毛霉菌性鼻窦炎25例临床特征分析
Clinical characteristics of mucormycotic rhinosinusitis in 25 cases
袁玥 1庞文会 1陈敏 1付圣尧 1于龙刚 1孙钰博 1李玲玲1
作者信息
- 1. 青岛大学附属医院 耳鼻咽喉头颈外科,山东 青岛 266003
- 折叠
摘要
目的 探讨侵袭性及非侵袭性毛霉菌性鼻窦炎患者的临床特征.方法 回顾性分析 25 例毛霉菌性鼻窦炎患者的临床特征,对两组患者的临床特点、治疗方法和预后进行总结分析.结果 非侵袭性毛霉菌性鼻窦炎多单侧发病,平均病程 6.83个月,临床表现以鼻塞(13/21)、脓涕(12/21)、头痛(11/21)和鼻内异味(9/21)常见,多无基础疾病(15/21),鼻窦CT表现为病变窦腔内软组织密度影伴钙化影(16/21).所有患者均采用鼻内镜手术治疗,术中见干酪样团块物(17/21),随访 6 个月无复发;侵袭性毛霉菌性鼻窦炎亦多单侧受累,平均病程 25.75 d,常见的临床表现为头痛(4/4)、眼部胀痛(3/4)和视力下降(3/4),均并发糖尿病(4/4),鼻窦CT示窦壁及周围骨质改变(4/4),采用鼻内镜手术联合口服抗真菌药物治疗,术中见大量霉菌团块及脓液(4/4)、窦壁及眶壁骨质破坏(3/4),随访 2 年,2 例未复发,2 例死亡.结论 非侵袭性毛霉菌性鼻窦炎临床少见,鼻內镜手术治疗是目前有效的治疗方法,通畅鼻腔鼻窦引流是治疗的关键,术后多无复发;侵袭性毛霉菌性鼻窦炎病程进展快,致死率高,尽早的手术与抗真菌药物的使用是治疗的关键.
Abstract
Objective This study aimed to explore the clinical characteristics of patients with invasive and non-invasive mucormycot-ic sinusitis.Methods We retrospectively analyzed 25 patients with mucormycotic sinusitis.The clinical characteristics,treatment methods,prognoses,and outcomes of the two groups of patients were analyzed.Results Non-invasive mucormycotic sinusitis mainly occurred unilaterally,with an average course of 6.83 months.The typical clinical manifestations were nasal congestion(13/21),purulent discharge(12/21),headache(11/21),and nasal odor(9/21).Most patients had no underlying diseases(15/21).CT revealed increased soft tissue density with calcification(16/21).All patients underwent endoscopic sinus surgery,during which cheese-like lumps were observed(17/21).No recurrence was observed during a follow-up of 6 months.Invasive mucormycotic si-nusitis was primarily unilateral,with an average course of 25.75 days.The typical clinical manifestations included headache(4/4),eye pain(3/4),and vision loss(3/4),and all patients were diabetic(4/4).CT findings revealed changes in the sinus walls and surrounding bones(4/4).The patients underwent endoscopic sinus surgery combined with antifungal medication.Numerous fungal masses with purulent discharge(4/4),and bone destruction of the sinus and orbital walls(3/4)were observed intraoperatively.After a 2-year follow-up,there was no incidence of recurrence in two patients;however,mortality was reported in two patients.Conclusion Non-invasive mucormycotic sinusitis,uncommon in clinical practice,can be treated effectively with endoscopic sinus surgery.Adequate nasal and sinus drainage is the key tosuccessful treatment and a low postoperative recurrence rate.Invasive mu-cormycotic sinusitis progresses rapidly and has a high mortality rate,for which early surgery and antifungal drugs are critical.
关键词
毛霉菌/鼻窦炎/侵袭性/鼻内镜手术Key words
Mucormycosis/Sinusitis/Invade/Endoscopic sinus surgery引用本文复制引用
出版年
2024
NETL
NSTL
万方数据