Ochi J W, Harris J P, Feldman J I, Press G A
Division of Head and Neck Surgery, University of California, San Diego 92103.
Laryngoscope. 1988 Dec;98(12):1339-42. doi: 10.1288/00005537-198812000-00011.
Rhinocerebral mucormycosis is a fulminant, devastating fungal disease. The use of amphotericin B, combined with aggressive surgical debridement, has increased survival rates from approximately 20% to 70%. Eleven patients with this rare disease have been treated over the past 6 years. Therapy with amphotericin B was begun in all patients as soon as the diagnosis of mucormycosis was suspected. Seven patients underwent aggressive surgical debridement; all seven had disease involving the sphenoethmoidal complex, requiring external ethmoidectomy with or without sphenoidotomy. Six patients had maxillary sinus disease, requiring Caldwell-Luc antrostomy or maxillectomy. Three patients required orbital exenteration. Surgery was performed within 24 hours of diagnosis on all but two of our patients. Despite prompt diagnosis, aggressive surgical debridement, therapy with amphotericin B, and correction of metabolic acidosis, our mortality rate was 82%. Rhinocerebral mucormycosis remains a rapidly progressive, frequently fatal disease.
鼻脑型毛霉菌病是一种暴发性、毁灭性的真菌疾病。两性霉素B联合积极的手术清创治疗已使生存率从约20%提高到70%。在过去6年中，已有11例患有这种罕见疾病的患者接受了治疗。一旦怀疑诊断为毛霉菌病，所有患者均立即开始使用两性霉素B进行治疗。7例患者接受了积极的手术清创；所有7例患者的疾病均累及蝶筛复合体，需要进行外部筛窦切除术，可选择或不进行蝶窦切开术。6例患者患有上颌窦疾病，需要进行柯-陆氏鼻窦切开术或上颌骨切除术。3例患者需要进行眶内容摘除术。除2例患者外，所有患者均在诊断后24小时内接受了手术。尽管诊断及时、积极进行手术清创、使用两性霉素B治疗以及纠正代谢性酸中毒，但我们的死亡率仍为82%。鼻脑型毛霉菌病仍然是一种进展迅速、常导致死亡的疾病。
