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。     

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。     

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的诊断和治疗

目的探讨变应性真菌性鼻窦炎（AFRS）的临床病理特点、治疗方法及预后。方法回顾性分析54例AFRS患者的临床资料。全部患者均接受以鼻内镜为主的综合治疗。结果术后随访6个月至6年,51例患者病情完全控制;3例患者术后1年复发,经再次手术和综合治疗,全部治愈,随访2~5年,未见复发。结论手术治疗是该病最有效的治疗方法,术后辅以糖皮质激素治疗以减少术后复发。综合治疗和术后定期随访是治疗成功的关键。     

鼻内镜手术治疗真菌性鼻窦炎60例临床观察

目的分析真菌性鼻窦炎的临床特点并评估鼻内镜手术治疗真菌性鼻窦炎的疗效。方法 2006年1月～2008年12月期间我科住院治疗的60例真菌性鼻窦炎患者,均行CT检查或病理确诊,在全麻或局部强化麻醉下行鼻内镜手术,术后给予抗生素和糖皮质激素处理并定期鼻腔冲洗和随访。结果随访6～12个月,治愈44例(73.3%),好转13例(21.7%),无效3例(5%)。出现术后并发症4例(6.67%),复发2例(3.3%);并发症为眼部并发症、鼻腔粘连和窦口闭锁等。结论采用鼻内镜手术视野清晰、创伤小,清除病灶准确彻底,能保护鼻腔及鼻窦的正常黏膜功能,建立良好的鼻腔鼻窦通气及长期引流通道,治愈率高,复发少。     

真菌性鼻窦炎54例临床分析

近年来随着广谱、高效抗生素的广泛应用以及诊断技术的不断提高，真菌性鼻窦炎在临床上有逐年增多趋势；本病常易误诊为慢性鼻窦炎和恶性肿瘤。为了提高临床医生对本病的诊断和治疗水平，减少误诊，现将我科1998年～2002年收治的54例真菌性鼻窦炎患者的临床资料报道如下。     

变应性真菌性鼻窦炎8例

变应性真菌性鼻窦炎(AFS)是真菌性鼻窦炎的一种类型,随着对AFS的逐渐认识,近年来其发病率明显增加,然而其确切的发病机制及有效的治疗方法尚有争论.本文分析2006 ～2007年我科收治的8例AFS患者,报道如下.     

变应性真菌性鼻窦炎的诊断与治疗体会

目的 探讨变应性真菌性鼻窦炎(AFS)的诊断及治疗方法.方法 回顾性分析16例经术后病理诊断证实AFS的临床表现、实验室检查、影像学表现、手术方法及术后综合治疗.结果 随访2～4年,治愈14例(占87.5%),显效1例(占6.25%),无效1例(占6.25%).结论 AFS的诊断主要依据CT中多个鼻窦腔实变膨胀,伴有弥散匍行状或云雾状高密度影,阴影周边为软组织影,术后病理组织示大量嗜酸性粒细胞浸润,并可见Charcot-Leyden晶体.手术关键纠正鼻腔鼻窦结构异常、彻底开放病变鼻窦、清除变应性粘蛋白,术后予免疫治疗、抗真菌治疗及鼻腔冲洗.     

鼻内镜手术治疗非侵袭型真菌性鼻窦炎18例

由于鼻内镜和CT的广泛应用,对真菌性鼻窦炎的确诊率有明显的提高。本文报道2000年1月~2004年12月我科应用鼻内镜手术治疗非侵袭型真菌性鼻窦炎18例,报道如下。1资料与方法1.1临床资料本组18例病人中,男10例,女8例;年龄28~69岁,平均46岁,病程1~5年,均无鼻息肉手术史,主要症状有单侧鼻塞,流恶臭脓,间有涕中带血,回吸有颗粒状干酪样物由鼻排出,患侧颌面部、上牙及患侧头痛。鼻内镜检查:中鼻道可见灰白色稠脓,有的可见褐色干酪样团块状物,钩突肥大及中鼻甲水肿并有息肉样变。CT检查示窦腔内高密度软组织影,并有不均匀斑片状或点状钙化影,部分…     

Isolation of fungi by standard laboratory methods in patients with chronic rhinosinusitis

OBJECTIVES/HYPOTHESIS: Allergic fungal sinusitis and the role of fungi in the pathogenesis of chronic rhinosinusitis are topics of interest and controversy in rhinology. The classification of chronic rhinosinusitis as either a bacterial infection or an allergic (eosinophilic) reaction to fungi has significant implications for treatment of this disease process. We designed a study to determine whether standard isolation techniques, as employed in a university hospital mycology laboratory, could isolate and identify fungi in the intraoperative specimens from patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. STUDY DESIGN: Forty-five random patients with a diagnosis of chronic rhinosinusitis by clinical and computed tomography criteria underwent endoscopic sinus surgery during 2001, performed by two senior surgeons (J.B.J., R.A.L.). Specimens of mucin, sinus secretions, and/or tissue were obtained intraoperatively and sent to the New York University Medical Center (New York, NY) mycology laboratory for isolation and identification of fungi. METHODS: Specimens were treated with Sputolysin and chloramphenicol; plated on Sabouraud, ChromAgar/Candida, Mycosel, and Niger seed agar plates; and incubated at 30 degrees C (or 37 degrees C) for up to 1 month. RESULTS: We were able to demonstrate the presence of fungi in 56% of intraoperative specimens obtained from patients undergoing surgery for chronic rhinosinusitis. CONCLUSIONS: Using a standard hospital mycology laboratory protocol, which is relatively inexpensive and readily available, fungus can be isolated from a majority of patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. Educational statement: Discuss the possible role of fungus in chronic rhinosinusitis and evaluate the efficacy of documenting the presence of fungus in a routine fashion to encourage clinically relevant directed treatments.)     

Surgical treatment of chronic recurrent rhinosinusitis: a preliminary report

OBJECTIVE: The objective of this study was to determine if endoscopic sinus surgery (ESS) is effective in the management of chronic recurrent rhinosinusitis (CRRS). METHODS: A consecutive series of patients with CRRS diagnosed according to stringent criteria was prospectively examined before and at least 1 year after ESS. Paranasal sinus computed tomography scans were staged and ESS was performed targeting radiographic disease and the ostiomeatal complex. Preoperative and postoperative disease severities in terms of symptom scores, medicine utilization, and resource factors were assessed using the rhinosinusitis symptom inventory (RSI). Improvements in RSI symptom domains, medical and economic resource factors were determined using effect sizes and statistical comparison before and after ESS. RESULTS: Nineteen patients (mean age, 42.3 years) completed the study with a mean follow up of 19.1 months. The mean Lund score was 3.42 (standard deviation, 4.09). Statistically significant decreases in nasal (-36.1), facial (-28.4), oropharyngeal (-34.6), systemic (-24.7), and total (-31.9) RSI symptom domain scores were observed (all P < .003) with effect sizes ranging from 0.87 to 1.63 (strong surgical effect). Statistically significant decreases in antihistamine use (-30%, P = .031), number of workdays missed as a result of CRRS (-1.9, P = .035), and number of acute infectious episodes (-2.5, P = .006) were also observed. However, declines in weeks of antibiotic use (-2.8 weeks, P = .293) and number of antibiotic courses (-1.7, P = .118) were not significant. CONCLUSIONS: Patients with CRRS may substantially benefit both symptomatically and medically from ESS. Although surgery should be used cautiously in treating CRRS, further trials of ESS for CRRS are warranted.     

诱导型一氧化氮合酶在变应性真菌性鼻-鼻窦炎黏膜中的表达

目的 :通过对变应性真菌性鼻 鼻窦炎窦腔病变黏膜 (AFRS)和慢性鼻窦炎 (CRS)病变黏膜中诱导型一氧化氮合酶 (iNOS)的定位和半定量研究 ,探讨AFRS和CRS发病机制的差异 ,一氧化氮 (NO)的生成情况和意义。方法 :用免疫组化 (S P法 )的方法对 2 8例AFRS和 6例CRS标本中iNOS进行定位和半定量检测。并且用Ridit分析进行统计分析。结果 :iNOS广泛存在于上皮组织、血管内皮、平滑肌细胞、黏膜下浆液性腺体和炎症细胞中 ,以细颗粒或粗颗粒存在于细胞质中 ,细胞膜上偶见。细胞核及间质细胞内无iNOS表达。AFRS黏膜与CRS黏膜之间的表达差异有显著性意义 (P <0 .0 1)。结论 :iNOS在AFRS窦腔黏膜中呈大量表达 ,iNOS对AFRS发病起重要作用 ;AFRS与CRS可能是不同的两个疾病     

Current understanding of allergic fungal rhinosinusitis

Studying the pathophysiology of allergic fungal rhinosinusitis (AFRS) has proved challenging. While this clinical entity is easily distinguishable based on the clinical criteria set forth by Bent and Kuhn twenty-five years ago, studies examining type 2 inflammatory profiles in AFRS can make it seem more alike other CRS subtypes than it is different. Still, evolving research seems to clearly delineate this subtype from others in CRS. This review will critically evaluate the evolution of research examining the pathophysiology of AFRS and will conclude with a summary of the special considerations in the management of this fascinating disease.     

Effect of nebulized budesonide on decreasing the recurrence of allergic fungal rhinosinusitis

Objective

The aim of this study was to evaluate the clinical efficacy and the effects on decreasing the recurrence of AFRS (allergic fungal rhinosinusitis) of a budesonide inhalation suspension delivered via transnasal nebulization to patients following endoscopic sinus surgery.