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摘要: 目的:进一步提高慢性真菌性鼻-鼻窦炎的诊疗水平。方法:40例真菌性鼻-鼻窦炎患者均接受经鼻内镜手术治疗。单纯蝶窦真菌病,中鼻甲外移或切除后三分之一,尽量扩大骨性窦口,清除真菌团块及息肉样病变黏膜,窦口黏膜内翻以防止狭窄;上颌窦真菌病保留钩突或仅切除钩突尾,视术野情况扩大上颌窦口后,清除病变组织;额筛窦病变则按常规处理。术后用等倍稀释的安尔碘液浸泡术腔5 min,碘仿纱条填塞术腔。结果:病理显示39例真菌感染(38例曲菌,1例毛霉菌),包括4例黏膜内真菌侵犯;34例一次手术治愈,4例复发(1例蝶窦,3例上颌窦)后再次手术或门诊换药治愈,1例合并蝶窦纤维母细胞瘤伴颅底侵犯,放射治疗后病变控制。另有1例虽培养和病理均未发现真菌,但临床特征提示为过敏性真菌性鼻-鼻窦炎,反复发作未能完全控制。无一例出现并发症。结论:鼻内镜手术是治疗真菌性鼻-鼻窦炎的有效方法,术中多点取病变黏膜送病检是易忽视的临床问题。明确有无黏膜内侵犯及致病菌类型对指导后续治疗、减少复发有重要意义。疗效欠佳者还应考虑有无其他并发疾病。Abstract: Objective: To further improve diagnosis and treatment for chronic fungal rhinosinusitis(CFRS).Method: Forty patients with CFRS were treated with nasal endoscopic surgrey(ESS). The key-points of surgery were as follows: ①for single fungal sphenoid sinusitis, fracturing middle turbinate ourward or resecting one-third of posterior middle turbinate, enlarging the osseous ostium of sinus, removing sinus fungal ball and polypoid nucosa, and flipping mucosa of ostium inside sphenoid sinus to avoid narrow of ostium;②for fungal maxillary sinusitis, retaining uncinate process or resecting tail of uncinate process, enlarging ostium of maxillary sinus according to surgical field, and resecting lesion tissue;③for frontal-ethmoidal sinus lesion, routine treatment was performed; ④iodoform gauze packing the surgical cavity after soaking it with diluted iodine solution(1∶1) for 5 min.Result: Pathological examination indicated that 39 cases were infected with fungus(38 cases with aspergillus and 1 case with mucor, respectively), including 4 cases in which lesion mucosa was invaded by fungus. Of these 39 cases,34 cured after receiving one operation, 4 cases relapsed and finally cured after receiving re-operation or outpatient treatment, 1 case had concomitant sphenoid sinus fibroblastoma with skull base invaded and was remitted after radiation therapy. In addition,1 case was diagnosed clinically as allergic fungal sinusitis although no fungus was found by culture and pathological examination, and the disease was not still controlled completely after several times of recurrence. No complication was observed for all of the cases.Conclusion: ESS is an effective treatment for CFRS, and intraoperative multi-point biopsy may be ignored easily.Confirming whether mucosa of sinus is invaded by fungus as well as pathogenic fungi types will have an important value for postoperative further treatment and reduction of recurrence. Concomitant disease should be considered for the cases with poor curative effect.
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Key words:
- fungi /
- sinusitis /
- endoscopic surgical procedures /
- pathology
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[1] PÁDUA F G, BEZERRA T F, VOEGELS R L, et al. The efficacy of functional endoscopic sinus surgery in the evolution of fever of unknown origin in ICU patients[J]. Acta Otolaryngol,2011,131:166-172.
[2] KIM S T, CHOI J H, JEON H G, et al. Comparison between polymerase chain reaction and fungal culture for the detection of fungi in patients with chronic sinusitis and normal controls[J]. Acta Otolaryngol, 2005,125:72-75.
[3] NICOLAI P, LOMBARDI D, TOMENZOLI D, et al. Fungus ball of the paranasal sinuses:experience in 160 patients treated with endoscopic surgery[J]. Laryngoscope, 2009,119:2275-2279.
[4] ZHANG J, LI Y, LU X,et al. Analysis of fungal ball rhinosinusitis by culturing fungal clumps under endoscopic surgery[J]. Int J Clin Exp Med,2015,8:5925-5930.
[5] MONTONE K T, LIVOLSI V A, FELDMAN M D,et al.Fungal rhinosinusitis:a retrospective microbiologic and pathologic review of 400 patients at a single university medical center[J]. Int J Otolaryngol,2012,2012:684835.
[6] 谢民强.耳鼻咽喉头颈部感染性疾病[M].北京:人民卫生出版社,2005:262-266.
[7] MARPLE B L, AND MABRY R L. Allergic fungal sinusitis:learning from our failures[J]. Am J Rhinol, 2000, 14:223-226.
[8] 李天成,曾镇罡,肖水芳,等.慢性侵袭性真菌性鼻-鼻窦炎临床分析[J]. 中华耳鼻咽喉头颈外科杂志, 2016,51(4):262-267.
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