鼻腔及鼻窦真菌病35例临床分析

目的探讨鼻腔鼻窦真菌病的临床特征、诊断及治疗方法.方法 35例患者诊断明确后根据病变和程度采用不同术式,非侵袭型采用上颌窦根治术或鼻窦内窥镜术,侵袭型采用扩大范围的鼻窦根治术,术后辅以抗真菌药治疗.结果非侵袭型26例,其中25例经手术治疗治愈;侵袭型9例,其中7例经手术治疗治愈,1例虽经4次手术,终因病变广泛未能有效控制,5个月后死亡.结论 CT对鼻腔鼻窦真菌病的诊断有重要价值,病理学检查是确诊的依据,手术是根本的治疗手段,无论哪种类型,均须彻底清除病灶,充分开放受累的鼻窦,对病变广泛的侵袭型还须扩大手术切除范围.

Clinical analysis to 35 cases of noninvasive and invasive naso-sinus fungus

Objective To study the clinical features,diagnosis and management of nose and nasal sinusen fungus.Methods Different manner of surgical procedure was taken according to the areas and degree of pathological changes.The patients with noninvasive fungus were treated with radical maxillary sinusotomy(cald-well-Luc operation) or endoscopic sinus surgery.The patients with invasive form were undergone by the sinusotomy of enlarging areas,and combined with a postoperatively antifungal therapy.Results Twenty-six patients were involved in noninvasive fungus,and 25 cases in them were cured in single surgery through different manner.Nine patients were in invasive one,and 7 in them were also cured by single surgery in dfferent manner.One patient with invasivi fungus died 5 months postoperatively for extensive area and noneffective treatment although four surgical excisions were done.Conclusion CT scan is very important in their diagnosis,and the histopathology leads to identification of the fungus.Surgical removal is a radical kind of treatment.It is essential to exercise and open entirely the involved sinus cavity whatever type,and to enlarge areas for the extensive invasive fungus.