急性侵袭性真菌性鼻窦炎致海绵窦综合征的临床分析

Clinical analysis of cavernous sinus syndrome caused by acute invasive fungal sinusitis

目的探讨急性侵袭性真菌性鼻窦炎(acute invasive fungal rhinosinusitis,AIFRS)所致海绵窦综合征(cavernous sinus syndrome,CSS)的临床表现、诊疗方法及预后。方法顾性分析我院在2013年10月~2019年10月收治的5例AIFRS致CSS患者的临床资料。所有病例均行鼻内镜清创及抗真菌治疗,重点分析2例具有典型病例的临床特点、辅助检查、诊疗经过及预后。结果5例患者中男性2例,女性3例;病程7天到1月;1例既往史无特殊的患者症状完全消失,1例肾病综合征患者症状基本消失,1例糖尿病并慢性肾功能不全患者的视力有所恢复,1例慢性贫血并糖尿病的患者偶有头痛,1例合并有支扩、慢阻肺、咯血、冠心病、高血压及糖尿病的患者遗留左眼失明。结论AIFRS致CSS临床少见,好发于免疫功能受损的患者,积极的外科手术清创及局部和全身给予足量抗真菌药治疗是良好预后的关键。

Objective To explore the clinical manifestations,diagnosis,treatment and prognosis of cavernous sinus syndrome(Cavernous Sinus Syndrome,CSS)caused by acute invasive fungal sinusitis(Acute Invasive Fungal Rhinosinusitis,AIFRS).Method The clinical data of 5 patients with CSS caused by AIFRS in our hospital from October 2013 to October 2019 were analyzed retrospectively.All cases were treated with nasal endoscopic debridement and antifungal therapy,focusing on the clinical characteristics,auxiliary examination,diagnosis,treatment and prognosis of 2 typical cases.Results Among the 5 patients,there were 2 males and 3 females,and the course of disease ranged from 7 days to 1 month.The symptoms of 1 patient with no special history disappeared completely,the symptoms of 1 patient with nephrotic syndrome basically disappeared,the visual acuity of 1 patient with diabetes mellitus complicated with chronic renal insufficiency recovered,and 1 patient with chronic anemia and diabetes had occasional headache.1 patient with bronchiectasis,chronic obstructive pulmonary disease,hemoptysis,coronary heart disease,hypertension and diabetes left left eye blindness.Conclusion CSS caused by AIFRS is rare and often occurs in patients with impaired immune function.Active surgical debridement and local and systemic administration of adequate antifungal drugs are the key to a good prognosis.