skull base, 6 cases（35.3%） showed bony erosion in middle and inferior turbinates, and one case showed bony erosion in the wall of the frontal sinus. CONCLUSION Sinonasal bony thickening and bony resorption were common in non-invasive fungal sinusitis. This highlights the importance of pre-operative imaging, which can help to diagnose this disease.