非侵袭性真菌性鼻窦炎.pptxVIP

非侵袭性真菌性鼻窦炎第1页/共21页 目录病因1临床表现2特征3诊断4治疗5第2页/共21页 病因真菌性鼻窦炎环境因素气候、职业全身因素糖皮质激素、免疫力低下局部因素鼻腔鼻窦通气引流障碍病原菌aspergillus、penicillium、monilia第3页/共21页 第4页/共21页 第5页/共21页 第6页/共21页 第7页/共21页 Click To Edit Title Style第8页/共21页 ClassificationChronic invasive fungal sinusitisAcute fulminant invasive fungal sinusitisAllergic fungal sinusitisSinus fungal ballInvasiveNon-invasive第9页/共21页 第10页/共21页 Sinus fungal ballSequestration of fungal elements within a sinus without invasion or granulomatous changesgrow while evading host immune system (no invasion)Aspergillus most common speciesMaxillary sinus most often involved (70-80% of cases)第11页/共21页 Diagnosis CT Scan:Single sinus in 59-94% of cases (maxillary)Complete or subtotal opacification of sinusBony sclerosis; destruction is rare (3.6-17% of cases)Biopsy = fungal elements第12页/共21页 第13页/共21页 TreatmentComplete surgical removal of fungal ballIrrigation of involved sinusesAntifungal therapyOnly if patient is high risk for invasive disease (very rare)Severely immunocompromisedContinued recurrence of disease despite proper medical/surgical managementConsider topical antifungal irrigation first and then systemic therapy if no improvement第14页/共21页 Allergic Fungal SinusitisFungal colonization resulting in allergic inflammation without invasionDiagnostic CriteriaEosinophlic mucin(组织病理学 黏蛋白)Nasal polyposis（鼻息肉或哮喘）Radiographic findings（典型影像学）Allergy to fungi（对霉菌过敏）第15页/共21页 第16页/共21页 第17页/共21页 第18页/共21页 TreatmentSurgicalRemove all mucinProvide permanent drainage and ventilation of affected sinuses(鼻窦开放)Systemic +/- topical steroids（糖皮质激素） - Immunotherapy第19页/共21页 SOUCE杨秀敏, 刘铭. 100 例真菌性鼻窦炎的病原菌分析[J]. 耳鼻咽喉: 头颈外科, 2000, 7(1): 9-13. 李永奇. 真菌性鼻窦炎的诊疗进展[J]. 国外医学: 耳鼻咽喉科学分册, 2003, 27(3): 162-166. 薛康. 鼻内镜手术治疗非侵袭性真菌性鼻窦炎 42 例[J]. 临床耳鼻咽喉头颈外科杂志, 2008, 22(17): 804-805. 张书文, 孙士铭. 真菌性鼻窦炎的 CT 与临床诊断[J]. 临床放射学杂志, 2002, 21(10): 778-780. GB/T 7714刘铭, 周兵, 刘华超, 等. 变应性真菌性鼻窦炎[J]. 中华耳鼻咽喉科杂志, 2002, 37(