Stammberger H
Ann Otol Rhinol Laryngol Suppl. 1985 Sep-Oct;119:1-11. doi: 10.1177/00034894850940s501.
Chronic sinusitis and its complications are often caused or perpetuated by fungi. In Europe and North America Aspergillus species are the most common contaminants of the sinuses, with relatively few cases of mycoses caused by Mucor, Candida, Penicillium, Cladosporium, and Fusarium reported in the literature. Although Aspergillus and Mucor are mainly saprophytic, they may cause severe, potentially lethal complications. Consequently, therapy should include complete removal of the mycotic masses and prevention of reinfection. In nearly all cases in our experience, fungal diseases of the maxillary sinuses are secondary diseases, the pathologic conditions for which are created by chronic recurring sinusitis. Nasal endoscopy has shown that in most cases of recurring sinusitis, infection spreads from the nose into the larger sinuses, mostly from an infected anterior ethmoid. Maxillary and frontal sinuses are fully dependent on the pathophysiologic conditions in the anterior ethmoid because their ventilation and drainage pass through its complicated system of fissures and clefts into the middle nasal meatus. Endoscopic endonasal surgery of the diseased ethmoid is therefore an important element in our treatment schedule. Stenotic and/or chronically infected areas of the anterior ethmoid are identified by conventional or computed tomography. These areas then undergo endonasal operation under the guidance of rigid endoscopes. Diseased mucosa is removed, narrow or stenotic areas are widened, and the natural maxillary sinus ostium is enlarged. In many cases it is possible to remove all mycotic masses through this new window. Fenestration into the inferior nasal meatus is unnecessary with this method, and the sinus mucosa is usually left untouched. For follow-up treatment, instillations of antimycotic or antibiotic ointments are used. Even in cases of massive mucosal changes, the dependent sinuses, such as the frontal or maxillary sinuses, usually heal spontaneously after this procedure without having been treated directly. More than 140 patients with mycotic sinusitis, 48 of whom were studied and followed up for this paper, were treated by us during the last 8 years. The endoscopic surgical technique we have developed is described in detail.
慢性鼻窦炎及其并发症常由真菌引起或因真菌而迁延不愈。在欧洲和北美，曲霉菌属是鼻窦最常见的污染物，文献报道由毛霉菌、念珠菌、青霉菌、枝孢菌和镰刀菌引起的真菌病病例相对较少。虽然曲霉菌和毛霉菌主要是腐生菌，但它们可能会引起严重的、潜在致命的并发症。因此，治疗应包括彻底清除真菌团块并预防再次感染。根据我们的经验，几乎在所有病例中，上颌窦真菌病都是继发性疾病，其病理状况是由慢性复发性鼻窦炎造成的。鼻内镜检查显示，在大多数复发性鼻窦炎病例中，感染从鼻腔蔓延至较大的鼻窦，主要是从受感染的前组筛窦蔓延而来。上颌窦和额窦完全依赖于前组筛窦的病理生理状况，因为它们的通气和引流通过其复杂的裂隙系统进入中鼻道。因此，对患病筛窦进行鼻内镜下手术是我们治疗方案中的一个重要环节。通过传统或计算机断层扫描确定前组筛窦的狭窄和/或慢性感染区域。然后在硬式内镜引导下对这些区域进行鼻内手术。切除病变黏膜，扩大狭窄区域，扩大上颌窦自然开口。在许多情况下，通过这个新窗口可以清除所有真菌团块。用这种方法无需在下鼻道开窗，通常也不触动鼻窦黏膜。后续治疗采用抗真菌或抗生素软膏滴鼻。即使在黏膜有大量改变的病例中，像额窦或上颌窦这样的受累鼻窦，在此手术后通常也能自行愈合，无需直接治疗。在过去8年中，我们治疗了140多名真菌性鼻窦炎患者，其中48名患者为此接受了研究和随访。我们详细描述了所开发的内镜手术技术。
