Choi S S, Milmoe G J, Dinndorf P A, Quinones R R
Department of Otolaryngology-Head and Neck Surgery, Children's National Medical Center, George Washington University, Washington, DC, USA.
Arch Otolaryngol Head Neck Surg. 1995 Oct;121(10):1188-92. doi: 10.1001/archotol.1995.01890100092016.
To evaluate the following: the incidence of invasive Aspergillus sinusitis (AS); the value of surveillance nasal cultures and screening radiologic studies in predicting AS; the clinical criteria used to decide on surgical biopsy in patients suspected of having AS; the surgical and medical management of AS; and the outcome of AS in the peritransplantation period of children who underwent bone marrow transplantation.
Retrospective medical chart review.
Tertiary care children's hospital.
Eighty pediatric patients who underwent bone marrow transplantation for a variety of refractory malignant neoplasms or lymphohematopoietic disorders at the Children's National Medical Center, Washington, DC, from April 1, 1988, to September 30, 1993.
Diagnostic surgical biopsies, surgical débridement, and treatment with amphotericin B.
Resolution of AS and discharge from the hospital.
Seventy-two patients had screening sinus radiographs, 27 of which showed abnormalities. Aspergillus sinusitis developed in three of the patients with abnormal screening radiographs. Fifty-eight patients had screening nasal cultures. One culture was positive for Aspergillus, and histopathologically proved AS developed in this patient. Twelve diagnostic biopsies were done in nine patients. Three biopsy specimens showed histopathologic evidence of AS. The three patients with AS were successfully treated with aggressive surgical and medical therapy and were discharged from the hospital.
The incidence of AS was 4% (3/80) in the patients who underwent bone marrow transplantation. Screening radiographs, while not a good predictor of AS, have a role in evaluation of patients undergoing bone marrow transplantation to define preexisting sinus disease. Screening nasal cultures do not reliably predict AS. When AS is suspected and diagnostic biopsy is considered, the seven clinical criteria outlined in this article should be used. Survival of immunocompromised patients with AS requires early diagnosis and aggressive surgical and medical therapy.
评估以下内容：侵袭性鼻窦曲霉菌病（AS）的发病率；监测鼻腔培养及筛查性影像学检查在预测AS方面的价值；用于决定对疑似AS患者进行手术活检的临床标准；AS的手术及药物治疗；以及接受骨髓移植的儿童在移植围手术期AS的转归。
回顾性病历审查。
三级医疗儿童医院。
1988年4月1日至1993年9月30日期间在华盛顿特区儿童国家医疗中心因各种难治性恶性肿瘤或淋巴造血系统疾病接受骨髓移植的80名儿科患者。
诊断性手术活检、手术清创及两性霉素B治疗。
AS的缓解及出院情况。
72例患者进行了鼻窦筛查X线片检查，其中27例显示异常。筛查X线片异常的3例患者发生了鼻窦曲霉菌病。58例患者进行了鼻腔筛查培养。1例培养结果曲霉菌阳性，该患者经组织病理学证实发生了AS。9例患者进行了12次诊断性活检。3份活检标本显示有AS的组织病理学证据。3例AS患者通过积极的手术及药物治疗成功治愈并出院。
接受骨髓移植的患者中AS的发病率为4%（3/80）。筛查X线片虽不是AS的良好预测指标，但在评估接受骨髓移植的患者以明确既往鼻窦疾病方面有一定作用。鼻腔筛查培养不能可靠地预测AS。当怀疑AS并考虑进行诊断性活检时，应采用本文概述的7项临床标准。免疫功能低下的AS患者存活需要早期诊断及积极的手术和药物治疗。
