28例鼻窦真菌病临床分析

A Clinical Analysis on Fungal Sinusitis among 28 Cases

目的 总结鼻窦真菌病的诊治体会。方法 对28例鼻窦真菌病患者的临床及病理资料进行回顾性分析。结果 所有患者均在术前取窦口附近干酪样物送病检而确诊。27例非侵袭型上颌窦曲霉菌病,1例采用上颌窦根治术,26例采用内镜鼻窦手术,5例术后加口服抗真菌药治疗;术中随机取9例患者的上颌窦腔粘膜病检,均未见霉菌侵犯;27例患者均获治愈。另1例为侵袭型鼻脑曲霉菌病,采用鼻侧切开术治疗,术后2月死亡。结论 ①窦口鼻道复合体是本病的发病、转归及手术治疗的关键部位;②取窦口附近干酪样物送病检有助于诊断;③非侵袭型鼻窦真菌病宜采用内镜鼻窦手术,彻底清除真菌团块,术后反复冲洗窦腔,术后不必全身应用抗真菌药。

Objective To make a clinical analysis on fungal sinusitis for its correct diagnosis and proper treatment. Methods A retrospective study was carried out a-mong 28 cases with this disease, through careful analysis on their clinical and pathological data associated with the condition. Results All the cases were diagnosed histopa-thologically based on the biopsied samples of caseous tissue taken from the region near to the sinus ostium before operation. Among these cases, 27 were non-invasive as-pergillomycosis of maxillary sinus, with one case treated by radical operation of maxillary sinus and 26 treated via endoscopic sinus surgery, 9 being seen pathologically with to fungal infecting to the mucosa of maxillary sinus, and all the cases in this group being cured in this way. In contrast, one of the 28 cases was diagnosd as invasive nasocerebral aspergillomycosis and was treated through lateral rhinotomy. However, this case was died 2 months latter following the surgery. Conclusions ①the ostiomeatal complex plays a key role in its pathogenesis, lesion developing and operative therapy of this disease; ②pathological determination is very helpful for the diagnosis of this disease made on the caseous sample taken from the region near to the sinus ostium; ③ESS was effective on non-invasive type of fungal sinus lesion, only if all the fungal mass in sinus cavity can be cleared away and rinsed repeatedly after operation. It is not necessary to use antimycotics for this type of lesion after surgery.