Tarkan Ozgür, Karagün Barbaros, Ozdemir Süleyman, Tuncer Ulkü, Sürmelioğlu Ozgür, Cekiç Erdinç, Kara Karahan
Çukurova University, Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, Adana 01330, Turkey.
Int J Pediatr Otorhinolaryngol. 2012 Oct;76(10):1458-64. doi: 10.1016/j.ijporl.2012.06.021. Epub 2012 Jul 12.
Acute invasive fungal rhinosinusitis (AIFR) is an aggressive fungal infection in immunocompromised patients with high mortality rates. The aim of this study is to present our experiences on endonasal treatment in immunocompromised pediatric hematology-oncology patients with AIFR.
Thirteen pediatric hematology-oncology patients treated for AIFR between March 2006 and December 2011 were analyzed retrospectively. We reviewed the following data for all patients: age, gender, predisposing disease, initial symptoms, pathological diagnosis, microbiological results, laboratory findings, surgical procedure, number of operations and treatment outcomes.
Nine of 13 patients with lesions confined to sinonasal cavity were operated with endoscopic approach. Open surgery was performed in four patients, three of them had palatal and buccal lesions and one had facial skin involvement. Endoscopic approach was also used for sinonasal lesions of these four patients. A total of 7 patients died: 4 patients with progression of the underlying disease, 2 patients with sepsis and 1 patient due to renal failure. Survival rate in surgically treated patients was found 46% (6/13 patients).
Endonasal endoscopic approach is both feasible and efficient technique, also enables excellent local control with less morbidity compared to open surgery. This approach is suitable for patients who are diagnosed in the early stages of AIFR and also presents a less traumatic option for patients with poor health status. Open surgical procedure should be preferred in patients with disease extending out of the sinonasal cavity.
急性侵袭性真菌性鼻-鼻窦炎（AIFR）是一种发生于免疫功能低下患者的侵袭性真菌感染，死亡率很高。本研究的目的是介绍我们对免疫功能低下的儿科血液肿瘤患者AIFR进行鼻内治疗的经验。
回顾性分析2006年3月至2011年12月期间接受AIFR治疗的13例儿科血液肿瘤患者。我们回顾了所有患者的以下数据：年龄、性别、易感疾病、初始症状、病理诊断、微生物学结果、实验室检查结果、手术程序、手术次数和治疗结果。
13例病变局限于鼻窦腔的患者中有9例采用内镜手术。4例患者进行了开放手术，其中3例有腭部和颊部病变，1例有面部皮肤受累。这4例患者的鼻窦病变也采用了内镜手术。共有7例患者死亡：4例因基础疾病进展，2例因败血症，1例因肾衰竭。手术治疗患者的生存率为46%（6/13例患者）。
鼻内镜手术是一种可行且有效的技术，与开放手术相比，它能以较低的发病率实现良好的局部控制。这种方法适用于AIFR早期诊断的患者，对于健康状况较差的患者也是一种创伤较小的选择。鼻窦腔外病变的患者应首选开放手术。
