Nithyanandam Suneetha, Jacob Moire S, Battu Ravindra R, Thomas Reji K, Correa Majorie A, D'Souza Ophelia
Department of Ophthalmology, St. John's National Academy of Health Sciences, Bangalore, India.
Indian J Ophthalmol. 2003 Sep;51(3):231-6.
The conventional management of rhino-orbito-cerebral (ROC) mucormycosis includes control of metabolic abnormality, administration of amphotericin B and surgery that spans simple sinus clearance, radical debridement and orbital exenteration. Recent literature includes anecdotal descriptions of successful treatment with conservative management of involved orbits. We evaluated the clinical features and outcome of treatment for the different stages of ROC mucormycosis.
In this retrospective case series, 34 case records of patients with a histopathological diagnosis of ROC mucormycosis treated between 1992 and 2000 were reviewed. Three clinical stages and three treatment groups were identified. Patients with limited sino-nasal disease (Clinical stage I) underwent sino-nasal debridement (Treatment group A). Patients with limited rhino-orbital disease (Clinical stage II) underwent either sino-nasal debridement alone (Treatment group A) or orbital exenteration in addition to sino-nasal debridement (Treatment group B). Patients with rhino-orbito-cerebral disease (Clinical stage III) did not undergo any surgical procedure (Treatment group C). Thirty-three patients received intravenous amphotericin B. Outcome for each group was measured as "Treatment success" (disease free, stable patient with metabolic abnormality under control) and "Treatment failure" (progression of disease with worsening general condition or mortality due to the disease).
Uncontrolled diabetes in 30 (88.2%) of 34 patients was the commonest underlying disease and 16 (53.3%) of 30 diabetics had ketoacidosis. Chronic renal failure (n = 4), hepatic disease (n = 3) and idiopathic thrombocytopenia (n = 1) were the other underlying diseases. Eleven patients had stage I disease, 16 patients had stage II disease and seven patients had stage III disease. All 11 patients with stage I disease received treatment A; of 16 patients with stage II disease, 7 received treatment A and the remaining with stage III disease received treatment B; 7 patients with stage II disease received treatment C. Ten of 11 patients (91%) with stage I disease had treatment success. In patients with stage II disease, 7 of 7 (100%) with treatment A and 1 of 9 (11.1%) with treatment B had treatment success. All seven patients with stage III disease had treatment failure.
Debridement of the sinuses is necessary in all cases of rhino-orbito-cerebral mucormycosis. Diagnosis in the early stage needs a high degree of suspicion. There is a definite role for retention of orbits in patients whose metabolic derangement is rapidly controlled and orbital involvement is non-progressive.
鼻眶脑型毛霉菌病的传统治疗包括控制代谢异常、给予两性霉素B以及手术治疗，手术范围涵盖单纯鼻窦清理、根治性清创术和眶内容摘除术。近期文献中有关于对受累眼眶进行保守治疗成功的病例描述。我们评估了鼻眶脑型毛霉菌病不同阶段的临床特征及治疗结果。
在这个回顾性病例系列研究中，我们回顾了1992年至2000年间34例经组织病理学诊断为鼻眶脑型毛霉菌病患者的病例记录。确定了三个临床阶段和三个治疗组。鼻窦疾病局限的患者（临床I期）接受鼻窦清创术（治疗组A）。鼻眶疾病局限的患者（临床II期）要么仅接受鼻窦清创术（治疗组A），要么在鼻窦清创术基础上进行眶内容摘除术（治疗组B）。鼻眶脑型疾病患者（临床III期）未接受任何手术治疗（治疗组C）。33例患者接受了静脉注射两性霉素B。每个组的治疗结果以“治疗成功”（无疾病，患者代谢异常得到控制且病情稳定）和“治疗失败”（疾病进展，全身状况恶化或因疾病死亡）来衡量。
34例患者中有30例（88.2%）存在未控制的糖尿病，这是最常见的基础疾病，3例糖尿病患者中有16例（53.3%）发生了酮症酸中毒。其他基础疾病包括慢性肾衰竭（4例）、肝病（3例）和特发性血小板减少症（1例）。11例患者为I期疾病，16例患者为II期疾病，7例患者为III期疾病。所有11例I期疾病患者接受了A组治疗；16例II期疾病患者中，7例接受了A组治疗，其余II期疾病患者接受了B组治疗；7例II期疾病患者接受C组治疗。11例I期疾病患者中有10例（91%）治疗成功。在II期疾病患者中，A组治疗的7例患者中有7例（100%）治疗成功，B组治疗的9例患者中有1例（11.1%）治疗成功。所有7例III期疾病患者治疗失败。
所有鼻眶脑型毛霉菌病病例均需进行鼻窦清创术。早期诊断需要高度怀疑。对于代谢紊乱迅速得到控制且眼眶受累无进展的患者，保留眼眶有明确作用。
Zotero 插件