Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Uludağ University, Bursa, Turkey.
Otolaryngol Head Neck Surg. 2010 Nov;143(5):614-20. doi: 10.1016/j.otohns.2010.08.017.
Acute invasive fungal rhinosinusitis (AIFRS) is a serious disease with a high mortality and morbidity rate, which almost always affects immunocompromised patients and/or patients with diabetes mellitus. Our purpose was to present the diagnostic and therapeutic management and outcome of these patients.
Case series with chart review.
Tertiary care university hospital.
Twenty-six patients, who were operated on because of AIFRS between September 1999 and June 2009, were retrospectively evaluated in this study. Endoscopic surgery was used in 19 patients, and open surgical debridement was performed in seven patients.
Overall survival rate of the patients in the open surgery group (4 of 7; 57.1%) was similar to that of the endoscopically treated group (9 of 19; 47.3%). Thirteen patients (50%) died of complications related to the underlying disease (9 of 13; 69.2%) and AIFRS (4 of 13; 30.7%). AIFRS-specific survival rate is 76.5 percent; 90 percent (9 of 10) and 57.1 percent (4 of 7) for endoscopic and open surgery groups, respectively. Four patients who died had pathological diagnosis of mucormycosis (P = 0.52).
AIFRS can be successfully treated with a combination of endonasal surgical debridement and antifungal medications. Endonasal approach is suitable for patients diagnosed in the early stages of the disease and provides a less traumatic option in those patients who already have a poor health status. Open surgery should be preferred in the presence of intraorbital extension, palatinal, and/or intracerebral involvement. Reversing the underlying disease process and immunosuppression is as important as the surgical and antifungal treatment.
急性侵袭性真菌性鼻-鼻窦炎（AIFRS）是一种严重的疾病，死亡率和发病率都很高，几乎总是影响免疫功能低下的患者和/或糖尿病患者。我们的目的是介绍这些患者的诊断、治疗管理和结果。
病例系列回顾。
三级保健大学医院。
本研究回顾性评估了 1999 年 9 月至 2009 年 6 月期间因 AIFRS 接受手术的 26 名患者。19 名患者采用内镜手术，7 名患者采用开放性手术清创术。
开放性手术组（7 例中的 4 例；57.1%）和内镜治疗组（19 例中的 9 例；47.3%）的总体生存率相似。13 名患者（50%）死于与基础疾病（13 例中的 9 例；69.2%）和 AIFRS（13 例中的 4 例；30.7%）相关的并发症。AIFRS 特异性生存率为 76.5%；内镜和开放性手术组分别为 90%（9/10）和 57.1%（4/7）。4 例死亡患者的病理诊断为毛霉菌病（P=0.52）。
AIFRS 可以通过鼻内手术清创和抗真菌药物联合治疗成功治疗。鼻内入路适用于疾病早期诊断的患者，对于已经健康状况不佳的患者，提供了一种创伤较小的选择。在存在眶内延伸、腭和/或颅内累及的情况下，应首选开放性手术。逆转基础疾病过程和免疫抑制与手术和抗真菌治疗同样重要。
