真菌性上颌窦炎37例临床研究.docVIP

真菌性上颌窦炎37例临床研究[摘要] 目的：探讨真菌性上颌窦炎的诊断及治疗方法。 方法：总结分析37例真菌性上颌窦炎的临床表现、病理学检查及治疗效果。结果：37例主要临床症状有鼻塞、流清涕伴头痛，涕中带血并有腥臭味或排出带有腥臭味的豆腐渣样碎屑团块；CT表现为上颌窦内不均匀性软组织密度影，伴不同程度的积液并常伴有沙粒状、小条片状、团块状的钙化；病变组织为大小不等灰白色、灰黄色、灰绿色、黑褐色干酪样团块状物或泥沙样物，伴出血、坏死。本组采用柯-陆式手术，术后冲洗随访8个月～3 年，均无复发。 结论：侵袭性真菌性上颌窦炎早期以最终病理诊断为依据，治疗以鼻窦清创术联合抗菌药物为主。 [关键词] 真菌；上颌窦炎；柯-陆手术；诊断及治疗 [中图分类号]R782[文献标识码]B [文章编号]1673-7210（2007）12（c）-055-02 The clinical analysis of fungal rhino-sinusitis of 37 cases CHEN Le （The Department of ENT, The 3rd People＇s Hospital of Yangjiang of Guangdong Province,Yangjiang 529500,China） [Abstract] Objective:To investigate the diagnosis and treatment of the fungal rhino-sinusitis. Methods:37 cases of fungal rhino-sinusitis were analyzed by clinical manifestation, pathology and therapeutic effect.Results:The main clinical symptoms has nasal obstruction, nasal discharge accompanied with headache, nasal discharge accompanied with blood or little bits which liked tofukasu accompanied smell of fish; CT revealed that the soft tissue opacity with heterogeneous density in maxillary sinuses, accompanied with with sand-like, streaked or globular calcification; All the patients were performed Caldwell-Luc operation. Conclusion:The final diagnosis of fungal rhino-sinusitis is according to pathology. The method of treatment is that debridement of accessory nasal cavity, combined with antibacterials. [Key words] Fungal;Sinusitis;Caldwell-Luc operation; Treatment and diagnosis 真菌性上颌窦炎因其临床表现与慢性细菌性鼻窦炎或上颌窦恶性肿瘤相似，易于延误诊断和治疗。作者对37例真菌性上颌窦炎的临床表现及CT影像特征及治疗等进行分析总结，以提高临床工作者对本病的认识。 1 资料及方法 1.1一般资料 患者共37例，其中，男8例，女29例；年龄23～69岁，平均36岁。病程最长8年，最短3个月。37例患者均无打喷嚏症状，单侧发病，其中，左侧28例，右侧9例，伴筛窦侵犯者11例。主要临床症状：鼻塞、流清涕伴头痛19例；涕中带血并有腥臭味14例；鼻中排出带有腥臭味的豆腐渣样碎屑团块9例；头痛、面颊部肿胀感16例；患侧牙痛，面颊部麻木感8例；间歇低热2例。其他症状有泪溢、嗅觉减退等。检查见：鼻腔黏膜慢性充血35例；鼻腔外侧壁内移11例；鼻中隔不同程度偏曲8例；钩突肥大、息肉样变10例；中鼻甲息肉样变12例，中鼻道内有灰黄色、黑褐色污秽干酪样物13例；涂片检查为曲霉菌。37例术前均做鼻窦轴位或冠位CT检查，CT均示患侧上颌窦窦腔密度增高，示有软组织及骨质破坏，其中，上颌窦内侧壁破坏17例，前壁破坏6例，后外侧壁破坏3例，伴筛窦破坏8例，骨破坏区多呈骨质局限性缺损、消失，断端边缘锐利，无虫蚀样改变。窦腔软组织中有35例可见散在