Zhang J, Liu J, Xie M Q, Deng Z Y, Zhang T
Department of Otorhinolaryngology Head and Neck Surgery, Zhujiang Hospital of Southern Medical University,Guangzhou,510282,China.
Department of Otorhinolaryngology Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-sen University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Nov;30(22):1765-1768;1773. doi: 10.13201/j.issn.1001-1781.2016.22.005.
To further improve diagnosis and treatment for chronic fungal rhinosinusitis(CFRS). Forty patients with CFRS were treated with nasal endoscopic surgrey(ESS). The key-points of surgery were as follows: ①for single fungal sphenoid sinusitis, fracturing middle turbinate ourward or resecting one-third of posterior middle turbinate, enlarging the osseous ostium of sinus, removing sinus fungal ball and polypoid nucosa, and flipping mucosa of ostium inside sphenoid sinus to avoid narrow of ostium;②for fungal maxillary sinusitis, retaining uncinate process or resecting tail of uncinate process, enlarging ostium of maxillary sinus according to surgical field, and resecting lesion tissue;③for frontal-ethmoidal sinus lesion, routine treatment was performed; ④iodoform gauze packing the surgical cavity after soaking it with diluted iodine solution(1∶1) for 5 min. Pathological examination indicated that 39 cases were infected with fungus(38 cases with aspergillus and 1 case with mucor, respectively), including 4 cases in which lesion mucosa was invaded by fungus. Of these 39 cases,34 cured after receiving one operation, 4 cases relapsed and finally cured after receiving re-operation or outpatient treatment, 1 case had concomitant sphenoid sinus fibroblastoma with skull base invaded and was remitted after radiation therapy. In addition,1 case was diagnosed clinically as allergic fungal sinusitis although no fungus was found by culture and pathological examination, and the disease was not still controlled completely after several times of recurrence. No complication was observed for all of the cases. ESS is an effective treatment for CFRS, and intraoperative multi-point biopsy may be ignored easily.Confirming whether mucosa of sinus is invaded by fungus as well as pathogenic fungi types will have an important value for postoperative further treatment and reduction of recurrence. Concomitant disease should be considered for the cases with poor curative effect.
为进一步提高慢性真菌性鼻窦炎（CFRS）的诊治水平。对40例CFRS患者行鼻内镜手术（ESS）。手术要点如下：①对于单纯真菌性蝶窦炎，向外折断中鼻甲或切除后中鼻甲的1/3，扩大鼻窦骨性开口，清除鼻窦真菌球及息肉样黏膜，将蝶窦开口处黏膜翻入窦内以避免开口狭窄；②对于真菌性上颌窦炎，保留钩突或切除钩突尾部，根据术野扩大上颌窦开口，切除病变组织；③对于额筛窦病变，行常规处理；④用稀释碘液（1∶1）浸泡5分钟后的碘仿纱条填塞术腔。病理检查显示39例有真菌感染（分别为38例曲霉菌感染和1例毛霉菌感染），其中4例病变黏膜有真菌浸润。这39例中，34例一次手术后治愈，4例复发，经再次手术或门诊治疗后最终治愈，1例合并蝶窦纤维瘤侵犯颅底，放疗后缓解。此外，1例临床诊断为变应性真菌性鼻窦炎，虽培养及病理检查未发现真菌，且经多次复发后病情仍未完全控制。所有病例均未观察到并发症。ESS是治疗CFRS的有效方法，术中多点活检易被忽视。明确鼻窦黏膜是否有真菌浸润以及致病真菌类型对术后进一步治疗及减少复发有重要价值。对疗效不佳的病例应考虑合并症。
