Zieske L A, Kopke R D, Hamill R
Department of Surgery, Tripler Army Medical Center, HI 96859-5000.
Otolaryngol Head Neck Surg. 1991 Oct;105(4):567-77. doi: 10.1177/019459989110500408.
Six cases of dematiaceous fungal sinusitis are reported, together with a review of 33 other cases collated from a review of the English literature. The sinusitis was more often unilateral vs. bilateral. A characteristic serpiginous hyperdense intrasinus opacification, as well as sinus expansion with bone erosion, was often seen on CT scan. MRI scan showed lucent sinus cavities on T1 and T2 weighting. A comparison of surgical treatment vs. surgery with systemic antifungal therapy revealed decreased recurrence and complication statistics in the combined therapy group. There was a trend toward increased recurrence/persistence and complications associated with invasive histologic findings and only surgical treatment, but not statistically significant. At the present time, we recommend comprehensive surgical treatment followed by systemic antifungal therapy, though clinical judgment and individualization should occur. Future studies are planned to further define the disease entity and its therapy.
本文报告了6例暗色丝孢霉性真菌性鼻窦炎病例，并对从英文文献综述中整理出的其他33例病例进行了回顾。鼻窦炎多为单侧而非双侧。CT扫描常可见特征性的匐行性高密度鼻窦内混浊影，以及鼻窦扩张伴骨质侵蚀。MRI扫描在T1和T2加权像上显示鼻窦腔呈低密度影。手术治疗与手术联合全身抗真菌治疗的比较显示，联合治疗组的复发率和并发症统计数据有所降低。侵袭性组织学表现且仅接受手术治疗的患者有复发/持续存在及并发症增加的趋势，但无统计学意义。目前，我们建议采用综合手术治疗，随后进行全身抗真菌治疗，不过应结合临床判断并个体化处理。计划开展进一步研究以更明确该疾病实体及其治疗方法。
