毛霉菌性鼻窦炎25例临床特征分析

doi:10.6040/j.issn.1673-3770.0.2023.192

摘要/Abstract

摘要： 目的探讨侵袭性及非侵袭性毛霉菌性鼻窦炎患者的临床特征。方法回顾性分析25例毛霉菌性鼻窦炎患者的临床特征,对两组患者的临床特点、治疗方法和预后进行总结分析。结果非侵袭性毛霉菌性鼻窦炎多单侧发病,平均病程6.83个月,临床表现以鼻塞(13/21)、脓涕(12/21)、头痛(11/21)和鼻内异味(9/21)常见,多无基础疾病(15/21),鼻窦CT表现为病变窦腔内软组织密度影伴钙化影(16/21)。所有患者均采用鼻内镜手术治疗,术中见干酪样团块物(17/21),随访6个月无复发;侵袭性毛霉菌性鼻窦炎亦多单侧受累,平均病程25.75 d,常见的临床表现为头痛(4/4)、眼部胀痛(3/4)和视力下降(3/4),均并发糖尿病(4/4),鼻窦CT示窦壁及周围骨质改变(4/4),采用鼻内镜手术联合口服抗真菌药物治疗,术中见大量霉菌团块及脓液(4/4)、窦壁及眶壁骨质破坏(3/4),随访2年,2例未复发,2例死亡。结论非侵袭性毛霉菌性鼻窦炎临床少见,鼻內镜手术治疗是目前有效的治疗方法,通畅鼻腔鼻窦引流是治疗的关键,术后多无复发;侵袭性毛霉菌性鼻窦炎病程进展快,致死率高,尽早的手术与抗真菌药物的使用是治疗的关键。

关键词: 毛霉菌, 鼻窦炎, 侵袭性, 鼻内镜手术

Abstract: Objective This study aimed to explore the clinical characteristics of patients with invasive and non-invasive mucormycotic sinusitis. Methods We retrospectively analyzed 25 patients with mucormycotic sinusitis. The clinical characteristics, treatment methods, prognoses, and outcomes of the two groups of patients were analyzed. Results Non-invasive mucormycotic sinusitis mainly occurred unilaterally, with an average course of 6.83 months. The typical clinical manifestations were nasal congestion(13/21), purulent discharge(12/21), headache(11/21), and nasal odor(9/21). Most patients had no underlying diseases(15/21). CT revealed increased soft tissue density with calcification(16/21). All patients underwent endoscopic sinus surgery, during which cheese-like lumps were observed(17/21). No recurrence was observed during a follow-up of 6 months. Invasive mucormycotic sinusitis was primarily unilateral, with an average course of 25.75 days. The typical clinical manifestations included headache(4/4), eye pain(3/4), and vision loss(3/4), and all patients were diabetic(4/4). CT findings revealed changes in the sinus walls and surrounding bones(4/4). The patients underwent endoscopic sinus surgery combined with antifungal medication. Numerous fungal masses with purulent discharge(4/4), and bone destruction of the sinus and orbital walls(3/4)were observed intraoperatively. After a 2-year follow-up, there was no incidence of recurrence in two patients; however, mortality was reported in two patients. Conclusion Non-invasive mucormycotic sinusitis, uncommon in clinical practice, can be treated effectively with endoscopic sinus surgery. Adequate nasal and sinus drainage is the key tosuccessful treatment and a low postoperative recurrence rate. Invasive mucormycotic sinusitis progresses rapidly and has a high mortality rate, for which early surgery and antifungal drugs are critical.

Key words: Mucormycosis, Sinusitis, Invade, Endoscopic sinus surgery

中图分类号:

R765.41

袁玥,庞文会,陈敏,付圣尧,于龙刚,孙钰博,李玲玲. 毛霉菌性鼻窦炎25例临床特征分析[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 102-107.

YUAN Yue, PANG Wenhui, CHEN Min, FU Shengyao, YU Longgang, SUN Yubo, LI Lingling. Clinical characteristics of mucormycotic rhinosinusitis in 25 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(4): 102-107.

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