摘要
目的 探讨慢性侵袭性真菌性鼻-鼻窦炎的临床新特点及治疗方法。方法 回顾性分析17例慢性侵袭性真菌性鼻-鼻窦炎的临床资料。患者均行鼻窦清创术＋鼻黏膜下多次小剂量注射抗真菌药配合全身治疗,其中行眶内容摘除2例,经鼻眶内清创引流4例。结果 真菌性鼻-鼻窦炎累及颞下窝5例、眼眶3例、颅内2例、肺部1例、颅内并眼眶3例、颅内并肺部3例。影像学显示病变侵袭可直接破坏;也可在骨壁完整情况下感染邻居近器官;或通过神经通路传播,在影像学上表现为神经走向的骨裂隙、骨管扩大。病理示所感染菌属中：曲霉菌8例,毛霉菌3例,双极霉菌1例,德氏霉菌2例,孢子丝菌3例。随访12~29个月,治愈12例;死亡5例（死于真菌性肺炎1例,死于真菌性脑病2例,死于基础疾病2例）。结论 慢性侵袭性真菌性鼻-鼻窦炎菌属趋多样化,除直接破坏外,沿神经周围、血管及呼吸道扩散途径侵袭。鼻窦清创术＋鼻黏膜下多次小剂量注射抗真菌药的综合治疗是一较为有效的治疗措施,经鼻眶内清创引流可使部分眶内感染不严重患者避免眼球摘除。
Objective To study the new clinical characteristics and treatment of chronic invasive fungal rbinosinusitis （CIFRS）. Methods Clinical data of 17 patients suffering from CIFRS treated in our hospital during 2009 and 2013 were analyzed retrospectively. All the cases received sinus debridement and repeated nasal submucosal injection with antifungal drugs of small dosage. Two patients received orbit evisceration, and orbit debridement drainage via nose was performed in 4 cases. Results Organs affected outside the sinus included infratemporal fossa （5 cases）, orbit （3 cases）, intracranial cavity （2 cases）, lung （1 case）, intraeranial cavity combined with orbit （3 cases）, intracranial cavity combined with lung （ 3 cases）. Imaging study showed invasion of lesion in three different ways ： direct damage, infection of the neighbor organs while the bone wall kept intact, or propagation along neural pathways presenting as enlargement of bone crevices and canal. Pathologic examinations revealed fungal genera as aspergillus （8 cases ） , mueormycosis （3 cases ） , bipolaris （ 1 case） , drechslera （2 cases） , and sporothrix （3 cases）. All patients had been followed up for 12 to 29 months postoperatively. 12 cases were cured and 5 died （1 case died of fungal pneumonia, 2 died of fungal encephalopathy and 2 died of basic diseases）. Conclusion The fungal genera of CIFRS appear diverse. Except direct damage, the invasive way includes propagation along neural pathways, blood vessel and respiratory tract. Comprehensive treatment of sinus debridement and nasal submucosal injection with antifungal drugs of small dosage is one of the most effective treatment measures. Enucleation can be avoided by orbital debridement drainage via nose in patients with orbital infection not serious.
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2015年第4期320-323,共4页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
关键词
鼻窦炎
真菌
治疗
Rhionsinusitis
Fungus
Treatment
