侵袭性真菌性鼻窦炎引发颅脑并发症的临床诊治  

Clinical diagnosis and treatment of craniocerebral complications caused by invasive fungal sinusitis

作　　者：严波[1] 危维[1] 杨晓彤[1] 彭晓林 YAN Bo;WEI Wei;YANG Xiaotong;PENG Xiaolin(Department of Otolaryngology Head and Neck Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院耳鼻咽喉头颈外科,北京100053

出　　处：《中国耳鼻咽喉颅底外科杂志》2023年第1期31-37,共7页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的 探讨侵袭性真菌性鼻窦炎(IFRS)引发颅脑并发症的临床表现、诊断、鼻内镜手术治疗及预后的可行性。方法 报道3例侵袭性真菌性鼻窦炎引发颅脑并发症的病例,包括额叶脑脓肿、脑膜炎、海绵窦血栓性静脉炎,并总结相关文献报道。结果 本组3例患者均行鼻内镜手术,病理确诊为毛霉菌感染,术后与神经内科协作进行规范的抗真菌药物治疗及定期鼻内镜复查,局部换药、鼻腔深海盐水冲洗等治疗后,均治愈。结论 侵袭性真菌性鼻窦炎引发颅脑并发症临床罕见,易漏诊、误诊,治疗十分棘手,鼻内镜手术彻底清除鼻窦原发灶,结合全身抗真菌治疗是非常有效的治疗策略。Objective To explore the clinical manifestations, diagnosis, transnasal endoscopic surgical treatment and prognosis of craniocerebral complications caused by invasive fungal sinusitis.Methods Clinical data of 3 cases suffered from craniocerebral complications caused by IFRS(invasive fungal rhino-sinusitis, IFRS) were reported, including cerebral abscess of frontal lobe(1 case), meningitis(1 case) and cavernous sinus thrombophlebitis(1 case), and relevant literature reports were summarized.Results All 3 patients in this group underwent transnasal endoscopic surgery, which were pathologically confirmed as mucor mycosis infection. All patients were cured after standard antifungal therapy, regular nasal endoscopic debridement, local dressing change, deep-sea saline irrigation and other treatments in collaboration with the neurology department.Conclusions Craniocerebral complications caused by IFRS were rare, easy to be missed and misdiagnosed. The treatment of the disease is very difficult. Transnasal endoscopic surgery combined with systemic antifungal therapy may be an effective treatment strategy.

关 键 词：侵袭性真菌性鼻窦炎 鼻源性颅脑并发症 鼻内镜手术 诊疗 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]