不同径路治疗真菌球型上颌窦炎临床观察

发布时间：2018-04-20 06:25

本文选题：真菌球型 + 双径路　；参考：《郑州大学》2012年硕士论文

【摘要】：目的和背景非侵袭性真菌性鼻-鼻窦炎(noninvasive fungal rhinosinusitis, NIFRS)属于非特异性真菌感染,多为单窦发病,易侵犯上颌窦,最常见类型为真菌球型上颌窦炎。NIFRS发病原因分为：①抗生素、免疫抑制剂、抗肿瘤药物,放疗等的广泛应用；②鼻腔解剖结构变异及窦口鼻道复合体的阻塞,如：鼻中隔偏曲、泡状中甲、潴留囊肿、鼻腔狭窄、上颌窦窦口息肉等；③慢性消耗性疾病和自身免疫缺陷性疾病,如：血管炎、糖尿病等；④免疫缺陷性疾病,如：感染艾滋病等；⑤环境因素。真菌球型上颌窦炎的特征为：(1)鼻内镜下查病窦腔见淡绿色或暗褐色干酪样物；(2)鼻窦CT示上颌窦内高密度软组织影似毛玻璃状,其中散在高密度钙化斑影；(3)组织病理学检查及真菌检测为干酪样或泥土样物内见大量真菌菌丝聚集缠绕成团,主要是曲霉菌和烟曲菌,但真菌未侵犯病窦黏膜。真菌球型上领窦炎的治疗原则是彻底清除窦腔内真菌团块,解除窦口鼻道复合体处的解剖结构异常和阻塞,提高窦口通气引流,消除真菌赖以生存的低氧低酸厌氧性环境。术后定期鼻窦冲洗及内镜检查。手术术式包括鼻内镜下单径路术和联合径路术,鼻内镜下单径路手术包括：中鼻道开窗,下鼻道开窗,纱条辅助下的中鼻道开窗等。联合径路术包括：内镜下中鼻道开窗术联合尖牙窝小视窗径路,内镜下中鼻道开窗联合下鼻道开窗径路等。本文通过对鼻内镜下中鼻道开窗术和内镜下中鼻道开窗联合尖牙窝小视窗双径路术术后疗效差异进行统计学分析,探讨真菌球型上颌窦炎手术方式的选择。方法 1.临床资料：搜集郑州大学第一附属医院耳鼻咽喉科2008年1月-2010年8月中50例确诊为真菌球型上颌窦炎的患者资料,随访时间为1-2年,平均1.5年。所有患者病例随访资料完整。 2.手术方式及疗效评定：50例患者中25例采用内镜下中鼻道开窗联合尖牙窝小视窗双径路术(治疗组),另25例采用单纯鼻内镜下中鼻道开窗术(对照组)。术后平均随访1.5年,定期鼻内镜检查及鼻窦冲洗。疗效评定标准按照1997年海口标准执行。 3.病原学检测：50例患者术后均行上颌窦窦腔分泌物的真菌检测,将真菌进行分类。病窦内容物及黏膜行HE染色检测。 4.统计学分析：采用SPSS17.0软件包进行秩和检验,检验水准a=0.05。结果真菌及HE染色检测：鼻腔鼻窦分泌物真菌检测率为78%,其中曲霉菌28例(56%),毛霉菌3例(6%),青霉菌1例(2%),其他霉菌7例(14%)。HE染色结果：鼻窦粘膜炎性水肿,黏膜及分泌物中大量嗜酸性粒细胞浸润,未见真菌侵犯黏膜。干酪样物中可见大量真菌菌丝聚集并缠绕成团。术后疾病转归：治疗组治愈22例(88%),好转2例(8%),无效复发1例(4%),有效率96%；对照组治愈16例(64%),好转3例(12%),无效复发6例(24%),有效率76%。两组进行统计学分析,χ2=4.268,p0.05,差异有统计意义。结论 1、真菌球型上颌窦炎最常见致病菌为曲霉菌,且真菌球仅存在于病窦窦腔内,病窦黏膜未见真菌侵犯。 2、真菌球型上领窦炎患者治疗原则是手术彻底清除霉菌团块。对于经鼻内扩大自然口困难者可加用唇龈沟小切口、尖牙窝小开窗以利彻底检查和清除病变,这样不会给患者带来面部麻木等痛苦。单径路鼻内镜手术治疗真菌性上颌窦炎,只要彻底清除窦口复合体区病变,足够扩大骨性上颌窦自然口,术中彻底去除病变,冲洗术腔,同样可达到治愈目的。
[Abstract]:Background and purpose
Non invasive fungal rhinosinusitis (noninvasive fungal rhinosinusitis, NIFRS) is a non specific fungal infection, most of which are single sinus and easily invading the maxillary sinus. The most common types of fungal spherical maxillary sinusitis are divided into.NIFRS: (1) extensive application of antibiotics, immunosuppressant, antitumor drugs, radiotherapy and so on; (2) nasal solution Caesarean section variation and sinus orifice complex obstruction, such as: nasal septum deviation, alveolar medium a, retention cyst, nasal stenosis, maxillary sinus and oral polyps, etc.; 3. Chronic consumptive disease and self immunodeficiency diseases such as vasculitis, diabetes and so on; (4) immunodeficiency diseases, such as infection of AIDS, and so on; 5. The characteristics of the ball type maxillary sinusitis were: (1) light green or dark brown cheese in the sinus cavity under the nasal endoscopy; (2) the high density soft tissue in the sinus of the sinus CT showed a glasslike appearance in the maxillary sinus, which scattered in the high density calcified plaque; (3) a large number of fungal mycelium gathered in the histopathological and fungal samples. It is mainly Aspergillus and Aspergillus fumigatus, but fungi do not infringe on the sinus mucosa. The treatment principle of fungal spherical upper sinusitis is to remove the fungal mass in the sinus cavity thoroughly, remove the anatomic structure abnormality and obstruction at the sinus orifice complex, improve the ventilation and drainage of the sinus mouth, and eliminate the hypoxic and low acid anaerobic environment on which the true bacteria live. Endoscopic sinus irrigation and endoscopic examination. Surgical procedures include nasal endoscopy single path and combined approach. Endoscopic sinus surgery includes: the middle nasal tract opening, the lower nasal passages, and the middle nasal passages assisted by the yarn. The combined approach includes the endoscopic sinus opening combined with the canine fossa path, and the endoscopes. Open the window and open the window for the lower nose.
In this paper, the difference in the curative effect of the middle nasal tract open window and the middle nasal tract open window combined with the small window of the canine fossa under endoscopy was analyzed statistically, and the selection of surgical methods for the fungal ball type maxillary sinusitis was discussed.
Method
1. clinical data: the data of 50 cases of fungal spherical maxillary sinusitis diagnosed in the Department of Otolaryngology, the First Affiliated Hospital of Zhengzhou University, January 2008 -2010 year 8, were followed up for 1-2 years on an average of 1.5 years. All patients were followed up with complete follow-up data.
2. mode of operation and evaluation of curative effect: 25 cases of 50 cases were treated by endoscopic sinus opening window combined with canine fossa small window double path (treatment group), and the other 25 cases were treated with simple nasal endoscope window opening (control group). The average follow-up was 1.5 years after operation, regular nasal endoscopy and nasal sinus rinsing. The evaluation standard was according to the Haikou standard in 1997. That's ok.
3. etiological examination: 50 patients underwent fungal examination of the secretions of the maxillary sinus cavity after operation. Fungi were classified. The contents of the sick sinus and mucosa were examined by HE staining.
4. statistical analysis: using SPSS17.0 software package for rank sum test, test level a=0.05.
Result
Fungi and HE staining test: the fungal detection rate of nasal sinus secretions was 78%, including 28 cases of Aspergillus (56%), 3 cases of Trichoderma (6%), 1 cases of Penicillium (2%), 7 cases (14%) of other moulds (14%).HE staining results: sinus mucositis, large amount of eosinophilic granulocyte infiltration in mucous and secretions, no fungal invasion of mucous membrane. A large number of cheese samples were seen. Fungal mycelium congregates and twine into a mass.
Postoperative disease outcome: the treatment group was cured in 22 cases (88%), improved in 2 cases (8%), 1 cases (4%) and 96% of invalid recurrence, 16 cases (64%) in the control group, 3 cases (12%), 6 cases (24%), and the effective 76%. two group were statistically analyzed, X 2=4.268, P0.05, the difference has statistical significance.
conclusion
1, the most common pathogen of fungal ball type maxillary sinusitis is Aspergillus, and fungus ball only exists in sinus sinus cavity, and no fungus invasion is found in the sinus mucosa.
2, the treatment principle of the fungal sphere upper sinusitis is to remove the mildew lump thoroughly. For those who have the difficulty of enlarging the natural mouth, the small incision can be added with the lip gingival groove, the small opening of the canine fossa to thoroughly check and clear the lesions, so that the patient will not suffer from the pain of facial numbness, and the single path endoscopic sinus surgery for the fungal maxillary sinusitis is treated by a single path endoscopic sinus surgery. As long as the lesions in the ostium complex area can be thoroughly removed, the natural orifice of the maxillary sinus can be enlarged sufficiently, and the lesions can be removed thoroughly and the cavity can be washed in operation.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R765.42

【参考文献】