孤立性蝶窦炎的细菌学及诊治分析37例

目的探讨孤立性蝶窦炎的临床细菌学特点及诊治方法。方法经CT或（和）磁共振成像检查证实的37例孤立性蝶窦炎，采用无菌方式在鼻内镜下取蝶窦分泌物及黏膜，进行细菌培养并药敏试验，同时行鼻内镜下蝶窦开放术。术后依据细菌培养结果进行药物治疗。结果37例孤立性蝶窦炎需氧菌检出30例，检出率为81．1％（30／37），与正常鼻腔上鼻道需氧菌检出率（80．0％，24／30）比较，差异无统计学意义（P〉0．05）。孤立性蝶窦炎病例中，革兰阳性菌27例，占90．0％，革兰阴性菌3例，占10．0％；而正常上鼻道组革兰阳性菌检出16例，占66．7％，革兰阴性菌8例，占33．3％，差异均具有统计学意义（P〈0．05）。应用敏感药物治疗，随访6个月，全部病例均治愈。影像学检查显示窦腔良好，鼻内镜检查显示窦口开放良好，无粘连。结论孤立性蝶窦炎感染以需氧菌为主，其中革兰阳性菌占绝大比例。CT或（和）磁共振成像检查联合鼻内镜手术是诊治孤立性蝶窦炎的较好方式。

Bacteriological characteristics and diagnosis and treatment of 37 patients with isolated sphenoid sinusitis

Objective To investigate the bacteriological features, diagnosis and treatment of isolated sphenoid sinusitis. Methods Sphenoiditis secreta and mucosa were taken out under the endoscope from 37 patients with isolated sphenoiditis, who had been identified with CT or magnetic resonance imaging test. The bacteria was cultured and the drug-sensitive test was performed. Meanwhile, drugs were applied according to the drug-sensitiveness results. Results The sphenoiditis detectable rate was 81.1% （30/37）, which was almost equal to that in the normal nose （80.0% ,24/30） （P 〉 0.05 ）. The gram-positive in isolated sphenoiditis took 90.0% （27/30）, and the negative 10.0% （3/30）. In nor- mal nose group, gram-positive took 66.7% （ 16/24 ）, and the gram-negative 33.3% （8/24）, with remarkable difference with that of the sphenoiditis group （ P 〈 0.05 ）. All patients were cured 6 months after the treatment. Conclusions Iso- lated sphenoiditis was mainly affected by the aerobic bacteria, the majority of which were gram-positive. CT or magnetic resonance imaging combined with the endoscopic surgery was a good method for the diagnosis and treatment of isolated sphenoiditis.