449例真菌球性鼻窦炎临床特征分析

王明婕; 周兵; 李云川; 崔顺九; 黄谦

doi:10.13201/j.issn.1001-1781.2018.03.016

449例真菌球性鼻窦炎临床特征分析

- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)(北京, 100730)
基金项目:
北京同仁医院院内科研骨干基金（No：TRYY-KYJJ-2016-003）

详细信息

通讯作者: 周兵,E-mail:entzhou@263.net

中图分类号: R765.4;R765.21

收稿日期: 2017-12-05

Clinical research of different characteristics of fungal ball sinusitis

- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, and Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, 100730, China

More Information

Corresponding author: ZHOU Bing, E-mail: entzhou@263.net

Received Date: 05 December 2017

摘要

摘要: 目的：探讨真菌球性鼻窦炎（FBS）不同的临床特征和诊治要点。方法：回顾性分析449例FBS患者的临床资料，针对其症状、体征、影像学特点、病理特点及术后随访，对不同临床特征和治疗特点进行总结和分析。结果：449例患者均明确诊断为FBS。依据临床资料可分为5种不同的临床特征，分别为：①单纯FBS 299例，主要症状为患侧头痛、脓涕、鼻塞，鼻窦CT具有典型FBS表现。②FBS合并鼻息肉78例，主要症状为双侧或患侧鼻塞、脓涕。手术以切除鼻息肉，扩大性开放受累鼻窦为主。③FBS合并变应性鼻炎（AR）51例，术中可见病变窦腔内黏膜高度水肿，呈囊肿样变。术后需联合抗组胺药物治疗。④FBS合并脓囊肿6例，主要症状为鼻塞、脓涕及头面部痛。鼻窦影像学特点既有典型的真菌性鼻窦炎特征，又有黏液囊肿的特点。术中对受累鼻窦进行抗生素盐水冲洗，术后全身抗生素联合抗生素盐水鼻腔冲洗治疗。⑤FBS合并息肉和AR患者15例，其诊治特点为2种类型的结合。结论：FBS根据其不同临床特征进行精准治疗，有利于提高治疗水平，减少术后复发，改善预后。
- 真菌球性鼻窦炎 /
- 鼻炎,变应性 /
- 脓囊肿 /
- 鼻息肉
Abstract: Objective: The aim of this study is to investigate the clinical features of different subtypes of fungal ball sinusitis.Method: Four hundred and forty-nine cases with fungal ball rhinosinusitis (FBS) were involved in this retrospective analysis. The clinical features including symptoms, signs, and imaging scans, pathological results were all collected for each patient and the patients were classified into different subtypes according to these clinical features and the follow-up treatment.Result: In this retrospective study, 449 patients who diagnosed with fungal ball sinusitis were involved. According to clinical features, these patients were divided into 5 subtypes respectively:①Subtype 1 simple FBS:there were 299 patients in this subtype. Main symptoms were one side headache, purulent rhinorrhea, nasal obstruction. CT scans showed the classical features of FBS. ②Subtype 2 FBS with nasal polyps:there were 78 patients in this subtype. Main symptoms were bilateral or unilateral nasal obstruction, purulent rhinorrhea. Histopathologic results showed nasal polyps with acute or chronic inflammation by inflammatory cell infiltration. Eosinophils infiltration was the most common phenomenon. Postoperative therapy was as same as the treatment to chronic rhinosinusitis. ③Subtype 3 FBS with allergic rhinitis:there were 51 patients in this subtype. During the operation, infected nasal sinus mucosa with serious edema could be found, often with asubmucosa cyst. Postoperative medical therapy with antihistamines during follow-up. ④Subtype 4 FBS with purulent cyst:there were 6 cases. Main symptoms were nasal obstruction, purulent rhinorrhea and facial pain. Sinus CT scans showed that the typical features of both fungal ball sinusitis and mucous cyst. Antibiotic saline nasal irrigation should be used intraoperatively and postoperatively, other than systemic antibiotic treatment. ⑤Subtype 5 mixed type:there were 15 cases. All of these patients were diagnosed with fungal ball sinusitis with nasal polyps combined with allergic rhinitis. The clinical features of diagnosis and treatment were combination of the two types.Conclusion: According to the different clinical features, fungal ball sinusitis could be classified with five different clinical features. This classification would help to standardize the treatment, reduce the postoperative recurrence rate, and improve the prognosis.
- fungal ball sinusitis /
- rhinitis, allergic /
- purulent cyst /
- nasal polyps

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