经鼻内镜手术治疗以眼部症状为首发的真菌性蝶窦炎

Endoscopic sinus surgery for fungal sphenoidal sinusitis with initial ocular symptoms

目的探讨以眼部症状为首发的真菌性蝶窦炎的早期诊断及导航辅助下真菌病变清除术。方法对2007年1月-2022年12月广州市中山大学附属第一医院耳鼻咽喉科收治的17例以眼部症状为首发的真菌性蝶窦炎患者的临床表现、影像学检查、手术方法及术后转归等方面进行回顾性分析,总结临床经验。结果17例患者影像学均符合真菌性鼻窦炎,且术后病理确诊为真菌感染。11例患者术后眼部症状得到不同程度改善,包括视力下降、眼球运动障碍、眼睑下垂等,6例患者术后症状无明显改善。结论临床上病因不明的渐进性视力下降及迁延不愈的头痛,应考虑真菌性蝶窦炎可能,及时完善头颅CT、MRI等检查,一经确诊首选鼻内镜下手术治疗。术中导航技术可辅助准确定位病变并判断病变范围,保障手术安全并提高手术效率。侵袭性真菌性鼻窦炎需要联合系统性抗真菌治疗。

Objective To explore the early diagnosis of fungal sphenoidal sinusitis with initial ocular symptoms and navigation-assisted endoscopic surgery for the fungal lesion resection.Methods A retrospective study was conducted on clinical data of 17 fungal sphenoidal sinusitis cases with initial ocular symptoms hospitalized in the Department of Otorhinolaryngology from January 2007 to December 2022.The collected data including symptoms,radiographic imaging,surgical records,pathologic diagnosis and postoperative outcomes were analyzed.Results Preoperative radiographic imagings of all the 17 patients were considered to be consistent with fungal sphenoidal sinusitis.All patients underwent endoscopic sinus surgery,and fungal sphenoidal sinusitis was confirmed based on histopathological evidence.Ocular symptoms including visual disturbances,eye movement disorder,and blepharoptosis got relieved in 11 patients,while the ocular symptoms of the remaining 6 patients were not significantly improved after surgery.Conclusions Fungal sphenoidal sinusitis should be considered in patients with progressive vision loss and persistent headache.Sinus/brain/ocular computed tomography and/or magnetic resonance imaging should be performed as soon as possible,and once confirmed,endoscopic sinus surgery is the preferred choice.Intraoperative navigation technology can assist in accurately locating the lesions and determining the extent of the lesions,which may ensure the surgical safety and improve surgical efficiency.Combined systemic anti-fungal therapy is critical for the treatment of invasive fungal rhinosinusitis.