不同真菌球性上颌窦炎特征分析(附49例报告)
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蚌埠医学院第一附属医院

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蚌埠医学院第一附属医院高新技术项目(No:2020112)


Analysis of characteristics of different fungal ball maxillary sinusitis (a report of 49 cases)
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    摘要:

    目的:探讨真菌球性上颌窦炎( fungal ball maxillary sinusitis,FBMS)的不同临床特点、治疗方法和疗效。方法 回顾分析我科2019年1月—2020年6月我院收治的真菌球性上颌窦炎49例患者的症状、体征、影像学特点、治疗方法和术后随访,对其不同临床特征和治疗特点进行总结和分析。结果:49例患者均明确诊断为FBMS。根据临床资料可分为4种不同的临床特征,分别为:①单纯FBMS 21例:主要临床症状为患侧头痛、脓涕、涕血、鼻塞;术中开放上颌窦并适当扩大窦口,术后给予鼻腔冲洗。②无症状型15例:此型主要是体检或者其它疾病检查无意发现,鼻窦影像学特点有典型的真菌性鼻窦炎特征;术中对上颌窦开放并适当扩大窦口,术后给予鼻腔冲洗。③合并鼻息肉8例:主要临床症状为患侧鼻塞、脓涕、头痛、头晕等症状。手术以切除鼻息肉,开放上颌窦并适当扩大窦口,术后安慢性鼻窦炎伴鼻息肉治疗同时给予鼻腔冲洗。④合并变应性鼻炎(allergic rhinitis AR)5例:主要临床症状为患侧涕血、鼻塞伴喷嚏、清涕、鼻痒等变应性鼻炎症状。术中可见病变窦腔内黏膜水肿,呈息肉样变。开放上颌窦并扩大窦口,术后给予变应性鼻炎治疗同时给予鼻腔冲洗。当病变位于上颌窦内下、底壁时,在0°内镜下加行改良泪前隐窝入路手术。结论:根据真菌球性上颌窦炎其不同临床特征进行分型有利于精准诊治;鼻内镜下不同手术入路可以减少术后复发,改善预后;伴有变应性鼻炎的患者需要药物治疗。

    Abstract:

    Objective:The aim of this study is to investigate the clinical features of different subtypes, treatment and curative effect of fungal ball maxillary sinusitis (FBMS). Methods: The symptoms, signs, imaging characteristics, treatment methods and postoperative follow-up of 49 patients with fungal bulbous maxillary sinusitis admitted to our department from January 2019 to June 2020 were retrospectively analyzed, and their different clinical characteristics and treatment characteristics were summarized and analyzed. Result: In this retrospective study, all the 49 patients were definitely diagnosed as FBMS. According to the clinical features, it can be divided into 4 different clinical characteristics, respectively as follows: ① Subtype1 simple FBMS: there were 21 patients in this subtype, The main clinical symptoms were headache, pus, runny blood and nasal obstruction on the affected side. Maxillary sinus was opened and sinus orifice was enlarged appropriately during the operation, and nasal irrigation was given after the operation. ②Subtype2 asymptomatic FBMS: there were 15 patients in this subtype, this type is mainly physical examination or other disease examination unintentionally found, sinus imaging characteristics have typical characteristics of fungal sinusitis; The maxillary sinus was opened intraoperatively and the sinus orifice was appropriately enlarged. ③ Subtype3 FBMS with nose polyp: there were 8 patients in this subtype ,main clinical symptom is suffer from the symptom such as side nose plug, pus nose, have a headache, giddy. Surgery was performed to remove the nasal polyp, open the maxillary sinus and expand the sinus orifice appropriately. ④ Subtype 4 FBMS with allergic rhinitis (AR): there were 5 patients in this subtype, the main clinical symptoms is suffering from side nasal blood, nasal congestion with sneezing, clear nose, nose itching and other allergic rhinitis symptoms. Intraoperatively, the mucosa of the sinus cavity was edematous and polypoid. The maxillary sinus was opened and the antrum was enlarged. When the lesion is located in maxillary sinus, bottom wall, inside line under 0 °endoscope and improved tear before surgery fossae. Conclusion: Classification according to different clinical characteristics of fungal bulbous maxillary sinusitis is conducive to accurate treatment. Different surgical approaches under nasal endoscope can reduce postoperative recurrence and improve prognosis; When patients with allergic rhinitis need medication..

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  • 收稿日期:2021-09-06
  • 最后修改日期:2021-11-09
  • 录用日期:2021-11-17
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