儿童变应性真菌性鼻窦炎病例分析及文献回顾

Presentation and management of allergic fungal rhinosinusitis in children

目的:分析儿童变应性真菌性鼻窦炎(AFRS)的临床特点及鼻内镜手术联合药物治疗的效果。方法:对3例AFRS患儿术前常规进行鼻内镜检查、鼻窦CT和MRI扫描及过敏原检测,术中取窦内分泌物及受累鼻窦黏膜行真菌学及组织病理学检查。患儿均行鼻内镜手术,术前及术后配合口服及鼻腔应用皮质类固醇激素,给予鼻腔冲洗治疗,并个体化使用抗过敏治疗及免疫治疗。术后随访3~12个月。结果:3例患儿均有鼻息肉和头痛,其中2例有眼球突出和面部不对称;均有典型的CT及MRI表现;血清总IgE均升高;2例真菌SIgE呈阳性。3例患儿均行全组鼻窦开放,其中1例可见真菌菌丝和孢子,2例其他真菌检测阳性。术后患儿面部不对称均自行缓解,其中2例有不同程度的黏膜肿胀、息肉样变。结论:AFRS是一种特殊类型的慢性鼻窦炎,在儿童人群中并非罕见。早期诊断、果断手术、规范治疗、长期随访,在儿童AFRS的诊治中至关重要。

Objective:To assess the presentation of allergic fungal rhinosinusitis(AFRS)in children and the role of long-term comprehensive therapy of endoscopic surgery combined with drug therapy.Methods:The 3 children with AFRS were routinely examined by nasal endoscopy,CT scan,MRI scan and allergen detection before surgery,and mycological and histomathological examination were performed on the secretions in the sinus and the mucosa of the affected sinuses.All the 3 patients underwent endoscopic surgery,preoperative and postoperative treatment with oral and nasal corticosteroid,nasal irrigation,and individualized anti-allergy therapy and immunotherapy.The patients were followed up for 3 to 12 months.Results:All 3 children had nasal polyps and headache,and 2 children had exophthalmos and facial asymmetry.There were typical CT and MRI findings on imaging.Serum total IgE were all elevated,and 2 cases were positive for fungal SIgE.All 3 children underwent endoscopic surgery.Fungal hyphae and spores were found in 1 child,and other fungi tests were positive in another 2 children.Postoperative facial asymmetry was relieved spontaneously,and mucosal swelling and polypoid changes were observed in 2 children.Conclusion:AFRS is a specific type of chronic rhinosinusitis that is not uncommon in children.Early diagnosis,prompt operation,standardized treatment and long-term follow-up are very important in the diagnosis and treatment of AFRS in children.