侵袭型真菌性鼻-鼻窦炎的诊疗和预后分析  

Managements and prognostic analyses in patients with invasive fungal rhinosinusitis

作　　者：周蔚[1] 刘全[1] 赵卫东[2] 于华鹏[1] 孙希才[1] 王晶晶[1] 刘琢扶[1] 李厚勇[1] 郑春泉[1] 王纾宜[3] 王德辉[2] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科,上海200031 [2]复旦大学附属眼耳鼻喉科医院内镜颅底中心,上海200031 [3]复旦大学附属眼耳鼻喉科医院病理科,上海200031

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第8期568-572,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：上海申康医院发展中心新兴前沿项目（SHDC12013121）

摘　　要：目的 通过分析侵袭型真菌性鼻-鼻窦炎的临床特征了解其预后的影响因素.方法 回顾性分析2006年3月至2015年11月期间术后病理证实为侵袭型真菌性鼻-鼻窦炎患者的临床资料,分析患者出现首发症状至确诊的时间、临床表现、影像学特征,鼻内镜手术联合抗真菌治疗的疗效.共18例患者入组,男性10例,女性8例,中位年龄54岁.急性3例,慢性15例.结果 从患者出现症状至确诊的中位时间是5个月.最常见的临床症状为头痛（10/18）,其次依次为视力下降（7/18）、鼻塞（4/18）、面颊部麻木或疼痛（2/18）、复视（2/18）.2例患者合并糖尿病,1例患者合并强直性脊柱炎并服用免疫抑制剂治疗1年.影像学检查显示4例局限于鼻窦,6例累及眶尖,3例累及眶内及视神经,5例累及海绵窦,5例累及翼腭窝和颞下窝,3例侵犯颅内,所有患者均为单侧发病.毛霉菌3例,曲霉菌15例;17例患者术后行全身抗真菌治疗.术后随访1-60个月,复发2例,死亡1例.结论 鼻内镜手术联合全身抗真菌治疗对鼻窦外侵犯的侵袭型真菌性鼻-鼻窦炎具有较好的疗效.Objective To evaluate the survival outcomes of invasive fungal rhinosinusitis by analyzing the clinical features. Methods A retrospective analysis was performed for cases of invasive fungal sinusitis proved by histological analysis between March 2006 and November 2015. All relevant factors including interval from the onset of symptoms to initiation of diagnosis, clinical characteristics, features of CT and MRI, treatment and prognosis were collected. A total of 18 patients （ 10 males; 8 females） were identified. The median age was 54 years old. Three patients suffered from acute invasive fungal sinusitis, while the other 15 suffered from chronic invasive fungal sinusitis. Results The mean duration between onset of symptoms and diagnosis was 5 months. The most common symptom was headache （10/18） , followed by visual disturbance （7/18）, nasal obstruction （ 4/18 ）, facial numbness and pain （ 2/18 ） and diplopia （2/18）. Two patients had diabetes mellitus; one patient had ankylosing spondylitis receiving immunosuppressive drugs treatment for one year. Four patients had the disease confined in the sinus. Complications of this disease included orbital apex involvement in 6 patients, intraorbital and optic nerve involvement in 3 patients, cavernous sinus involvement in 5 patients, pterygopalatine fossa and infratemporal fossa involvement in 5 patients, intracranial extension involvement in 3 patients. Fungal species included aspergillus （15 cases） and mucor （3 cases）. Seventeen patients received intravenous antifungal therapy after surgery. The duration of follow-up ranged from 1 to 60 months. Two patients reoccurred and one patient died of the disease. Conclusion Endoscopic debridement combined with intravenous antifungals is efficacious in the management of invasive fungal sinusitis.

关 键 词：鼻窦炎 真菌 内窥镜检查 耳鼻喉外科手术 预后 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]