慢性侵袭性真菌性鼻-鼻窦炎临床分析  

Clinical analysis of chronic invasive fungal rhinosinusitis

作　　者：李天成[1] 曾镇罡[1] 肖水芳[1] 秦永[1] 王鹤[2] 王全桂[1] 

机构地区：[1]北京大学第一医院耳鼻咽喉头颈外科,100034 [2]北京大学第一医院影像科,100034

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第4期262-267,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 探讨慢性侵袭性真菌性鼻-鼻窦炎（chronic invasive fungal rhinosinusitis,CIFRS）的临床特点及其治疗方法.方法 回顾性分析2006年6月至2011年8月北京大学第一医院收治的经病理证实为CIFRS的7例患者的临床资料.分析内容包括患者的病程、症状、鼻窦CT/MRI、手术方式、术后病理以及药物治疗方法.本组患者治疗方法采取手术加系统抗真菌药物治疗.着重分析2例具有典型临床特征患者的病历资料,探讨CIFRS的临床特点和治疗方法.结果 7例患者中女性5例,男性2例;病程2个月至8年,7例患者均无全身免疫系统疾病史及糖尿病病史,有面部外伤史1例,车祸后长期卧床并应用抗生素1例.发病初期病变位于单侧上颌窦者6例,单侧筛窦者1例.病理检查和/或真菌培养检出曲霉菌6例,毛霉菌1例.随访1～5年,治愈6例,死亡1例.结论 CIFRS多发生于免疫功能正常患者,单窦发病为主,上颌窦最多见,曲霉菌多见;临床表现及早期鼻窦CT缺乏特异性.治疗以手术联合足量足程抗真菌药物为主.Objective To investigate the clinical features and treatment of chronic invasive fungal rhinosinusitis（CIFRS）.Methods From June 2006 to August 2011,seven patients were pathologically diagnosed as CIFRS in otorhinolaryngology department of Peking university first hospital and included in this study.The clinical records were reviewed.The clinical features,clinical course,symptoms,clinical signs,CT/MRI scan of the sinuses,surgical approach,postoperative pathology and medications were analyzed retrospectively.These 7 patients received both surgical and systemic anti-fungal treatment.Among them,2 cases with characteristically clinical features were addressed into further analyses to explore the clinical feature and treatment of CIFRS.Results Among the 7 patients,5 were female and 2 were male.The course of diseases were from 2 months to 8 years.All patients had no systemic immune diseases and history of diabetes mellitus,while 1 case had a history of facial trauma,and another 1 case had received antibiotics for long-stay in bed after a car accident.The onset lesions of 6 cases were in unilateral maxillary sinus and 1 in unilateral ethmoid sinus.Aspergillus fungi were detected in 6 cases and mold fungi were detected in 1 case by pathology or fungal culture.After follow-up for 1-5 years,6 patients were cured,and 1 was died.Conclusions CIFRS are often diagnosed in patients with normal immune function.Lesions alwasys occur in single sinus,and maxillary sinus is the most commonly involved.Aspergillus is the most common pathogens.Early clinical manifestation and sinus CT images are lack of specificity.Surgery associated with adequate antifungal treatment might be the best treatment strategy.

关 键 词：鼻窦炎 真菌 感染 抗真菌药 治疗结果 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]