蝶窦真菌球的临床特征回顾性分析
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摘要
目的通过分析蝶窦真菌球的临床特点,进一步提高其早期诊断率和治疗效果。方法回顾分析2012年3月～2016年6月在我科手术并经病理确诊的21例蝶窦真菌球患者的临床资料,总结蝶窦真菌球的一般特点、临床症状、鼻窦CT表现及鼻内镜手术治疗效果。结果蝶窦真菌球发病年龄多在40岁以上,平均年龄为48.2岁,多单侧发病(95.2%),23.8%患者首次在耳鼻喉科就诊。最常见症状为头痛(85.7%),多出现在眶部(50%),鼻部症状包括鼻塞及脓涕(19.0%)、涕中带血(14.3%)、鼻腔异味(9.5%)、嗅觉减退(9.5%)等。13例有明显鼻中隔偏曲,1例患侧嗅裂内有明显息肉。仅有1例合并糖尿病。常见鼻窦CT表现为病变蝶窦腔软组织影中有微小钙化影或密度不均匀软组织影(81.0%),同时可伴局部骨质增厚、硬化(52.4%),也可出现骨质破坏(9.5%)或类似于蝶窦炎密度均匀一致的软组织影(19.0%)。所有患者均在全身麻醉下行鼻内镜手术,术后病理符合真菌块和黏膜慢性炎。术后随访至少半年以上,无复发病例。结论蝶窦真菌球最常见的临床症状是头痛,鼻腔结构性病变可能是其发生的主要原因。鼻窦CT诊断特异性较强,鼻内镜下蝶窦开放手术是最有效的治疗方法。
Objective To analyze the clinical characteristics of sphenoid sinus fungus ball(SSFB) in order to enhance the diagnosis rate and the therapeutic effect at early stage. Methods Clinical data of 21 patients pathologically diagnosed as SSFB hospitalized from Mar. 2012 to Jun. 2016 were reviewed retrospectively. The general characteristics,clinical symptoms,computed tomography(CT) findings and the therapeutic effect of endoscopic surgery of SSFB were summarized. Results The age of the patients was more than 40 years,with mean age of 48.2 years. SSFB lmostly occurred in the unilateral sinus cavity. Headache(85.7%) was the most common symptom,50% of which occurred in the orbital part,followed by nasal symptoms,including purulent rhinorrhea and nasal obstruction(19.0%),rhinorrhea with blood(14.3%),peculiar smell in the nasal cavity(9.5%),and hyposmia(9.5%).Physical examination found that 13 patients had significant nasal septal deviation,and one patient had significant nasal polyp in the olfactory cleft. Only one patient suffered from diabetes mellitus. The major CT findings showed heterogeneous opacification with small calcification(81%),accompanied by bony sclerosis and thickening of the bony wall(52.4%) or local bone destruction(9.5%). Sometimes CT also found the sign of homogeneous density like sphenoid sinusitis. All patients had accepter surgery under general anesthesia. Postoperative pathology presented masses of fungi and chronic mucosal inflammatory reaction. No recurrence of SSFB occurred after endoscopic surgery.Conclusions Headache is the most common symptom of SSFB. The nasal lesions of abnormal structure may be the major factor. CT findings are specific in the diagnosis of SSFB and endoscopic sphenoidotomy with removal of the fungus ball is an effective treatment approach.
Objective To analyze the clinical characteristics of sphenoid sinus fungus ball(SSFB) in order to enhance the diagnosis rate and the therapeutic effect at early stage. Methods Clinical data of 21 patients pathologically diagnosed as SSFB hospitalized from Mar. 2012 to Jun. 2016 were reviewed retrospectively. The general characteristics,clinical symptoms,computed tomography(CT) findings and the therapeutic effect of endoscopic surgery of SSFB were summarized. Results The age of the patients was more than 40 years,with mean age of 48.2 years. SSFB lmostly occurred in the unilateral sinus cavity. Headache(85.7%) was the most common symptom,50% of which occurred in the orbital part,followed by nasal symptoms,including purulent rhinorrhea and nasal obstruction(19.0%),rhinorrhea with blood(14.3%),peculiar smell in the nasal cavity(9.5%),and hyposmia(9.5%).Physical examination found that 13 patients had significant nasal septal deviation,and one patient had significant nasal polyp in the olfactory cleft. Only one patient suffered from diabetes mellitus. The major CT findings showed heterogeneous opacification with small calcification(81%),accompanied by bony sclerosis and thickening of the bony wall(52.4%) or local bone destruction(9.5%). Sometimes CT also found the sign of homogeneous density like sphenoid sinusitis. All patients had accepter surgery under general anesthesia. Postoperative pathology presented masses of fungi and chronic mucosal inflammatory reaction. No recurrence of SSFB occurred after endoscopic surgery.Conclusions Headache is the most common symptom of SSFB. The nasal lesions of abnormal structure may be the major factor. CT findings are specific in the diagnosis of SSFB and endoscopic sphenoidotomy with removal of the fungus ball is an effective treatment approach.
引文
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[6]朱新华,刘月辉,汪美群,等.真菌性蝶窦炎的诊断及治疗[J].山东医药,2009,49(42):46-47.
[7]徐桂花,张世华,钟凯人.真菌性筛窦炎及蝶窦炎引发上睑下垂1例[J].汕头大学医学院学报,2010,23(3):175.
[8] JIANG Z,ZHANG K,HUANG W,et al. A preliminary study on sinus fungus ball with micro CT and X-Ray fluorescence technique[J]. PLo S One,2016,11(3):e0148515.
[9]洪志军,曹志伟,顾兆伟,等.真菌球型真菌性鼻窦炎的CT特征及诊断[J].中国耳鼻咽喉颅底外科杂志,2009,15(6):440-444.
[10] BROGLIE M A,TINGUELY M,HOLZMAN D,et al. How to diagnose sinus fungus balls in the paranasal sinus? An analysis of an institution's cases from January 1999 to December 2006[J].Rhinology,2009,47(4):379-384.
[11] ELOY P,GRENIER J,PIRLET A,et al. Sphenoid sinus fungal ball:a retrospective study over a 10-year period[J]. Rhinology,2013,51(2):181-188.
[12]古庆家,李静娴,樊建刚,等.孤立性蝶窦病变临床分析[J].中国耳鼻咽喉头颈外科,2013,20(2):109-110.
[2] KARKAS A,RTAIL R,REYT E,et al. Sphenoid sinus fungus ball[J]. Eur Arch Otorhinolaryngol,2013,270(3):893-898.
[3]王媛媛,陈丹,陈璐,等.真菌球型蝶窦炎的临床特点分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(1):48-51.
[4] KIM J S,KIM B K,HONG S D,et al. Characteristics of sphenoid sinus fungal ball patients with visual disturbance[J]. Clin Exp Otorhinolaryngol,2016,9(4):326–331.
[5] LIM H S,YOON Y H,XU J,et al. Isolated sphenoid sinus fungus ball:a retrospective study conducted at a tertiary care referral center in Korea[J]. Eur Arch Otorhinolaryngol, 2017,274(6):2453-2459.
[6]朱新华,刘月辉,汪美群,等.真菌性蝶窦炎的诊断及治疗[J].山东医药,2009,49(42):46-47.
[7]徐桂花,张世华,钟凯人.真菌性筛窦炎及蝶窦炎引发上睑下垂1例[J].汕头大学医学院学报,2010,23(3):175.
[8] JIANG Z,ZHANG K,HUANG W,et al. A preliminary study on sinus fungus ball with micro CT and X-Ray fluorescence technique[J]. PLo S One,2016,11(3):e0148515.
[9]洪志军,曹志伟,顾兆伟,等.真菌球型真菌性鼻窦炎的CT特征及诊断[J].中国耳鼻咽喉颅底外科杂志,2009,15(6):440-444.
[10] BROGLIE M A,TINGUELY M,HOLZMAN D,et al. How to diagnose sinus fungus balls in the paranasal sinus? An analysis of an institution's cases from January 1999 to December 2006[J].Rhinology,2009,47(4):379-384.
[11] ELOY P,GRENIER J,PIRLET A,et al. Sphenoid sinus fungal ball:a retrospective study over a 10-year period[J]. Rhinology,2013,51(2):181-188.
[12]古庆家,李静娴,樊建刚,等.孤立性蝶窦病变临床分析[J].中国耳鼻咽喉头颈外科,2013,20(2):109-110.