鼻内镜手术治疗非侵袭性真菌性鼻-鼻窦炎

目的探讨非侵袭性真菌性鼻-鼻窦炎的临床特征,鼻内镜手术方法及疗效。方法回顾性分析102例非侵袭性真菌性鼻-鼻窦炎患者临床资料。结果所有患者均行鼻内镜手术治疗,随访6个月至4年,治愈77例,好转20例,复发5例。结论鼻腔鼻窦解剖异常是非侵袭性真菌性鼻-鼻窦炎的主要致病因素。鼻内镜手术是治疗非侵袭性真菌性鼻-鼻窦炎的有效手段,术后复发与手术的彻底性、术后鼻腔鼻窦处理有关。     

鼻内镜下手术治疗慢性侵袭性真菌性鼻-鼻窦炎的探讨

目的：评价鼻内镜手术治疗慢性侵袭性真菌性鼻-鼻窦炎的效果。方法：回顾性分析鼻内镜下手术治疗的术后病理确诊为慢性侵袭性真菌性鼻-鼻窦炎的63例患者资料。结果：随访6个月～1年,全部痊愈,少数有轻度并发症。结论：鼻内镜手术是治疗鼻-鼻窦真菌性疾病的有效方法,可不使用抗真菌药。     

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。     

鼻内镜治疗非侵袭性真菌性鼻窦炎的临床应用效果观察

目的观察鼻内镜治疗非侵袭性真菌性鼻窦炎的临床效果。方法于我院2017年9月-2019年9月耳鼻喉科治疗的非侵袭性真菌性鼻窦炎筛选58例展开分析,运用随机综合平衡法将其均分成例数相等的两组,包括研究组和参照组,分别纳入29例。参照组采取传统手术治疗,研究组采用鼻内镜手术治疗,分析疗效、治疗情况、疼痛情况、并发症情况。结果经对研究结果实施统计后发现,研究组并发症率低于参照组,治疗总有效率低于参照组,鼻腔内镜评分和VAS评分均低于参照组,组间存在显著差异,P<0.05。结论给予非侵袭性真菌性鼻窦炎患者鼻内镜治疗的效果显著优于传统手术,可促进治疗效果提升,且并发症率较低,有利于改善鼻腔内镜评分和疼痛情况,值得在非侵袭性真菌性鼻窦炎的治疗中进行推广。     

非侵袭性真菌性鼻窦炎手术治疗方式的比较

目的探讨鼻内镜手术代替传统柯-陆手术治疗非侵袭性真菌性鼻窦炎的疗效。方法回顾分析四川省人民医院31例经鼻内镜手术及病理报告确诊为非侵袭性真菌性鼻窦炎患者的临床资料。结果31例症状体症均消失。结论采用鼻内境手术治疗非侵袭真菌性鼻窦炎，较之传统柯-陆手术创伤小、照明好、清除病灶准确；不损害鼻腔正常的生理功能；保证鼻窦通气引流，减少复发，治愈率高。     

鼻内镜下治疗非侵袭性真菌性鼻-鼻窦炎的术式选择与疗效

目的探讨鼻内镜手术与传统术式结合治疗非侵袭性真菌性鼻-鼻窦炎的疗效。方法对我科2003年6月～2009年6月有完整随访资料的接受鼻内镜手术治疗的58例非侵袭性真菌性鼻-鼻窦炎患者的临床资料进行分析。其中采用单纯鼻内镜手术32例,鼻内镜联合改良柯-陆术式11例,鼻内镜联合下鼻道开窗15例,并对所有患者术后情况进行随访。结果随访1年以上,仅3例手术后复发,其余55例在随访期内均未见复发。结论鼻内镜手术是治疗非侵袭性真菌性鼻-鼻窦炎安全且有效的手段,可基本完整保留鼻腔、鼻窦正常的解剖结构。彻底清除真菌团块、术后定期随访是治疗成功的关键。     

鼻内镜下治疗非侵袭性真菌性鼻窦炎58例临床分析

真菌性鼻窦炎是由真菌在鼻腔-鼻窦所引起的一种感染性或（和）变应性疾病。可分为非侵袭性真菌性鼻窦炎和侵袭性真菌性鼻窦炎。我科2006～2009年收治的58例非侵袭性真菌性鼻窦炎进行回顾分析，探讨鼻内镜手术的疗效，现报道如下。     

鼻内镜手术治疗慢性侵袭性真菌性鼻窦炎45例

目的探讨鼻内镜下治疗慢性侵袭性真菌性鼻窦炎的疗效。方法在鼻内镜下对45例慢性侵袭性真菌性鼻窦炎患者行鼻窦清创术,部分病例加行下鼻道开窗术,彻底清除鼻窦病变组织及鼻病变黏膜和骨质,充分开放鼻窦,术后应用大扶康冲洗术腔,并定期行鼻内镜检查。结果随访6个月至6年,治愈41例,复发4例。复发病例经再次鼻内镜手术后治愈,无手术并发症。结论鼻内镜下鼻窦清创术是治疗侵袭性真菌性鼻窦炎的重要手段,术后定期复查并辅以大扶康术腔冲洗,疗效良好。     

鼻内镜下治疗真菌性鼻窦炎93例

目的探讨真菌性鼻窦炎经鼻内镜手术治疗的方法及疗效.方法回顾性分析93例真菌性鼻窦炎病例,经鼻内镜下手术治疗的疗效及有关问题.结果93例患者术后经随访3月～2年,窦口引流通畅,无1例复发.结论非侵袭型鼻窦真菌病宜行鼻内镜手术,以彻底清除窦腔病变,术后应继续反复冲洗窦腔,术后不必全身应用抗真菌药物.     

158例非侵袭性真菌性鼻窦炎的临床分析

目的分析非侵袭性真菌性鼻窦炎的临床特点、影像学特征、治疗方法及预后。方法收集郑州大学第一附属医院2019年10月至2021年10月收治的158例非侵袭性真菌性鼻窦炎患者的临床资料, 所有患者均行鼻内镜手术, 经病理明确真菌感染, 术后给予规范化药物治疗及鼻内镜检查随访。结果非侵袭性真菌性鼻窦炎主要侵犯上颌窦(67.72%)、蝶窦(23.42%), 以头痛(61.39%)、鼻塞(41.77%)为主要临床表现, 鼻窦CT主要表现为软组织影内可见钙化点, 病理可见真菌菌丝, 鼻内镜手术是目前主要的治疗方法。结论非侵袭性真菌性鼻窦炎临床症状不典型, 诊断依据影像学检查及病理结果, 鼻内镜手术可以彻底治疗, 预后好, 复发率不高。     

Comparison of techniques for transsphenoidal pituitary surgery

BACKGROUND: The aim of this study was to compare three different techniques for transsphenoidal pituitary surgery: (1) sublabial transseptal approach with microscopic resection, (2) transnasal transseptal approach with endoscopic resection, and (3) endoscopic approach with endoscopic resection. METHODS: We performed a retrospective review of 50 pituitary surgeries performed by the same neurosurgeon. Demographic, radiographic, and clinical data were collected. RESULTS: Fifteen patients underwent sublabial approach with microscopic tumor resection, 21 patients underwent the transnasal approach with endoscopic resection, and 14 patients underwent the completely endoscopic technique. There were a total of 20 complications in the sublabial group, 13 transnasal complications, and 6 endoscopic complications. Cerebrospinal fluid leak incidence was 53% in the sublabial approaches, 47% transnasal, and 28% in the endoscopic patients. Diabetes insipidus was encountered in 33% of sublabial approaches, 5% of transnasal approaches, and 7% of endoscopic approaches. Lumbar drains were required in 40% of sublabial approaches, 38% of transnasal approaches, and 7% of endoscopic approaches. Nasal packing was used in 100% of sublabial and transnasal approaches and 0% of endoscopic approaches. Mean recurrence rate and follow-up was sublabial in 6.6% (50 months), transnasal in 9.5% (11 months), and endoscopic in 0% (7 months). Average hospital stay for sublabial approaches, transnasal approaches, and endoscopic approaches was 8.3, 6.2, and 3.4 days, respectively (p < 0.05). CONCLUSION: Transsphenoidal pituitary surgery has evolved over the past several decades, because advances in technology have been the catalyst for minimally invasive surgeries. Less invasive approaches, such as the transnasal approach with endoscopic resection of tumor and the completely endoscopic .technique have less morbidity and a shorter hospital stay than traditional sublabial approaches. Continued follow-up is needed to confirm long-term benefits and similar recurrence rates.     

Resultados de cirugía endoscópica nasal en el tratamiento de sinusitis fúngica invasiva en niños con cáncer e inmunosupresión

Background and objectiveto describe the results of the treatment of invasive fungal sinusitis with nasal endoscopic surgery in an immunocompromised paediatric oncological population.Methodsretrospective study of all patients diagnosed with invasive fungal sinusitis operated in the National Paediatric Oncology Unit between 2012 and 2016. Data taken from their medical history included: epidemiological characteristics, oncological diagnosis, haematological data, symptoms, tomographic studies, surgical interventions, results of pathology and cultures, medications received, complications, evolution and survival.Results18 patients were identified, 7 male and 11 female. The average age was 12 years, 13 had a diagnosis of acute lymphocytic leukemia and 5 of acute myeloid leukemia. Seventeen patients presented severe neutropenia at the time of diagnosis. The most frequently identified aetiological agent was Aspergillus in 13 patients. In 16 patients (89%) the disease was controlled with nasal endoscopic surgery. Ten patients died due to unrelated causes throughout the study.Discussion and conclusionsInvasive fungal sinusitis should be considered a medical emergency due to its high mortality. The diagnosis is based on a high index of suspicion in patients with predisposing factors (leukaemia, neutropenia, persistent fever, nasogastric tube) and endoscopic nasal evaluation. Antifungal medical treatment and aggressive nasal endoscopic surgery is indicated regardless of the patient's condition to reduce the fungal burden and associated high mortality. The treatment must be provided by a multidisciplinary team that includes paediatrics, haemato-oncology, infectology and otorhinolaryngology.     

Juvenile psammomatoid ossifying fibroma in paranasal sinus and skull base

Conclusion: The endoscopic transnasal approach with IGS is a safe and effective technique, allowing completely resection of JPOF, with minimal morbidity and recurrence.

Objectives: JPOF is a benign but locally aggressive fibro-osseous lesion. This study presents a series of JPOF cases, involving anterior skull base and orbit, treated by endoscopic transnasal approach with image guidance system (IGS) to resect the mass completely.

Method: This study retrospectively reviewed the clinical presentations, surgical procedures, and complications of 11 patients with JPOF who were treated by endoscopic approach from May 2009 to April 2014. All patients were followed by endoscopic and CT scan evaluations during follow-up.

Results: All of the 11 cases were boys, with a mean age of 11.8 years (range?=?6–17 years). The size of mass in the paranasal sinus ranged from 2.5–4.6?cm in greatest dimension (mean?=?3.7?cm), and the medial orbital wall and cranial base were involved in all patients. All 11 patients received successful operation and were relieved from symptoms without mortality and major complications. During follow-up (range from 17–67 months; mean follow-up?=?25.8 months), only one patient was recurrent in local position. The skull base partial resected during surgery was found to rebuild after 1 year.     

Endoscopic surgery for congenital basal meningoencephaloceles in children

Conclusions Endoscopic surgery is safe and effective for children with congenital basal meningoencephaloceles (CBMs); it provides an acceptable operative outcome with a short recovery time and fewer complications and may be considered as a primary approach. Objectives To explore the safety and effectiveness of using transnasal or transoral endoscopic surgery on children with CBMs. Methods The clinical data of eight CBMs children who underwent transnasal or transoral endoscopic surgery in a hospital from January 2011 to January 2015 were collected. The presenting symptoms, lesion locations, surgical outcomes, and complications were examined retrospectively. Results Of the eight children, five (62.5%) patients were male, and their ages ranged from 1 year and 6 months to 14 years (median of 9 years). Six patients presented with the transethmoidal sub-type, and two presented with the transsphenoidal sub-type. The average hospital stay of all patients was 8.6?±?2.6 days. There were neither intra-operative nor post-operative complications observed in any of the cases during the follow-ups that occurred between 6–54 months (mean of 15.5 months).     

鼻内镜下治疗经蝶脑膜脑膨出致脑脊液鼻漏3例

目的：探讨经蝶脑膜脑膨出致脑脊液鼻漏的诊断及经鼻内镜下修补的可行性,总结修补的成功经验。方法：鼻内镜下切除经蝶脑膜脑膨出3例,并以肌肉、筋膜、人工硬膜等填塞致脑脊液鼻漏的颅底缺损部位。结果：3例患者均一次手术治愈,其中1例术后并发颅内感染（脑膜炎）,余均无并发症发生,随访6个月～3年,仅1例因医源性原因于术后半年复发,二次修补成功,余无复发。结论：经鼻内镜手术治疗经蝶脑膜脑膨出所致脑脊液鼻漏是可行的,并且是微创的、安全的。     

Invasive sphenoidal aspergillosis: successful treatment with sphenoidotomy and voriconazole

Treatment of invasive sphenoidal aspergillosis is surgical, followed by antifungal therapy, mostly amphotericin B. To optimize the adjuvant antifungal treatment, which is often limited by severe side effects, the new triazole antifungal agent voriconazole with broad coverage of fungal pathogens including Aspergillus was investigated in a study of 4 patients with clinical, radiological and histological signs of invasive sphenoidal aspergillosis. They first underwent endoscopic sphenoidotomy with drainage and extraction of the fungal mass. Postoperatively, 2 patients were immediately treated with voriconazole. Two patients initially received amphotericin B; but this treatment had to be stopped because of acute renal toxicity. Finally, all patients were treated orally with 200 mg voriconazole twice a day for 12-14 weeks. After this combined treatment all patients were asymptomatic and there were no endoscopic or radiological signs of residual fungal disease. The only side effects were nausea in one and transient visual disturbances in 2 other patients. In the 4 patients presented and treated, voriconazole was shown to be effective and less toxic than amphotericin B in adjuvant treatment of invasive sphenoidal aspergillosis.     

Experiencia de 20 años en el tratamiento microquirúrgico de la atresia de coanas

Introduction and objectivesChoanal atresia is the most common congenital nasal anomaly. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and different surgical techniques and approaches are used. We describe our experience in transnasal microsurgical treatment of congenital choanal atresia.MethodsWe retrospectively evaluated 49 patients with congenital choanal atresia operated in the Department of Respiratory Endoscopy over a period of 20 years. The clinical variables analysed were type of atretic plate, age at diagnosis and surgery, associated malformations, maternal history of hyperthyroidism treated with methimazole during pregnancy, mode of airway stabilisation before surgery, surgical technique, complications, and outcome.ResultsMixed bilateral choanal atresia was the most frequent (29 cases). Its incidence was higher in females (61.2%). Almost 51% of patients showed associated malformations, and 7 had a history of maternal hyperthyroidism treated with methimazole during pregnancy. The surgical procedure consisted of a transnasal microscopic approach and placement of a silicone endonasal stent for one to 12 weeks. Thirty-five patients required revision after surgery. Nine patients had complications. Suitable nasal ventilation was achieved in 46 patients (93.9%). One patient died of causes unrelated to the surgery. Two patients with permeable choanae remain with tracheotomy.ConclusionThe transnasal microsurgical repair with endonasal stent proved to be a safe and effective procedure.     

Acute invasive fungal rhinosinusitis--case report

A case report of acute invasive fungal rhinosinusitis in 28 year old woman with acute myeloid leukemia is described in this paper. The diagnosis of the fungal disease was based on clinical presentation, endoscopic evaluation of nasal cavity, computed tomography and magnetic resonance imaging of the paranasal sinuses and histopathological findings. An aggressive treatment including antifungal therapy (amphotericin B), antibiotics and the surgery of paranasal sinuses was implemented. Unfortunately the underlying disease and the fungal invasion progressed rapidly and the patient died on the forth week post-op due to cardiorespiratory failure.     

内镜下治疗鼻源性视觉障碍的临床研究

目的 探讨鼻源性视觉障碍性疾病的诊断与治疗模式.方法 回顾性分析23例(25眼)资料完整的鼻眼相关视功能障碍病例,23例均行内镜下鼻腔鼻窦探查+鼻窦开放术,其中9例行视神经管减压术.结果 双侧全组鼻窦炎4例,单侧后组筛窦、蝶窦炎6例,额窦、筛窦炎1例,孤立性蝶窦炎5例,单侧后组筛窦、蝶窦真菌病5例,单侧蝶窦、筛囊肿或脓囊肿2例,均经术后病理证实.术前视功能:2例(2眼)无光感;6例(7眼)眼前手动;7例(7眼)眼前指数(＜ 20 cm);8例(9眼)有不同程度视力下降.1例次(1眼)眼球突出、直接和间接瞳孔对光反射消失;3例次(3眼)复视;2例次(2眼)外展麻痹;3例次(3眼)视野缺损(1眼中央性,2眼颞侧);1例次(1眼)上睑下垂.全部病例术后鼻窦术腔上皮化.术后视功能:2眼无改善;10眼恢复到发病前水平;13眼由术前眼前手动、指数改善到眼前指数(30～60 cm).其他眼部症状消失.结论鼻源性视觉障碍患者出现视力障碍时,若药物保守治疗无效应及早行鼻内镜下鼻腔鼻窦探查术;对严重视力障碍、视力急剧下降患者及早实施视神经减压手术,可以有效改善患者的视功能.     

Rupture of the internal carotid artery pseudoaneurysm resulting from fungal sinusitis

Although vasculitis due to infection with fungi, including Aspergillus, causes aneurysm formation, reports of internal carotid artery aneurysm formation resulting from fungal sinusitis are few. We report on a patient who experienced massive epistaxis from rupture of an internal carotid artery pseudoaneurysm, caused by fungal sinusitis. We treated the aneurysm with endovascular coil embolization, followed by endoscopic sinus surgery to remove the fungal mass. Intraoperative findings included a torn internal carotid artery and exposure of the coil to the sinus. Performing endoscopic sinus surgery before the embolization procedure would have increased the risks of massive intraoperative bleeding and mortality. Even after achieving hemostasis, serious sequelae, such as cerebral infarction, might occur. In this type of case, otorhinolaryngologists and neurosurgeons should collaborate, and an aneurysm should be treated before endoscopic sinus surgery. Although the treatment strategy for fungal internal carotid artery aneurysms is controversial, this case suggested the use of the embolization procedure followed by endoscopic debridement and antifungal therapy to treat a pseudoaneurysm of the internal carotid artery caused by fungal sinusitis.