孤立性蝶窦炎11例报告

目的探讨孤立性蝶窦炎的早期诊断和治疗方法.方法回顾分析孤立性蝶窦炎11例的临床资料.结果11例均经鼻窦冠状位CT扫描明确诊断,行内窥镜鼻窦手术治疗,随诊12～18个月,8例痊愈,2例缓解,复发1例行2次手术后治愈,无并发症发生.结论CT能早期明确诊断孤立性蝶窦炎,鼻内窥镜下蝶窦开放术治疗孤立性蝶窦炎安全,疗效好.     

孤立性真菌球性蝶窦炎的诊断和治疗

目的 总结孤立性真菌球性蝶窦炎的临床特征及其诊断与治疗经验.方法 回顾性分析12例孤立性真菌球性蝶窦炎的临床资料及鼻内镜手术后的随访结果,总结本病诊断与治疗的临床经验与体会.结果 所有病例中,表现头痛或眼部疼痛者9例(75％),涕中带血3例(25％).CT扫描均表现为窦腔高密度影,窦内有斑点状或条块状钙化影者10例(83％).12例均在鼻内镜下手术治疗.术后随访6～24个月,术腔黏膜康复良好,无病变复发.结论 孤立性真菌球性蝶窦炎临床症状无诊断特异性,CT扫描是诊断本病的主要影像学方法,鼻内镜下经蝶窦前壁自然口的术式应为首选手术方法.     

鼻内镜下蝶窦开放术治疗真菌性蝶窦炎10例

目的观察鼻内镜下蝶窦开放术治疗真菌性蝶窦炎的疗效。方法回顾性分析鼻内镜下行蝶窦开放术治疗的10例真菌性蝶窦炎患者，总结其临床表现、影像学特征及治疗效果。结果真菌性蝶窦炎以涕中带血、头痛为主要症状表现，鼻窦CT扫描在其诊断中具有重要意义。经鼻内镜下蝶窦开放术治疗后随访1年，10例均未见复发。结论鼻内镜手术具有创伤小、出血少视野清晰、安全等优点，符合功能性手术的理念，是真菌性蝶窦炎的有效治疗方法。     

蝶窦后鼻孔息肉的鼻内镜治疗(附3例报告)

目的探讨蝶窦后鼻孔息肉的临床特征、诊断和鼻内镜手术治疗效果。方法对3例蝶窦后鼻孔息肉病人术前行冠状位CT扫描并行鼻内镜手术治疗。结果鼻内镜检查和冠状位CT扫描可确定息肉的起源。所有病人均一次治愈,术后随访8~26个月未见复发。结论临床特征、鼻内镜检查和冠状位CT扫描对蝶窦后鼻孔息肉的诊断起重要作用,鼻内镜手术是最佳治疗方法。     

蝶窦炎性疾病的诊断与手术治疗

目的探讨蝶窦炎性病变的诊断与手术治疗。方法回顾性分析1996年5月～2006年12月的25例蝶窦炎性疾病的临床表现、影像学特点、手术治疗结果和随访。结果本病主要症状为头痛和眼部症状,25例患者均经CT检查,均在全身麻醉经鼻内镜下蝶窦开放手术,术后病理确诊,症状先后缓解或消失,随访6个月至2年末见复发。结论蝶窦炎性疾病临床表现无特异性,易误诊;鼻内镜和CT检查能提高诊断率,鼻内镜下蝶窦手术是治疗蝶窦炎性疾病安全、有效。     

蝶窦和筛窦真菌球性病变急性发作的诊断及治疗

目的:分析蝶窦和筛窦真菌球性病变急性发作时的特征,提高诊断的准确性和治疗的及时性。方法:回顾分析18例真菌球性蝶窦炎和筛窦炎患者资料,急性发作时症状以头痛、发热为主,鼻内镜检查、鼻窦CT与MRI可以协助诊断。13例患者药物抗炎治疗后行鼻内镜下鼻窦开放手术;5例患者拒绝手术,随访观察。结果:13例患者病理证实为真菌病变,完全去除病变后患者恢复良好。术前CT与MRI显示结果与术中所见一致。1例未手术者2.5个月后发生头痛,应用抗生素及鼻腔药物后症状改善。结论:临床特征和影像学检查有助于蝶窦和筛窦真菌球性病变急性发作的鉴别诊断,并采取针对性治疗。     

儿童孤立性蝶窦炎的诊治体会

目的:回顾性分析儿童孤立性蝶窦炎的临床表现、诊断及治疗方式,以提高对该病的认识达到早期正确诊治.方法:对2001-06-2010-01期间收治的17例儿童孤立性蝶窦炎患者的临床资料进行回顾性分析.结果:17例患儿中主诉头痛9例,回吸黏脓涕中带血伴头痛、发热3例,鼻后滴漏伴头痛、低热5例.病史15 d～1年不等.专科检查5例嗅裂少许黏脓涕引流,1例蝶筛隐窝处单发息肉,8例腺样体明显肥大,余无阳性体征,CT或MRI均示蝶窦炎或蝶窦积液.8例经抗生素规范治疗痊愈,余9例行鼻内镜下手术治疗,症状均缓解,随访1～5年无复发.结论:儿童孤立性蝶窦炎主要表现为不同程度及部位不定的头痛,少有鼻部症状,易误诊漏诊; CT或MRI是确诊的依据;治疗急性蝶窦炎可经抗生素规范治疗;慢性者应及时行鼻内镜手术治疗,蝶窦开放首选上鼻甲径路蝶窦自然开口开放术.     

蝶窦后鼻孔息肉8例临床分析

目的　分析蝶窦后鼻孔息肉的临床特点、诊断及治疗方法。方法　回顾性分析8例蝶窦后鼻孔息肉患者。结果　5例患者表现为孤立性蝶窦病变,早期出现鼻后滴漏5例,头痛4例。3例患者表现为蝶窦后鼻孔息肉伴多组鼻窦炎。8例患者均行鼻内镜检查和鼻窦CT扫描。行鼻内镜下蝶窦手术,随访7个月～12年未见复发。6例息肉根蒂与蝶窦内囊肿相连,1例源于蝶窦前内壁,1例源于蝶窦前下壁。结论　患者出现鼻后滴漏、头痛、单侧鼻塞时应考虑到患该病,及时行鼻内镜、电子鼻咽镜检查及鼻窦CT扫描,鼻内镜下蝶窦手术是治疗该病的有效方法。术中扩大蝶窦开口、彻底切除息肉蒂部及囊肿壁是蝶窦后鼻孔息肉手术治疗的重点和防止术后复发的关键。     

真菌球型蝶窦炎临床分析

目的 提高对孤立性真菌球型蝶窦炎的认识,有利于早期诊断和治疗.方法 回顾性分析10例孤立性真菌球型蝶窦炎的临床表现、影像学特点、鼻内镜手术方法及疗效.结果 10例患者最主要的临床表现为头痛或/和涕中带血,主要影像学特征为单侧蝶窦内软组织影,骨壁增厚,中央常可见高密度钙化斑.全部患者鼻内镜下行蝶窦开放术,定期换药,随访3～18个月,全部治愈.结论 孤立性真菌球型蝶窦炎临床表现无特异性,早期不易发现,CT扫描及鼻内镜检查有利于早期诊断,病理学检查可确诊,采用鼻内镜下蝶窦开放术具有创伤小、并发症少和术后恢复快等优点,值得推广.     

鼻内镜下蝶窦开放术治疗真菌性蝶窦炎32例临床体会

目的 探讨鼻内镜下蝶窦开放术治疗真菌性蝶窦炎的技术要点和疗效分析。方法 回顾分析2006年6月～2009年6月在我院确诊为真菌性蝶窦炎患者32例的临床资料,总结其影像学特征及临床表现,并分析手术技术要点及治疗效果。结果 鼻窦CT显示蝶窦腔内可见明显的高密度斑点或条块状钙化影,是本病特征性的表现。真菌性蝶窦炎临床表现以头痛、涕中带血为主。术后随访12~18个月,患者症状明显好转,无鼻腔黏连、复发等发生。结论 鼻窦CT检查可提高真菌性蝶窦炎的诊断率,鼻内镜手术具有视野清晰、创伤小、出血少、安全性高等优点,符合功能性手术的理念,是治疗真菌性蝶窦炎的首选术式。     

Isolated sphenoid sinus diseases: report of 76 cases

CONCLUSION: Inflammatory diseases, such as non-specific sinusitis, fungal sinusitis and mucocele, commonly involve the sphenoid sinus. Endoscopic surgery provides an easy and successful access to isolated sphenoid sinus diseases (ISSDs) with rare complications. OBJECTIVES: The incidence of ISSDs has decreased since a wide use of antibiotics. ISSDs can cause severe complications due to the deep location in the skull base. Endoscopic surgery for the sphenoid sinus has recently become popular, with several advantages. The aim of this study was to analyse ISSDs in terms of the clinical symptoms, histological diagnosis and treatment outcomes with our 22 years' experience. PATIENTS AND METHODS: Seventy-six patients with ISSDs, who were treated at Seoul National University Hospital between 1985 and 2007, were analysed. Patients with lesions confined to the sphenoid sinus were included. A retrospective chart review was performed with respect to the symptoms, pathology and treatment outcomes. RESULTS: Fifty-seven of 76 cases were inflammatory lesions, 9 neoplastic lesions and 10 fibrous dysplasia. Headache was the most common symptom (65.8%), followed by nasal obstruction (22.4%) and postnasal drip (21.0%). Ophthalmologic symptoms were observed in 15 cases (19.7%). Endoscopic sphenoidotomy was performed in 51 of the 57 ISSDs. Symptoms completely improved in 92.2% of the patients.     

孤立性蝶窦疾病的诊断和治疗

目的探讨孤立性蝶窦疾病的临床表现,提高首诊准确率,并寻求合适的治疗方法。方法22例术前均行CT或MRI和鼻内镜检查,术中取病变组织送病理明确诊断。结果经鼻内镜手术后随访5个月至两年半,22例症状明显好转,蝶窦前壁通畅,窦壁光滑。结论孤立性蝶窦疾病并非罕见,头痛是常见非特异性症状,可伴有视力下降等颅神经损害及血性涕等症状。鼻内镜手术是治疗本病的首选术式。     

Isolated inflammatory sphenoid sinus disease in children

Isolated inflammatory disease of the sphenoid sinus is very uncommon in the pediatric population. A 10-year review of all patients at our institution 16 years of age or younger with inflammatory sphenoid sinus disease found 8 patients with isolated sphenoid sinusitis and 3 with sphenoid mucoceles. The most common symptoms were headache and visual disturbance. Five patients with uncomplicated sinusitis were successfully managed medically, while 3 with either complicated sinusitis or sinusitis not responding to antibiotics were treated by endoscopic sphenoidotomy. All patients with a mucocele were treated surgically. Isolated inflammatory sphenoid sinusitis should be considered in children age 7 years or older who present with headache that does not respond to simple analgesia. Delayed diagnosis and advanced disease may lead to life-threatening complications.     

Isolated sphenoid sinus diseases: report of 76 cases

Conclusion. Inflammatory diseases, such as non-specific sinusitis, fungal sinusitis and mucocele, commonly involve the sphenoid sinus. Endoscopic surgery provides an easy and successful access to isolated sphenoid sinus diseases (ISSDs) with rare complications. Objectives. The incidence of ISSDs has decreased since a wide use of antibiotics. ISSDs can cause severe complications due to the deep location in the skull base. Endoscopic surgery for the sphenoid sinus has recently become popular, with several advantages. The aim of this study was to analyse ISSDs in terms of the clinical symptoms, histological diagnosis and treatment outcomes with our 22 years’ experience. Patients and methods. Seventy-six patients with ISSDs, who were treated at Seoul National University Hospital between 1985 and 2007, were analysed. Patients with lesions confined to the sphenoid sinus were included. A retrospective chart review was performed with respect to the symptoms, pathology and treatment outcomes. Results. Fifty-seven of 76 cases were inflammatory lesions, 9 neoplastic lesions and 10 fibrous dysplasia. Headache was the most common symptom (65.8%), followed by nasal obstruction (22.4%) and postnasal drip (21.0%). Ophthalmologic symptoms were observed in 15 cases (19.7%). Endoscopic sphenoidotomy was performed in 51 of the 57 ISSDs. Symptoms completely improved in 92.2% of the patients.     

孤立性蝶窦疾病18例临床分析

目的：探讨孤立性蝶窦疾病的诊断及合理的治疗方法。方法：回顾性分析18例经鼻内镜手术治疗的孤立性蝶窦疾病患者的临床资料。结果：18例中，炎性疾病l5例(急性炎症2例，慢性炎症3例，囊肿8例，真菌病2例)，恶性肿瘤3例。经鼻内镜手术后随访3个月至半年，蝶窦前壁开窗通畅，窦腔各壁光滑，症状明显改善，无并发症发生。结论：头痛是孤立性蝶窦疾病的常见症状，另有视力损害、血性涕及其他脑神经麻痹症状，CT、MRI及鼻内镜检查为其诊断提供有力依据；鼻内镜手术治疗是一种安全、有效、简便的方法。     

鼻内镜下慢性蝶窦炎手术

目的：探讨经鼻内镜手术治疗慢性蝶窦炎的方法和疗效。方法：50例84侧慢性蝶窦炎患者，均采用鼻内镜手术治疗。结果：经6～12个月随访复查，根据内镜鼻窦手术疗效评定标准，治愈61侧，占72．62％；好转13侧，占15．48％；无效10侧，占11．90％；有效率为88．10％。结论：经鼻内镜手术治疗慢性蝶窦炎具有视野清楚，手术进路安全，创伤小，患者痛苦小，疗效好等优点。     

Ocular cranial nerve palsies secondary to sphenoid sinusitis

ObjectiveThe clinical presentation of sphenoid sinusitis can be highly variable. Rarely, sphenoid sinusitis may present with cranial nerve complications due to the proximity of these structures to the sphenoid sinus.MethodA case series from Rabin Medical Center and all cases of cranial nerves palsies secondary to sphenoid sinusitis that have been reported in the literature were reviewed.ResultsSeventeen patients were identified. The abducent nerve was the most common cranial nerve affected (76%), followed by the oculomotor nerve (18%). One patient had combined oculomotor, trochlear and abducent palsies. The most common pathology was isolated purulent sphenoid sinusitis in 64% followed by allergic fungal sinusitis (AFS) in 18%, and fungal infection in 18%. 94% had an acute presentation. The majority (85%) received a combined intravenous antibiotics and surgical treatment. The remainder received conservative treatment alone. Complete recovery of cranial nerve palsy was noted in 82% during follow up.ConclusionSphenoid sinusitis presenting as diplopia and headaches is rare. A neoplastic process must be ruled out and early surgical intervention with intravenous antimicrobial therapy carry an excellent outcome with complete resolution of symptoms.