Saedi B, Sadeghi M, Seilani P
Otolaryngology Department, Tehran University of Medical Sciences, Tehran, Iran.
J Laryngol Otol. 2011 Aug;125(8):807-10. doi: 10.1017/S0022215111001289. Epub 2011 Jun 10.
Mucormycosis is an aggressive fungal infection which may still cause fatal complications. However, the rarity of this disease has made optimal treatment a controversial issue. This study aimed to evaluate the use of topical amphotericin B in endoscopic management of rhinocerebral mucormycosis.
Thirty patients with infection limited to the nose and sinuses were selected. Patients underwent endoscopic debridement of all necrotic tissue; cottonoid pledgets soaked in amphotericin B solution were then placed in the nasal cavity. Subsequently, long-term antifungal therapy was administered.
The overall survival rate was 60 per cent (18 cases); survival rates in the diabetic and malignancy groups were 70.58 and 40 per cent, respectively. Apart from predisposing factors, orbital and maxillary sinus involvement also had a significant correlation with patient outcome.
Topical use of amphotericin B combined with endoscopic surgical debridement, followed by intravenous amphotericin B treatment, may constitute acceptable management for selected patients, with less morbidity than conventional treatments.
毛霉病是一种侵袭性真菌感染，仍可能导致致命并发症。然而，这种疾病的罕见性使得最佳治疗成为一个有争议的问题。本研究旨在评估局部使用两性霉素B在内镜治疗鼻脑型毛霉病中的应用。
选取30例感染局限于鼻腔和鼻窦的患者。患者接受了所有坏死组织的内镜清创术；然后将浸泡在两性霉素B溶液中的棉片置于鼻腔内。随后，给予长期抗真菌治疗。
总生存率为60%（18例）；糖尿病组和恶性肿瘤组的生存率分别为70.58%和40%。除了易感因素外，眼眶和上颌窦受累也与患者预后有显著相关性。
局部使用两性霉素B联合内镜手术清创，随后进行静脉注射两性霉素B治疗，对于部分患者可能是可接受的治疗方法，且发病率低于传统治疗。
