以视功能障碍为主诉的孤立性真菌球型蝶窦炎的临床分析  

Clinical analysis of patients with sphenoid fungal ball related visual disturbances

作　　者：石鹏宇 刘承耀[1] 魏洪政[1] 李云川[1] SHI Pengyu;LIU Chengyao;WEI Hongzheng;LI Yunchuan(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing,100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730

出　　处：《中国耳鼻咽喉头颈外科》2022年第10期638-640,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金(81070768);吴阶平临床研究特别资助基金(320.6750)。

摘　　要：目的分析以视力障碍为主诉的蝶窦炎临床特点及治疗。方法选取2009年9月29日~2019年4月11日于首都医科大学附属北京同仁医院因视功能障碍为主诉的24例真菌球型蝶窦炎患者进行临床资料分析及随访研究。结果患者临床表现为视功能障碍,包括视力下降20例(24眼),复视9例(11眼),上睑下垂5例(7眼),视野缺损2例(2眼)。术前视力在无光到20/25之间。头痛(22例)是最常见的临床表现,常出现在视功能障碍之前。经过平均44.6个月(1~10年)随访,20眼视力均有提高,4眼无明显改善。其他症状恢复。结论当患者临床表现为视功能障碍时,如若伴随持续性头痛,应考虑蝶窦来源的疾病。在经药物保守治疗无效后,应尽早实行内镜手术。OBJECTIVE To evaluate the important role of paranasal sinus fungal ball in patients with visual disturbances as main complaints.METHODS Clinical data of 24 patients with sphenoid sinus fungal ball who were firstly diagnosed with optic neuritis treated by medical therapy ineffectively in Beijing Tongren Hospital from September 29,2009 to April 11,2019.RESULTS The symptoms of visual disturbances included different extents of defects in visual acuity(24 eyes),diplopia(11 eyes),ptosis(7 eyes),visual field defect(2 eyes).The preoperative visual acuities were between no light perception to 20/25.Headache(22 patients)was the most common symptom,and it often appeared before visual symptoms.After a mean 44.6 months(range 1-10 years)follow-up,the visual acuities of 20 eyes improved from no light perception to 20/13,and 4 eyes showed no improvement.Other symptoms showed different degrees of recovery.CONCLUSION When a patient presents clinically with visual disturbances,a disease of sphenoid sinus origin should be considered if it is accompanied by persistent headache.Endoscopic surgery should be performed as soon as possible whether conservative treatment with medications has failed or not.

关 键 词：蝶窦 真菌 视觉障碍 视神经 鼻窦炎 

分 类 号：R765.44[医药卫生—耳鼻咽喉科]