鼻内镜手术治疗真菌性鼻窦炎

目的 探讨鼻内镜治疗真菌性鼻窦炎的临床效果及与鼻腔解剖异常之间的关系。方法 回顾性分析经病理学确诊的31例真菌性鼻窦炎（fungal Sinustis,FS）的鼻内镜检查和CT扫描的病变特征、临床表现以及鼻内镜下鼻窦开放术式治疗真菌性鼻窦炎的效果。结果 CT扫描或鼻内镜检查显示31例患者鼻腔均有不同程度的解剖异常或病变及窦腔内病灶;全部病例病理学检查均发现真菌孢子、菌丝和黏膜炎症,临床分型均属非侵袭性FS,其中5例为变应性真菌性鼻窦炎（allergic fungal sinusitis,AFS）。术后随访2-4年,治愈27例（87．1％）,显效2例（6．5％）,无效2例（6．5％）。结论 鼻腔解剖异常及局部病变与FS关系密切。     

111例非侵袭性真菌性鼻及鼻窦炎临床特征分析

目的:分析非侵袭性真菌性鼻及鼻窦炎的临床特点、诊治过程及疗效,探讨其诊断要点、处理措施及影响疗效和转归的因素。方法:回顾性总结111例非侵袭性真菌性鼻及鼻窦炎患者的临床资料,分析该疾病的临床症状、鼻内镜及CT检查、手术方法、疗效及复发患者的处理。结果:通过临床症状、鼻内镜及CT检查,86例患者术前已获确诊。全部患者经功能性内镜鼻窦手术治疗均获临床治愈,无一例出现手术并发症,随访1～5年,复发12例,于门诊表面麻醉下鼻内镜处理后7例治愈,5例效果不佳。结论:非侵袭性真菌性鼻及鼻窦炎具有独特的鼻内镜及CT表现,可与一般的慢性鼻鼻窦炎相鉴别;鼻内镜手术是治疗非侵袭性真菌性鼻及鼻窦炎的有效手段;彻底清除病变及术后鼻窦引流通畅是影响疗效和转归的最主要因素。     

鼻内镜上颌窦置管法治疗非侵袭性真菌性鼻窦炎

非侵袭性真菌性鼻窦炎（noninvasive fungal rhino-sinusitis, NIFRS 是鼻科临床常见的感染性疾病,药物及鼻窦穿刺冲洗治疗疗效不佳,易反复发作,手术是彻底治愈非侵袭性真菌性鼻窦炎最有效的方法。回顾我科2007年10月-2011年10月采用经鼻内镜行上颌窦置管法治疗非侵袭性真菌性鼻窦炎125例,取得满意疗效,现报道如下。     

变应性真菌性鼻窦炎CT影像特征

目的回顾性总结变应性真菌性鼻窦炎CT影像表现,并与手术中所见比较,探讨其CT影像特征及其在诊断中的参考作用。方法收集21例确诊为变应性真菌性鼻窦炎患者的CT影像资料。男17例,女4例;年龄15岁～50岁。鼻窦CT扫描采用骨窗和软组织窗扫描。术前行鼻内镜检查、皮肤点刺变态反应皮试、总IgE及鼻分泌物嗜酸粒细胞涂片检查。手术中记录鼻窦和鼻腔病变且与CT影像对照。术后行组织病理学检查和真菌涂片＋培养。结果鼻内镜检查见所有病例鼻腔单发或多发半透明粉白色息肉,周围稀薄黄色或黏白色分泌物。9例11侧鼻腔可见果酱样黄褐色黏着分泌物。鼻窦CT扫描提示单侧鼻窦发病10例（10侧）,双侧病变为11例（22侧）;单侧或双侧病变全组鼻窦均受累;鼻窦腔散在均匀高密度影,呈毛玻璃样特征,周边为软组织影,3例4侧颅底骨质吸收,1例颅内侵犯。20例行鼻内镜手术,1例行双冠经路＋鼻内镜手术。术中见17例窦腔有果酱样黄褐色黏着分泌物（黏蛋白）,4例窦腔为褐绿色泥样分泌物。随访6个月至7年,治愈14例,好转7例,其中3例术后2年再手术。结论鼻窦CT扫描显示鼻窦腔内片状毛玻璃样高密度影,可伴骨质吸收或侵袭性生长,为变应性真菌性鼻窦炎具有诊断意义的影像检查特征。     

鼻内镜手术治疗真菌性鼻-鼻窦炎26例临床分析

真菌性鼻-鼻窦炎为慢性鼻窦炎里的一种类型,随着CT及鼻内镜的广泛普及,其诊断和治疗取得了较好的效果。2007-01-2011-01期间我科共收治26例真菌性鼻-鼻窦炎患者,均在鼻内镜下手术治疗,随访6个月～3年,效果满意,现报告如下。1资料与方法1.1临床资料通过CT冠状位检查,鼻内镜手术及术后病理证实26例患者为真菌性鼻鼻窦炎,男7例,女19     

变应性真菌性鼻-鼻窦炎的诊断与治疗

目的 探讨变应性真菌性鼻-鼻窦炎（allergic fungal rhino sinusitis, AFRS）的临床特点及治疗方法。方法 回顾性分析确诊的16例AFRS的临床表现、CT扫描结果、血清检测、皮肤点刺实验、术后病理结果以及鼻内镜手术治疗效果。结果 AFRS患者临床表现不典型,CT有特异性表现,病理切片可见真菌菌丝。16例患者中有5例复发,再次治疗后无复发。结论 诊断AFRS主要依据病史、CT表现、病理学检测。鼻内镜手术结合激素应用是治疗AFRS的有效手段。     

修正性鼻内镜手术疗效与影响因素

目的　分析修正性鼻内镜手术的临床疗效,了解其相关影响因素。方法　对我院行修正性鼻内镜手术80例慢性鼻-鼻窦炎（chronic rhinosinusitis,CRS）患者临床资 料进行回顾性分析,采用鼻内镜检查评分、CT检查评分及视觉模拟量表（visual analog scale,VAS）评分等进行疗效评定,分析手术临床疗效及影响因素。结果　80例CRS患者62例痊愈,11例好转,7例无效,总有效率为91.25%。单因素分析显示手术次数、鼻息肉史、变应性鼻炎史与随访依从性对手术疗效影响较大（P＜0.05）。多因素Logistic回归分析显示,影响临床疗效的主要危险因素包括手术次数、变应性鼻炎史、VAS评分、鼻内镜检查评分、鼻息肉史、CT检查评分、鼻腔粘连和随访依从性（相对危险度1.4～2.8）。结论　手术次数、变应性鼻炎史、鼻息肉史与随访依从性是影响修正性鼻内镜手术疗效的最关键因素。     

非侵袭性真菌性鼻-鼻窦炎患者鼻窦骨质改变的CT评估

目的　评价非侵袭性真菌性鼻-鼻窦炎骨质改变的发生率,提高真菌性鼻-鼻窦炎的诊断精确性。方法  回顾性分析2010～2017年就诊于我院行鼻内镜手术的152 例患者的CT扫描结果,包括真菌球135例,变应性真菌性鼻-鼻窦炎17例,分别记录窦腔骨质改变的形式及部位。结果　135例真菌球患者中,134例（99%）发生骨质增厚,101例（74.8%）发生骨吸收。在17例变应性真菌性鼻-鼻窦炎中,2例（11.7%）上颌窦外侧骨壁出现轻微骨质增生,10例（58.8%）筛窦、蝶窦骨壁及颅底骨质吸收,6例（35.3%）患者中鼻甲、下鼻甲骨质吸收,1例（5.9%）出现额窦骨质吸收。结论　非侵袭性真菌性鼻-鼻窦炎患者中骨增生及骨吸收发生率均较高,其中骨质吸收应注意与肿瘤性骨破坏相鉴别。     

变应性真菌性鼻窦炎的综合治疗

目的 探讨内、外科综合治疗手段对变应性真菌性真窦炎的治疗作用。方法 对31例变应性真菌性鼻窦炎进行了以手术治疗为中心的综合治疗．其中鼻内镜手术24例,柯-陆氏手术7例,术前、术后进行抗生素、皮质类固醇激素和抗真菌药物治疗。结果 术后均随访1年以上,无手术并发症发生．采用鼻内镜手术的患者无复发．3例采用柯-陆氏手术治疗的患者复发行二次手术。结论 本研究表明鼻内镜外科手术对变应性真菌性鼻窦炎是一种有效的微创治疗手段．手术结合内科用药对变应性真菌性鼻窦炎的治疗具有良好的效果。     

鼻内镜手术联合药物治疗变应性真菌性鼻-鼻窦炎疗效分析

目的观察鼻内镜手术联合药物治疗变应性真菌性鼻-鼻窦炎的临床疗效。方法将68例变应性真菌性鼻-鼻窦炎患者分为3组,A组鼻内镜术后采用二性霉素B冲洗,每周2次,连续3个月;B组术前1周开始口服强的松40 mg/d,每周递减10 mg,连服4周,术后1周开始丙酸氟替卡松鼻腔喷用,连续使用3个月;C组在B组治疗方法基础上,于术后第1、5、9周口服伊曲康唑3个疗程,0.2 g/d,连服7 d为1疗程。分别于治疗前与治疗后12个月采用视觉模拟评分评估各组患者的临床症状,鼻内镜检查各组患者的鼻腔情况。统计3组临床疗效并记录药物的不良反应。结果在症状评估、鼻内镜评分、有效率3方面,C组优于B组,B组优于A组,所有患者未见明显药物不良反应。结论鼻内镜手术联合药物治疗变应性真菌性鼻-鼻窦炎疗效好,用药安全性高。     

Different types of fungal sinusitis occurring concurrently: implications for therapy

The purpose of this study is to describe the clinical and histopathological features, management and outcome of a series of patients with simultaneous occurrence of invasive and non-invasive fungal sinusitis (mixed fungal sinusitis). The histopathological records of patients with fungal sinusitis seen over the last 6 years were reviewed. The clinical, histopathological, treatment and follow up details of all cases with mixed fungal sinusitis were noted. Six cases of mixed fungal sinusitis with concurrent occurrence of chronic granulomatous fungal sinusitis and allergic fungal sinusitis (AFS) were seen during the study period. Most (83.3 %) had bilateral disease. All patients had undergone prior endoscopic sinus surgery at least once within the previous 2 years. Histopathological features showed predominance of invasive disease in half the patients. Except for one patient who did not report for follow up, all patients with predominant chronic granulomatous fungal sinusitis received systemic antifungal therapy and inhaled steroids. Those with predominant features of AFS received oral and inhaled steroids. Five patients with mixed fungal sinusitis who had follow up ranging from 6 months to 5 years were disease free following treatment. Mixed fungal sinusitis should be recognized by the surgeon and pathologist as a separate category of fungal sinusitis whose treatment depends on accurate histological diagnosis. A good outcome may be expected with appropriate therapy.     

Investigations on allergic fungal genesis of chronic rhinosinusitis

BACKGROUND: The incidence of allergic fungal sinusitis (AFS) is estimated differently. The importance of hyphal findings in nasal mucus for initiation of chronic hyperplastic sinusitis is not proven. METHODS: 124 patients with clinical signs and CT-scan findings of a chronic-hyperplastic rhinosinusitis were treated by functional endoscopic sinus surgery. During the operation a thick mucus was found in each patient. The mucus was isolated and investigated by histopathological analysis with special Grocott-stain and a culture for fungal growth was initiated. Furthermore the diagnostic for allergic reactions against fungus was done by prick- and RAST-tests. RESULTS: 21 patients had positive histopathological findings of fungus. In 10 cases fungal hyphae were found embedded in typical eosinophilic mucus. A positive allergic reaction against fungus was seen in 7 of these 10 patients. The culture results showed different pictures according to the isolated species, in 3 cases of the 10 AFS cases the culture was negative. The other 11 cases of 21 positive histological findings of fungus were cases of a fungus ball. The other 103 patients were without any sign for fungus in the HE- or Grocott-stain. CONCLUSIONS: A high incidence of AFS is not evident in group of chronic hyperplastic rhinosinusitis. The presence of eosinophilic "allergic" mucus is not the evidence for AFS. The inflammatory cascade leading to the clinical picture is a multifactorial event. The role of detectable fungus hyphae have to be estimated by further investigations.     

Role of local immunoglobulin E production in the pathophysiology of noninvasive fungal sinusitis

OBJECTIVES/HYPOTHESIS: Immunoglobulin (Ig)E-mediated hypersensitivity to fungi has been postulated to explain allergic fungal sinusitis (AFS). Not all patients suspected to have AFS demonstrate systemic evidence of allergy. Locally produced IgE might explain those patients with no systemic evidence of allergy but clinical features of AFS. The aim was to determine whether fungal-specific IgE could be demonstrated in sinus mucin in patients with eosinophilic mucin rhino-sinusitis. STUDY DESIGN: A prospective study was undertaken in a tertiary rhinology practice in Adelaide, South Australia. METHODS:: Eighty-six consecutive patients with nasal polyposis and thick, colored macroscopically "fungal-like" sinus mucin at time of surgery for chronic sinusitis were entered in the study. The sinus mucin was liquefied and underwent testing for fungal-specific IgE (Pharmacia UniCAP) and fungal culture. Serum fungal-specific and total IgE, eosinophil count, C-reactive protein (CRP), and eosinophilic cationic protein (ECP) were measured. RESULTS: Fifty-six (65%) patients were fungal culture positive, and 37% had a detectable fungal-specific IgE in sinus mucin. Data were available to classify 81 patients: AFS = 24 (30%), AFS-like = 6 (7%), nonallergic eosinophilic fungal sinusitis = 32 (40%), nonallergic, nonfungal eosinophilic sinusitis = 19 (23%). Patients with AFS were significantly more likely to have fungal-specific IgE in sinus mucin (17/24, 71%, P =.02). In all fungal culture-positive patients, positive mucin fungal-specific IgE was significantly associated with systemic fungal allergy (P =.005), but a raised total serum IgE was not. Six (19%) of the 32 patients with positive fungal cultures but negative serum fungal-specific IgE had a positive mucin fungal-specific IgE, suggesting that they may be reclassified as AFS. The mean ECP and total IgE were raised most significantly in the AFS subgroup. CONCLUSIONS: This is the first study to show that fungal-specific IgE may be demonstrated in sinus mucin. It was significantly associated with systemic fungal allergy and may play a role in a minority of fungal sinusitis patients in the absence of systemic fungal allergy.     

Tissue-specific immunoglobulin E in maxillary sinus mucosa of allergic fungal sinusitis

OBJECTIVE: The objectives of this prospective study were to analyze the specific immunoglobulin E (sIgE) in maxillary sinus mucosa and to determine the importance of local tissue sIgE in the patients with allergic fungal sinusitis (AFS). METHODS: We investigated tissue-specific IgE in the maxillary sinus mucosa. Thirty-four patients with rhinosinusitis and nasal polyposis were included in the study. The patients were divided into three groups--AFS, fungal sinusitis and chronic rhinosinusitis (CRS). The sIgE profile of the maxillary sinus mucosa was studied by the CAP method. Other parameters, such as allergic symptoms, presence of fungi hyphae and eosinophilic mucin in the sinus cavities as well as computed tomography (CT) scanning findings were also evaluated in all groups. RESULTS: All patients in the AFS group had allergic symptoms, and the serum IgE test was positive to mites or house dust, but none had a positive serum IgE response to Aspergillus. However, 85.7% of this group had tissue sIgE to Aspergillus. CONCLUSIONS: The local tissue sIgE profile is more specific than the systemic sIgE profile in determining the allergic status of AFS patients. Tissue sIgE for fungi may be considered as a part of AFS diagnostic criteria.     

Computed Tomography and Magnetic Resonance Diagnosis of Allergic Fungal Sinusitis

The objective of this study was to describe CT and MR findings in patients with allergic fungal sinusitis (AFS). CT and MR images were examined from 10 patients with histologically proven AFS. All patients demonstrated CT evidence of central sinus high attenuation and T2-weighted MR signal void corresponding to surgically proven areas of thick inspissated allergic mucin. AFS is a distinct clinical entity with a highly specific radiographic appearance based on CT and MRI.     

变应性真菌性鼻窦炎

目的　通过总结 3例变应性真菌性鼻窦炎 (allergicfungalsinusitis,AFS)的诊断、治疗过程 ,结合复习文献中关于本病的病理、生理过程的探讨 ,提示本病的诊断、治疗特点。方法　通过对 3例病史、鼻窦CT检查、鼻窦分泌物及鼻腔检查 ,对临床怀疑变应性真菌性鼻窦炎的 3例患者进行鼻窦内镜手术。通过分泌物真菌涂片、培养 ,组织病理学检查以及放射免疫吸附试验 (radioallergosorbenttest,RAST)结果 ,明确AFS诊断。术后口服强的松 ,局部雷诺考特喷鼻及大扶康冲洗鼻腔。结果　通过上述系统治疗 ,2例术后分别随访 2 5个月和 15个月症状完全缓解 ,1例术后 6个月症状复发 ,变应性黏蛋白再次出现 ,经术腔清理及大扶康冲洗后局部症状及分泌物完全消失 ,随访 2个月无复发。结论　变应性真菌性鼻窦炎有其独特的临床发生、发展过程。慢性鼻窦炎、鼻息肉中存在着一定比例的AFS ,应对其做出及时的诊断和进行合理、完善的综合治疗 ,以降低本病的并发症和复发率。     

Conversion to Chronic Invasive Fungal Sinusitis From Allergic Fungal Sinusitis in Immunocompetence

A review of the treatment of allergic and invasive fungal sinusitis, as well as a presentation of the first recorded case of a conversion from allergic fungal sinusitis (AFS) to chronic granulomatous invasive sinusitis and the fourth case of invasive fungal sinusitis associated with Curvularia. This immunocompetent patient suffering from chronic AFS converted after repeated high‐dose steroid tapers and noncompliance. AFS may present atypically and should be suspected even in immunocompetent patients with sinus disease who report new onset pain and neurologic symptoms. Clinicians should consider the potential complications associated with repeated systemic steroid administration. Laryngoscope, 129:2447–2450, 2019     

变应性真菌性鼻窦炎的临床观察

目的 :探讨变应性真菌性鼻窦炎 (AFS)的诊断及治疗。方法 :8例AFS患者均行鼻内窥镜手术、激素治疗及抗真菌药物冲洗术腔。结果 :随访 13～ 4 0个月 ,2例复发 ,再次接受同样治疗 ,现仍在随访中。结论 :AFS的症状主要表现为变应性鼻炎的症状及骨质吸收 ,需要鼻内窥镜手术、激素及抗真菌药物等综合治疗。AFS易复发 ,长期随访很重要     

变应性真菌性鼻窦炎

目的 通过总结3例变应性真菌性鼻窦炎（allergic fungal sinusitis,AFS)的诊断、治疗过程，结合复习文献中关于本病的病理、生理过程的探讨，提示本病的诊断、治疗特点。方法 通过对3例病史、鼻窦CT检查、鼻窦分泌物及鼻腔检查，对临床怀疑变应性真菌性鼻窦炎的3例患者进行鼻窦内镜手术。通过分泌物真菌涂片、培养，组织病理学检查以及放射免疫吸附试验（radioallergosorbent test,RAST)结果，明确AFS诊断。术后口服强的松，局部雷诺考特喷鼻及大扶康冲洗鼻腔。结果 通过上述系统治疗，2例术后分别随访25个月和15个月症状完全缓解，1例术后6个月症状复发，变应性黏蛋白再次出现，经术腔清理及大扶康冲洗后局部症状及分泌物完全消失，随访2个月无复发。结论 变应性真菌性鼻窦炎有其独特的临床发生、发展过程。慢性鼻窦炎、鼻息肉中存在着一定比例的AFS，应对其做出及时的诊断和进行合理、完善的综合治疗，以降低本病的并发症和复发率。     

Further evidence for allergic pathophysiology in allergic fungal sinusitis

Controversy continues over whether allergic fungal sinusitis represents a true allergy, an infection, or a point somewhere along a spectrum between allergy and infection. The present study describes two experiments that add weight to the argument that allergic fungal sinusitis (AFS) is truly an immunologically mediated hypersensitivity and not a form of infection. In the first experiment, eight patients with Bipolaris culture-positive AFS were prospectively evaluated with Bipolaris antigen skin testing and with inhibition radioallergosorbent (RAST) and enzyme-linked immunosorbent assay (ELISA) for Bipolaris-specific IgE and IgG antibodies. The Bipolaris AFS cases were compared with 10 control patients with no history of AFS. All eight AFS cases demonstrated positive skin testing to Bipolaris and in addition, all tested positive by RAST and ELISA for IgE and IgG Bipolaris antibodies, respectively. In the control group one patient had a positive skin test, ELISA, and RAST and one additional patient had a positive ELISA only. Good correlation was noted between skin test, RAST, and ELISA results. In the second experiment, sinus mucosa from 14 AFS patients and 10 control patients with other forms of surgical sinus disease was analyzed by immunohistocytochemistry for the eosinophilic inflammatory mediators major basic protein (MBP) and eosinophil derived neurotoxin (EDN) and the neutrophil mediator neutrophil elastase. All AFS cases demonstrated evidence of eosinophilic mediator release, and MBP and EDN predominated over neutrophil elastase. In the control group eosinophil and neutrophil mediator release in sinus mucosa was equal. The two experiments support the concept that AFS is an antigen-triggered, IgE- and IgG-mediated hypersensitivity response with a late-phase inflammatory reaction involving release of eosinophilic mediators. Laryngoscope, 108:1485–1496, 1998