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目的探讨真菌性鼻窦炎的诊断要点和治疗方法。方法 50例患者术前均作鼻窦CT扫描。其中非侵袭性真菌性鼻窦炎22例,上颌窦受累16例(双侧均受累2例),蝶窦6例,筛窦6例。鼻内镜下传统上颌窦根治术及钓突切除术23例,经鼻内钓突切除、前筛开放、上颌窦自然口扩大及经下鼻道钻孔上颌窦冲洗术21例,Wigland术式行蝶窦开放及病灶清除术6例。50例中同期行鼻中隔矫正术11例。术后定期清理及鼻窦冲洗,部分患者应用抗真菌药物及类固醇激素治疗。结果术后病理报告50例均见真菌菌丝,部分病例见到孢子。随访2个月至5年,3例复发,48例治愈。结论 CT对本病的诊断有重要价值,应注意其与慢性化脓性上颌窦炎及上颌窦恶性肿瘤的区别;手术彻底清除病灶、通畅引流是其治疗的主要手段。
Objective To investigate the diagnosis and treatment of fungal sinusitis. Methods Fifty patients underwent sinus CT scan before operation. Noninvasive fungal sinusitis in 22 cases, 16 cases of maxillary sinus involvement (bilateral involvement in 2 cases), sphenoid sinus in 6 cases, 6 cases of ethmoid sinus. Nasal endoscopic surgery and maxillary sinus surgery in 23 cases of angioplasty, rhinotracheal excision, open the front screen, the natural maxillary sinus enlargement and drilling through the lower nasal sinus in 21 cases, Wigland surgery Open sphenoid sinus surgery and 6 cases. In 50 cases, nasal septum was corrected in 11 cases. Regular postoperative cleansing and sinus rinse, some patients with antifungal drugs and steroid treatment. Results Postoperative pathological findings were found in 50 cases of fungal hyphae, spores in some cases. Followed up for 2 months to 5 years, 3 patients relapsed, 48 patients were cured. Conclusion CT has important value in the diagnosis of this disease. It should pay attention to the difference between it and chronic suppurative maxillary sinusitis and maxillary sinus malignant tumor. Thoroughly removing the lesion and unobstructed drainage is the main method of its treatment.