慢性侵袭性真菌鼻-鼻窦炎46例临床分析  

A retrospective review of 46 cases of chronic invasive fungal rhinosinusitis

作　　者：徐慧敏[1] 周泠宏 李谦 胡越凯 朱浩翔 秦艳丽 陈忠清 王璇 朱利平 

机构地区：[1]山东省临沂市人民医院感染科,276034 [2]复旦大学附属华山医院感染科 [3]复旦大学附属华山医院病理科

出　　处：《中华传染病杂志》2017年第9期537-540,共4页Chinese Journal of Infectious Diseases

摘　　要：目的探讨慢性侵袭性真菌鼻-鼻窦炎的临床特征。方法回顾性分析复旦大学附属华山医院2009年1月至2016年12月间收治的46例慢性侵袭性真菌鼻-鼻窦炎确诊病例的临床特征和转归。结果46例患者中鼻窦受累的患者分别为左侧蝶窦24例，左侧筛窦23例，左侧上颌窦20例，右侧上颌窦18例，右侧筛窦16例，右侧蝶窦15例，左侧额窦9例，右侧额窦6例。鼻-鼻窦外最常累及的部位为中枢神经系统和眼部，受累患者各22例。在中枢神经系统受累的患者中病变鼻窦最多见左侧蝶窦（17例）和左侧筛窦（15例）；在眼部受累的患者中病变鼻窦最多见为左侧筛窦（14例）和左侧蝶窦（13例）。42例患者的病原体为曲霉，2例为接合菌，白念珠菌和暗色丝状真菌各1例。37例病理表现为非肉芽肿型，9例为慢性肉芽肿型，肉芽肿型均发生于免疫正常患者。早期临床症状以头痛、头晕及鼻塞、流脓涕等鼻部表现最为多见，而首诊则以头痛、头晕及眼部症状如视物模糊、视力下降、失明最为常见。抗真菌药物联合手术清除、引流病灶疗效显著，治愈42例。结论慢性侵袭性真菌鼻一鼻窦炎患者早期有鼻部症状或头痛、头晕非特异性症状，后期出现视力异常等表现时，应高度警惕该病的可能。Objective To investigate the clinical characteristics of chronic invasive fungal rhinosinusitis. Methods Clinical features and outcomes of 46 proven cases of chronic invasive fungal rhinosinusitis admitted in Huashan Hospital, Fudan University from January 2009 to December 2016 were retrospectively reviewed. Results Of the 46 patients enrolled, left sphenoid sinus, ethmoid sinus and maxillary sinus were affected in 24, 23 and 20 cases, respectively, while right maxillary sinus, ethmoid sinus and sphenoid sinus were affected in 18, 16 and 15 cases, respectively. Left and right frontal sinus were affected in 9 and 6 cases, respectively. The central nervous system and orbit were the most commonly affected sites in external nasal involvements, noted in 22 cases respectively. Left sphenoid （17 cases） and ethmoid sinus （15 cases） involvements were most common in central nervous system affected patients. Left sphenoid （14 cases） and ethmoid sinus （13 cases） involvements were most common in orbit affected patients. Aspergillus species were the primary pathogens observed in 42 cases. Zygomycete, candida and dark filamentous fungus were observed in two, one and one case, respectively. Pathologically, 37 of the cases were chronic nongranulomatous type and the left 9 were chronic granulomatous type who were all immunocompetent hosts. The initial symptoms usually included headache, dizziness and nasal discomforts including nasal obstruction and purulent secretion. The chief complaints usually included headache, dizziness, and visual disturbances including blurred vision, vision loss or even blindness. Antifungal treatment combined with surgical interventions for removal or drainage focus lesions achieved significant effect, and 42 patients were cured. Conclusions Chronic invasive fungal rhinosinusitis should be taken into consideration in the presence of nasal discomforts or nonspecific symptoms such as headache and dizziness. The possibility of chronic invasive fungal rhinosinusitis should be cautious after t

关 键 词：慢性 真菌鼻-鼻窦炎 临床特征 治疗 

分 类 号：R765[医药卫生—耳鼻咽喉科]