真菌性蝶窦炎的临床特征及手术疗效分析  

Analysis of the clinical characteristics and postoperative efficacy of fungal sphenoid sinusitis

作　　者：谢铠鹏 康渊春 刘海斌 邹柳凤 彭浒 纪振华 程寅 杨子轩 陈进璜 张国民 伍小琴 Xie Kaipeng;Kang Yuanchun;Liu Haibin;Zhou Liufeng;Peng Hu;Ji Zhenhua;Cheng Yin;Yang Zixuan;Chen Jinxuan;Zhang Guomin;Wu Xiaoqin(Department of Otolaryngology Head and Neck Surgery,PLA Support Force No.909 Hospital,Zhangzhou 363000,Fujianprovince,China;Department of Otolaryngology Head and NeckSurgery,Longhai First Hospital,Zhangzhou 363100,Fujian province,China;Department of Otolaryngology Head and Neck Surgery,the Affiliated to the Naval Military Medical University,Shanghai 200003,China)

机构地区：[1]解放军联勤保障部队第909医院耳鼻咽喉头颈外科,福建漳州363000 [2]龙海市第一医院耳鼻咽喉头颈外科,福建漳州363100 [3]海军军医大学附属长征医院耳鼻咽喉头颈外科,上海200003

出　　处：《中国临床解剖学杂志》2021年第4期473-476,共4页Chinese Journal of Clinical Anatomy

基　　金：国家自然基金项目(81770980)。

摘　　要：目的探讨真菌性蝶窦炎的临床及影像学特征,评估鼻内镜手术治疗该病的临床效果。方法回顾性分析2008年1月~2018年1月3家医院收治的67例真菌性鼻窦炎侵及蝶窦患者的临床资料,总结其临床表现及影像学特点。所有患者接受鼻内镜下蝶窦开放、病灶清除术,术后随访6~12月,评估手术疗效,主观症状采用视觉模拟评分(VAS),客观体征采用Lund-Kennedy评分,比较术前与术后3、6、12个月的差异。结果本组67例均经1次手术痊愈,术后无严重并发症发生。VAS评分术前为(8.34±1.36)分,术后持续下降,术后3个月为(2.45±1.06)分,术后6个月为(1.65±1.24)分,术后12个月为(1.21±0.66)分。Lund-Kennedy评分术前为(8.42±1.16)分,术后3、6、12个月分别下降为(2.56±0.86)、(1.74±1.16)、(1.15±0.76)分。两种评分术前与术后差异均有统计学意义(P<0.001)。结论真菌性蝶窦炎以头痛为主要症状,无特殊规律性,内镜检查可见蝶筛隐窝黏膜水肿、窦口有干酪样分泌物及黏脓性分泌物,CT影像特征为蝶窦腔内不均匀的软组织密度影,其内有高密度斑片状钙化影,窦壁骨质有硬化增厚。根据不同范围的病变,采用全麻下鼻内镜或鼻内镜辅助开放手术治疗真菌性蝶窦炎是一种简便、安全、有效的方法。Objective To explore the clinical and imaging characteristics of fungal sphenoid sinusitis and to evaluate the clinical effect of nasal endoscopy surgery.Methods The clinical data of 67 patients admitted to the department of Otonolaryngosis Head and Neck Surgery of the following hospitals from January 2008 to January 2018 were retrospectively analyzed(the PLA Joint Service Protection Force 909 Hospital,Longhai City First Hospital and the Affiliated to the Naval Military Medical University).The clinical and imaging characteristics of the 67 patients with fungal sphenoid sinus invasion and sphenoid sinus were summarized.All patients received endoscopic sphenoid sinus opening and lesions removal surgery,and were followed up for 6 months to 12 months to evaluate the surgical efficacy.Visual analog scale(VAS)was used for subjective disease assessment,while the Lund-Kennedy scoring was used for objective disease.The differences between preoperative and postoperative 3,6 and 12 months were compared.Results All 67 cases were cured by one operation,and none of them had serious complications after surgery.The VAS score was(8.34±1.36)preoperatively,but decreased continuously.The VAS score of 3,6,12 months after surgery were(2.45±1.06)points,(1.65±1.24)points,(1.21±0.66),respectively.Lund-Kennedy's score was(8.42±1.16)before surgery,but decreased to(2.56±0.86),(1.74±1.16),(1.15±0.76)at 3,6,12 months after surgery,respectively.There were statistical differences in the VAS score and Lund-Kennedy's score before and after surgery(P<0.001).Conclusions The main symptoms of fungal sphenoid sinusitis is headache without any regularity.Endoscopic examination showed mucosal edema in the sphenoidal crypt,and there are caseous and mucinous secretions at the sinus orifice.CT images are characterized by uneven soft tissue density shadow in the sphenoidal sinus cavity,with high-density plaque-like calcification shadow,and thickening of the bone in sinus wall.According to different ranges of lesions,it is a simple,safe and effective

关 键 词：蝶窦 真菌性病变 临床特征 内镜 手术 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]