单侧真菌性上颌窦炎192例临床分析

Clinical Analysis of 192 Cases of Fungal Maxillary Sinusitis

摘要: 目的：探讨真菌性上颌窦炎临床特点。方法：回顾性分析2008年1月~2018年1月海军军医大学附属长征医院、福建龙海第一医院以及解放军联勤保障部队909医院耳鼻咽喉头颈外科收治的285例真菌性鼻窦炎患者中192例单侧上颌窦发病患者临床资料，均经手术病理检查证实。分析其临床表现、诊断、治疗及转归等，总结临床特点。结果：临床分型多见非侵袭型，好发于单侧，主要临床特征为鼻塞、涕血；CT显示上颌窦腔内不均匀软组织密度影，部分伴窦壁骨质增生硬化与局限性骨质破坏；根据上颌窦气化发育的情况以及真菌所在的范围分别行鼻内镜下单纯中鼻道开窗入路、鼻内镜辅助下的柯–陆氏入路、鼻内镜辅助下的中鼻道联合下鼻道开窗入路以及鼻内镜辅助下的泪前隐窝入路进行治疗，术中无明显并发症，仅少数患者术后出现面部肿胀及鼻腔少许渗血现象；术后6个月评估疗效，病情完全控制153例，病情部分控制25例，有效率92.7%，术后随访12个月，复发率7.3%。结论：真菌性上颌窦炎多见非侵袭型，且病变多发于单侧，主要临床特征为鼻塞、涕血，术前CT检查可辅助诊断。鼻内镜辅助下的多种入路手术为该病治疗首选方式，安全有效，值得临床推广。

Abstract: Objective: To investigate the clinical characteristics of fungal maxillary sinusitis. Methods: The clinical data from January 2008 to January 2018, 285 patients with fungal sinusitis were admitted to Changzheng Hospital affiliated to Naval Military Medical University, Longhai First Hospital of Fujian Province and People’s Liberation Army Joint Service Support Force 909 Hospital. 192 pa-tients with fungal maxillary sinusitis were retrospectively analyzed, all confirmed by surgical pathological examination. The clinical manifestations, diagnosis, treatment and outcome were an-alyzed, and the clinical characteristics were summarized. Results: Clinical classification is mostly non-invasive type, which mostly occurs in one side. The main clinical feature is nasal obstruction and bloody nose. CT showed the uneven soft tissue density shadow in the maxillary sinus cavity, some of which were accompanied by bone hyperplasia and sclerosis in the sinus wall and localized bone destruction. According to the gasification development of the maxillary sinus and the scope of the fungus, the following four surgical methods were selected: middle nasal meatus fenestration under nasal endoscopy, nasal endoscope assisted maxillary sinus radical, middle and inferior nasal meatus combined fenestration under nasal endoscopy and nasal endoscopic anterior lacrimal recess approach; there were no obvious complications during the operation. Only a few patients showed local bleeding or facial swelling after the operation. Six months after surgery, 153 cases were cured, 25 cases were improved, and the effective rate was 92.7%. After 12 months of follow-up, the recurrence rate was 7.3%. Conclusion: Fungal maxillary sinusitis is mostly non-invasive, and the lesions are mostly unilateral. The main clinical features are nasal obstruction and bloody nose. Preoperative CT examination can assist diagnosis. Nasal endoscopic surgery is the first choice for the treatment of this disease, safe and effective, worthy of clinical promotion.