慢性侵袭性真菌性鼻-鼻窦炎的诊疗体会

目的探讨慢性侵袭性真菌性鼻-鼻窦炎的早期诊断、外科干预措施。方法以最终病理学诊断为依据,总结分析12例慢性侵袭性鼻-鼻窦炎患者的临床资料、诊治经过与随访结果。结果 5例以眶尖综合征为首症,无明显鼻-鼻窦症状,首诊神经内科;其中4例行内镜经鼻鼻窦-眶尖-颅底探查术,3例同时行视神经减压术。7例表现为不同程度的鼻-鼻窦症状,行内镜下鼻窦开放,窦内病变清除术。术后给予两性霉素B和(或)伊曲康唑,术后平均随访35个月;其中6例治愈,2例症状改善,1例术后17个月复发,行二次内镜下鼻窦开放,随访29个月无复发,3例死亡,分别死于颅内真菌扩散、脑干出血、败血症。结论联合鼻内镜手术及全身应用抗真菌药物是慢性侵袭性真菌性鼻-鼻窦炎的主要治疗手段。鼻内镜下彻底清除鼻窦内坏死组织,直至完全暴露出新鲜组织。免疫功能低下的患者预后差。

Treatment of Chronic Invasive Fungal Rhinosinusitis

Objective To discuss the early diagnosis,surgical treatment and antifungal therapy of CIFRS.Methods The clinical features and course,sinus CT characteristics together with outcomes of 12 cases of CIFRS confirmed by pathologic examination were observed and analyzed.Results Five patients initially presented with orbital apex syndrome without apparent rhino-sinus disease.Four patients underwent transnasal endoscopic surgical exploration of rhino-orbital-skull base,and three of them simultaneously underwent optic nerve decompression.One patient underwent the rhinopharyngeal biopsy.Other 7 patient underwent endoscopic surgical debridement.Combination antifungal therapy were performed for all 12 patients,recovery in 6 patients,recurrence in 1 patient in postoperative 17 months.After performance of the second endoscopic debridement,no recurrence occurred postoperative 29months.Three patients respectively died of massive intracranial spread,postoperative brainstem hemorrhage and sepsis.Conclusion Early diagnosis of CIFRS and endoscopic debridement associated with anti-fungus drugs can improve its prognosis.Effective surgical treatment requires adequate exposure to remove all devitalized tissues and permits the penetration of the antifungal agent by the bloodstream.