真菌球性上颌窦炎临床特征分析

Analysis of characteristics of different fungal ball maxillary sinusitis

摘要:

目的 探讨真菌球性上颌窦炎的不同临床特点、治疗方法和疗效。方法 回顾性分析2019年1月—2020年6月收治的49例真菌球性上颌窦炎患者的症状、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真菌球性上颌窦炎。根据临床资料可分为4种不同的临床特征：①单纯真菌球性上颌窦炎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他疾病检查无意发现，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，术后按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，当病变位于上颌窦前、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手术后复发，改善预后。

关键词:真菌球性;鼻窦炎;分型;鼻内镜手术;疗效

Abstract:

Objective To investigate the clinical features, treatment and curative effect of different subtypes of fungal ball maxillary sinusitis (FBMS).Methods The symptoms, signs, imaging characteristics, treatment methods and postoperative follow-up outcomes of 49 FBMS patients admitted to our department from Jan 2019 to June 2020 were analyzed retrospectively, and their clinical features and treatment characteristics were summarized and analyzed.Results All the 49 patients were definitely diagnosed as FBMS. According to the clinical features, they were divided into 4 different clinical types. The first type was simple FBMS (n=21). The main clinical symptoms of this type were headache, pus stuff, bloody nasal discharge and nasal obstruction on the affected side. Maxillary antrostomy was performed with appropriate enlargement of sinus orifice intraoperatively and postoperative nasal irrigation. The second was asymptomatic FBMS (n=15). No clinical symptoms were presented but with imaging characteristics of FBMS unintentionally revealed in physical examination or other disease examination. For this type, maxillary antrostomy with appropriate enlargement of sinus orifice was performed. The third type was FBMS with nasal polyps (n=8), and the major clinical symptoms were nasal obstruction, pus stuff, headache on the affected side and dizziness. Surgery was performed to resect the nasal polyps, open the maxillary sinus and expand the sinus orifice appropriately with postoperative management of chronic rhinosinusitis. The last one was FBMS with allergic rhinitis (n=5), the main symptoms included bloody nasal discharge on the affected side based on the symptoms of allergic rhinitis. Intraoperatively, the mucosa of the maxillary sinus cavity was revealed to be edematous and polypoid. Maxillary antrostomy with appropriate enlargement of sinus orifice was performed, and combined with improved prelacrimal recess approach in cases with lesion located in anterior, infero-medial part or bottom of maxillary sinus.Conclusions Classification according to clinical characteristics of FBMS is conducive to accurate treatment. Different surgical approaches under nasal endoscope can reduce postoperative recurrence and improve prognosis.

Key words:Fungal ball maxillary sinusitis;Subtype;Endoscopic nasal surgery;Curative effect