孤立性蝶窦真菌病临床诊治分析

目的 回顾性分析孤立性蝶窦真菌病的临床特点,评估鼻内镜手术治疗该病的临床疗效.方法 选取2005年2月至2017年2月于成都医学院第一附属医院耳鼻咽喉头颈外科就诊,并经病理确诊,临床资料完整的60例孤立性蝶窦真菌病患者为研究对象,总结其临床表现及影像学特点.所有患者均接受鼻内镜下蝶窦开放、病灶清除术,术后随访3个月~3年,根据症状缓解程度、快慢,有无复发等指标评估手术疗效.主观病情评估采用视觉模拟评分(VAS)评估,客观病情采用Lund-Kennedy 评分法对患侧鼻腔评分,比较术前及术后3、6、12个月评分的差异.结果 患者主要临床表现为头痛、涕中带血、鼻涕异味及视力改变,其中头痛43例(71.67%);涕血或回吸性血涕10例(16.67%);鼻涕异味5例(8.33%);视物模糊2例(3.33%).术前鼻部冠状位及横断面CT主要表现为蝶窦内不均匀的软组织密度影.术前鼻内镜检查发现合并有鼻中隔偏曲36例(60.00%),嗅裂区息肉15例(25.00%).56例患者术后7 d症状缓解明显,半年后治愈率为96.7%(58/60).术后3、6、12个月VAS评分与术前比较,差异有统计学意义(P<0.05).术后3、6、12个月鼻内镜Lund-Kennedy评分与术前相比,差异有统计学意义(P<0.05).结论 孤立性蝶窦真菌病发病隐匿,头痛是非特异性临床表现,鼻腔解剖结构异常致蝶窦口狭窄或阻塞可能为该病主要诱因.鼻窦CT检查有助于临床诊断,可提供重要的诊断依据.手术标本的病理检查为确诊的金标准,经鼻-鼻内镜下蝶窦开放、病灶清除术是治疗孤立性蝶窦真菌病的首选方法.

Clinical Diagnosis and Treatment of Nosomycosis of Isolated Sphenoid Sinus

Objective To analyze the clinical features of nosomycosis of isolated sphenoid sinus retrospectively and evaluate the treatment efficacy of nasal endoscope.Methods A total of 60 patients who where confirmed pathologically and treated with complete clinical data from February of 2005 to February of 2017 in the First Affiliated Hospital of Chengdu Medical collage were selected as the research object in the study, and all their clinical and imaging features were summarized.All those patients received the treatment of sphenoidostomy and focal cleaning under nasal endoscope and they were followed up for 3 months to 3 years.The treatment efficacy was evaluated according to the indexes including symptom remission and recurrence.The subjective disease condition was assessed by the visual analogue scale (VAS) and the objective disease condition of the affected bilateral nasal was assessed by the Lund-Kennedy score.Those scores before operation and 3, 6 and 12 months after operation were compared respectively.Results The main clinical manifestations included headache, bloody discharge in the nasal mucus, peculiar smell discharge and vision changes.Among those manifestations, there were 43 patients with headache (71.67%), 10 patients with bloody discharge in the nasal mucus (16.67%), 5 patients with peculiar smell discharge (8.33%), and 2 patients with blurred vision (3.33%).The main manifestation of CT was heterogeneous soft tissue density in sphenoid sinus before operation.The results of the preoperative nasal endoscopic examination revealed that there were 36 cases (60.00%) with nasal septum deviation and 15 cases (25.00%) with polyps in olfactory cleft areas.The postoperative symptom remission was obvious.56 cases showed obvious symptom remission 7 days after operation and 58 out of 60 cases were cured with the cure rate of 96.7%.The VAS score and Lund-Kennedy score before operation were significantly different from the scores 3, 6 and 12 months after operation respectively (P<0.05).Conclusion The symptoms of nosomycosis of isolated sphenoid sinus are concealed and headache is the nonspecific clinical manifestation.The stenosis or obstruction of sphenoid sinus resulting from the abnormal nasal anatomic structures may be the main inducement of this disease.The CT examination of paranasal sinuses contributes to clinical diagnosis and supplies the important diagnostic basis of this disease.The pathological examination of the surgical specimens is the gold standard for confirmed diagnosis.The treatment of sphenoidostomy and focal cleaning under nasal endoscope is the first-line treatment of nosomycosis of isolated sphenoid sinus.