真菌性鼻-鼻窦炎_医学论文.docVIP

真菌性鼻-鼻窦炎_医学论文 真菌性鼻-鼻窦炎_医学论文 作者：刘亭彦 彭华光 蒲章杰 蒋建华 【关键词】 真菌 【摘要】 目的 探讨真菌性鼻-鼻窦炎的发病、分类及诊治，提高临床医师的认识和诊治水平。方法 回顾性分析真菌性鼻-鼻窦炎26例的诊治过程，结合文献复习进行讨论。结果 随访6个月到5年，治愈率96. 15%；分泌物涂片真菌阳性率为92. 31%；真菌培养阳性率为69. 23%，曲霉菌属占83. 33%；全部病例均经病理检查确诊。结论 真菌性鼻-鼻窦炎的类型不同，其诊断标准、治疗原则各不相同，明确诊断依赖于思想重视、典型的分泌物、临床表现和CT检查及真菌学检查；彻底清理病变、术后定期复查是主要治疗手段。临床医师特别是中小医院临床医师(包括放射科医师)要进一步提高对本病的认识水平和诊治水平，尽量减少漏诊、误诊和误治。 【关键词】 真菌；鼻-鼻窦炎；诊断；治疗 【Ａbstract】 Ｏbjective To discuss the incidence,classification,diagnosis，and management of fungal rhinosinusitis (FRS).Methods 26 cases with FRS were analyzed retrospectively.5 Caldwell-Luc operations and 21 endoscopic operations were performed.The histological diagnosis was made on the mucous material.The secretion smear and culture of fungi were undergone.Postoperative check up were performed regularly.Ｒesults 25 cases had been followed up for 6 months to 5 years and the cure rate was 96. １５％（２５／２６）．The positive rates of the secretion smear and culture of fungi were 92. ３１%（２４／２６） and 69. ２３％(18／２６）．The histological diagnosis showed that 5 cases were chronic indolent fungal rhinosinusitis,18 cases were fungal ball and 3 were allergic fungal rhinosinusitis.Conclusion Diagnosis of FRS required a high index of suspicion.A confirmatory diagnosis was made from the typical secretion,clinical and CT findings along with careful mycological tests.Surgical debridement,regular postoperative check up and other essential therapy might provide long-term control of FRS.Clinic doctors should study hard and pay more attention to FRS. 【Key words】 fungi,rhinosinusitis,diagnosis,therapy 真菌性鼻-鼻窦炎(fungal rhinosinusitis,FRS)于1791年被首次报道［１］。到目前为止FRS的分类、诊断、治疗已趋于统一，并且都已有了基本标准，但是由于临床医师、特别是中小医院的临床医师主观上对本病认识匮乏，客观上受诊治条件制约，所以还存在不少问题，如漏诊、误诊、误治问题，全面准确的诊断问题，治疗的盲目性问题等。甚至已发表的文献中也存在着诊断不准确、分类模糊甚至错误的问题［２，３］。我们通过回顾性分析26例FRS的诊治，结合文献复习，对本病的发病情况、分类、诊断及治疗进行讨论，以期提高临床医师特别是中小医院临床医师对本病的认识水平和诊治水平，减少漏诊、误诊及误治。 １ 临床资料 １．１ 一般资料 26例患者中，男10例，女16例；年龄34～７０岁，平均年龄55. 4岁。病程2个月～１０年，平均1. 5年。单侧发病21例，双侧发病5例；有鼻塞者21例，脓性鼻漏者14例，血脓性鼻漏者10例，伴头