鼻内镜手术治疗真菌球型鼻窦炎的临床研究

发布时间：2018-10-13 10:33

【摘要】：目的：本文探讨鼻内镜下手术治疗真菌球型鼻窦炎的疗效，分析其发病原因及治疗方法。方法：本文总结2009年10月至2011年06月收治的17例真菌球型鼻窦炎患者的临床资料，同时复习既往行传统柯-路氏手术治疗的真菌球型鼻窦炎患者临床资料，对二者疗效进行统计学分析。所有的患者术前均经鼻内镜检查、鼻窦冠状位或水平位CT(computertomography, CT)和病理和（或）真菌涂片确诊为真菌球型鼻窦炎。均为单侧发病，其中病变仅位于上颌窦14例，病变同时位于上颌窦及筛窦3例；其中女性病例13例，男性病例4例，年龄38-62岁。患者以涕中带血为主诉入院8例，以脓涕入院3例，头痛为主诉入院1例，以面部麻木及（或）牙齿麻木为主诉入院2例，嗅觉减退2例，涕中带有真菌团块入院1例。术前所有患者均行CT冠状位、水平位平扫检查、鼻内镜检查，排除免疫缺陷病人，所有病例术前均未接受过抗真菌治疗。手术使用STORZ手术影像系统（karl-storz endoscopy inctuttlingen，germany）及STORZ鼻窦手术器械，影像记录采用重庆人从众公司的内窥镜图像采集及处理软件。所有患者均在全身麻醉气管插管下行ESS，术中以1:10000盐酸肾上腺素注射液棉条收缩术区鼻腔黏膜，以0o鼻内镜检查鼻腔，如有鼻中隔弯曲影响手术入路，，则先行鼻中隔黏膜下矫正术，所有手术按照Messerklinger术式进行，于0o鼻内镜下切除钩突，若术前发现筛窦亦有炎症或真菌存在，则一并切除，开放并扩大上颌窦自然孔至1.5cm-2.5cm，更换30~o或70~o鼻内镜，观察窦腔情况，以直角吸引器吸出窦腔内分泌物，可见窦腔内存留黑褐色泥沙样物，所有病例均见到黑色样或黄褐色样团块物，若真菌团块较大，于上颌窦开口无法顺利取出，则鼻窦咬切钳切割团块，分次取出。尽量保护正常的窦腔黏膜。以生理盐水于直角吸引器反复加压冲洗窦腔至无脓性分泌物流出，30~o或70~o鼻内镜反复检查无真菌团块存留。术区以美敦力公司生产的高膨胀止血海棉填塞止血。待患者全麻苏醒后送回病房。术后给予头孢菌素类抗生素静脉点滴7天，术后第2天撤出鼻腔填塞物后给予鼻腔生理盐水每日冲洗同时清除血痂。术后1个月、3个月、6个月、12个月定期鼻内镜复查，6个月行CT鼻窦平扫及鼻内镜复查。按照1997年海口标准，以术后第6个月鼻内镜复查结果评价手术效果。结果：17例真菌球型上颌窦炎患者，13例患者均达到临床治愈，3例患者好转，1例患者复发鼻窦炎（非真菌性鼻窦炎，仅为慢性鼻窦炎复发）。对比既往行柯—路氏手术治疗真菌球型鼻窦炎患者资料，统计学分析无明显差异。结论如下：鼻内镜手术在内镜下处理上颌窦内病变，视野清楚，与传统柯-路氏手术比较，损伤小，在完整清除病灶同时最大程度上保留鼻腔正常黏膜，对恢复鼻腔的正常生理功能有重要作用。由于真菌性鼻窦炎其病灶仅限于窦腔黏膜内，黏膜表面并无菌丝生长，故术中可通过反复冲洗清除较小的菌丝，正常黏膜可保留，另外术后鼻腔给予生理盐水冲洗既可清洁鼻腔，加速黏膜生理功能的恢复。鼻内镜手术对治疗真菌球型鼻窦炎有效、安全、微创。
[Abstract]:Objective: To investigate the curative effect of endoscopic surgery for fungal spherical cholangitis, and to analyze its causes and treatment methods. Methods: From October 2009 to June 2011, the clinical data of 17 patients with spherical hepatitis B were retrospectively reviewed. All patients underwent nasal endoscopic examination, coronal or horizontal CT (CT) and pathology and/ or fungal smears were diagnosed as fungal spheroids. All of them were unilateral. Among them, the lesions were only located in 14 cases of maxillary incisors, and the lesions were located in 3 cases of maxillary incisors and sieves. Among them, 13 cases were female, 4 cases were male, 38-62 years old. The patient was admitted to the hospital with blood as the main complaint, the hospital was admitted to the hospital in 3 cases, the headache was the main complaint, the admission was 1, the numbness of the face and (or) numbness of the teeth as the main complaint, 2 cases of hospital admission, 2 cases with decreased smell of smell, and the admission of fungus lumps in the hospital. 1 case. All patients before operation underwent CT coronal, horizontal scanning, nasal endoscopy, and immune deficiency patients. All cases were not accepted before operation. Antifungal therapy. The surgical use of the STORZ surgical image system (karl-storz endoscoptutlingen, GERMANY), and the STORZ surgical instrument, the image record was collected by Chongqing people from the company's endoscope image and processing software. All patients were intubated in the descending ESS of the whole-body anesthesia endotracheal tube, and the nasal mucosa of the nasal mucosa was checked with a 1: 10000 hydrochloric acid epinephrine injection in the operation, and the nasal cavity was examined with a 0o nasal endoscope. If the nasal mucosa was bent to affect the surgical access, then the nasal mucosa was first mucked. Under membrane surgery, all procedures were performed according to Messerklinger, and the hooks were cut off at 0o nasal endoscope. If the sifter was found to have inflammation or fungi before operation, it was excised, opened and expanded to 1. 5cm-2.5cm, and 30 ~ o or 70 ~ o nasal endoscope was replaced. Check the cavity condition, suck the secretions in the uterine cavity with a right-angle suction device, and see the black-brown sediment sample in the cavity of the maxillary cavity. All cases shall be black-like or tan-like mass. If the fungus mass is large, the opening of the maxillary gland can not be taken out successfully, then the cut-off forceps shall be used to cut the lump. Then take it out. Try to protect it as much as possible. The mucous membrane of the nasal cavity of the nasal cavity was repeatedly pressurized with physiological saline at a right-angle aspirator to wash the nasal cavity to no pus discharge, and 30 ~ o or 70 ~ o nasal endoscopic repeated examination was not true. A high-expansion hemostatic sponge produced by Medtronic Inc. in the area of the bacteria. Hemostasis is padded with cotton. It is to be recovered by general anesthesia of patients. It was sent back to the ward. After the operation, it was given intravenous drip for 7 days. After the second day of the operation, the nasal cavity was withdrawn. The nasal cavity was treated with normal saline. Blood flow was cleared at the same time. 1 month, 3 months, 6 months, 12 months' regular nasal endoscopic review, 6 months CT scan. Purging and nasal endoscopic review. Follow-up to the Haikou criteria for 1997 to review endoscopic sinus surgery at the 6th month of the procedure Results: The operative results were evaluated. Results: 17 cases of fungal spherical maxillary proinflammatory disease, 13 patients achieved clinical cure, 3 patients improved, 1 patient had recurrent dysphagia (non-Hodgkin's disease, only A comparative study of data, statistics, The results are as follows: Endoscopic surgery in the endoscopic treatment of the lesions of the upper maxilla, the visual field is clear, compared with the traditional Kirschner's operation, the injury is small, the normal mucosa of the nasal cavity is retained to the maximum extent at the same time, and the normal birth of the nasal cavity is restored. Due to the fact that the lesion of the nasal cavity is limited to the mucous membrane of the uterine cavity, the surface of the mucosa does not grow, so that the small hypha can be cleared by repeated washing, the normal mucosa can be preserved, Restoration of the physiological function of the membrane. The nasal endoscopic procedure is used for the treatment of the spherical surface of the fungus.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R765.4

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