真菌性鼻-鼻窦炎鼻石形成致鼻中隔穿孔1例并文献复习

A case of nasal septal perforation caused by fungal sinusitis with rhinolith

摘要:

目的通过分析1例真菌性鼻-鼻窦炎（FRS）鼻石形成致鼻中隔穿孔患者的临床资料，总结该疾病的诊疗方案，以提高对该病的认识。方法患者，男，55岁，因“反复嗅到臭味5年余，伴左侧头痛1周”入院，入院后完善影像学等相关检查，提示：FRS、鼻石症及鼻中隔穿孔，于全身麻醉鼻内镜下行左侧鼻窦开放＋鼻腔肿块切除＋鼻中隔修补术。结果患者手术顺利，术后第4天出院，术后随访半年，鼻中隔穿孔修补满意，鼻腔黏膜无水肿，各鼻窦开放口良好，鼻道及窦腔内均未见异常分泌物。至今未见复发。结论FRS鼻石形成致鼻中隔穿孔较少见，临床表现缺乏特异性，诊断主要依靠影像学检查及病理学检查，手术切除为主要治疗手段，术后有复发的可能，应注意随访。

Abstract:

ObjectiveTo analyze the clinical data of a patient with nasal septal perforation caused by fungal rhinosinusitis (FRS)due to rhinolith formation, and the diagnosis and treatment of this disease are summarized to improve the understanding of this disease.MethodsA 55yearold male patient was admitted to hospital with "repeated odor for more than 5 years, accompanied by left headache for 1 week". After admission, results of imaging and other relevant examinations suggested that the patient had fungal sinusitis, rhinoliphosis and nasal septum perforation. The patient underwent left nasal sinus opening, nasal mass resection and perforation repair under general anesthesia and nasal endoscopy.ResultsThe patient was discharged from hospital on the 4th day after the operation. The patient was followed up for half a year postoperation. The perforation of the nasal septum was repaired satisfactorily, which is no edema over the nasal mucosa. The opening of each sinus was good, and no abnormal secretions were found in the nasal passage and sinus cavity.No recurrence has been seen so far.ConclusionsThe nasal septal perforation caused by FRS due to rhinolith formation is rare in clinic. The clinical manifestations are lack of specificity，and the diagnosis of this disease mainly depends on imaging and pathological examination. Surgical resection is the main treatment method.It should be closely followed up because postoperative recurrence is possible.