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目的:探讨侵袭性真菌性鼻-鼻窦炎(IFRS)的早期诊断、治疗方法及预后。方法:总结确诊为IFRS的18例患者的临床资料、鼻窦CT/MRI、诊治经过、病理诊断与随访结果,分析IFRS的早期诊断与治疗方法。结果:急性IFRS患者5例,致病菌均为毛霉菌感染,其中3例因手术禁忌症未手术,均死于颅内并发症;慢性IFRS患者13例,其中曲霉菌9例,毛霉菌3例,另有1例培养阴性。合并糖尿病9例,强直性脊柱炎1例,低蛋白血症3例,器官移植1例,白血病1例。15例患者接受扩大的鼻腔鼻窦开放术及彻底的坏死病灶清除,术后给予抗真菌治疗。随访1~3年,复发3例,死亡1例。结论:FRS的诊断需要结合临床表现、影像学特点以及病理学检查。治疗需要手术彻底清除病变组织(扩大鼻窦开放术)结合抗真菌药物足量使用。
Objective: To investigate the early diagnosis, treatment and prognosis of invasive fungal rhinosinusitis (IFRS). Methods: The clinical data of 18 patients diagnosed as IFRS, CT / MRI of sinuses, diagnosis and treatment of pathological changes and follow-up were analyzed. The methods of early diagnosis and treatment of IFRS were analyzed. Results: In 5 patients with acute IFRS, all the pathogens were Mucor infection, 3 of them died of intracranial complications due to surgical contraindications. Thirteen patients with chronic IFRS, including 9 Aspergillus species, Cases, and another case negative culture. 9 cases of diabetes mellitus, 1 case of ankylosing spondylitis, 3 cases of hypoproteinemia, organ transplantation in 1 case, leukemia in 1 case. Fifteen patients underwent open nasal sinus surgery and complete necrotic debridement, and antifungal therapy was given postoperatively. Follow-up 1-3 years, 3 cases of recurrence, 1 patient died. Conclusion: The diagnosis of FRS needs to combine clinical manifestations, imaging features and pathological examination. Treatment requires surgery to completely remove the diseased tissue (open sinus surgery) combined with antifungal drugs sufficient use.