摘要
目的 通过总结 3例变应性真菌性鼻窦炎 (allergicfungalsinusitis,AFS)的诊断、治疗过程 ,结合复习文献中关于本病的病理、生理过程的探讨 ,提示本病的诊断、治疗特点。方法 通过对 3例病史、鼻窦CT检查、鼻窦分泌物及鼻腔检查 ,对临床怀疑变应性真菌性鼻窦炎的 3例患者进行鼻窦内镜手术。通过分泌物真菌涂片、培养 ,组织病理学检查以及放射免疫吸附试验 (radioallergosorbenttest,RAST)结果 ,明确AFS诊断。术后口服强的松 ,局部雷诺考特喷鼻及大扶康冲洗鼻腔。结果 通过上述系统治疗 ,2例术后分别随访 2 5个月和 15个月症状完全缓解 ,1例术后 6个月症状复发 ,变应性黏蛋白再次出现 ,经术腔清理及大扶康冲洗后局部症状及分泌物完全消失 ,随访 2个月无复发。结论 变应性真菌性鼻窦炎有其独特的临床发生、发展过程。慢性鼻窦炎、鼻息肉中存在着一定比例的AFS ,应对其做出及时的诊断和进行合理、完善的综合治疗 ,以降低本病的并发症和复发率。
Objective To discuss and analyze the diagnosis and management of allergic fungal sinusitis Method Three middle aged patients with allergic fungal sinusitis (AFS) were observed The histological diagnosis was made on the mucous material and allergy evaluation based on the strong history of inhalant mold allergies, a positive result of skin test, total immunoglobulin E level and radioallergosorbent test to fungal antigens The management included wide local endoscopic sinus debridement, adequate sinus aeration, postoperative use of systemic and intranasal corticosteroid Systemic antifungal therapy was not used Results All 3 patients were immunocompetent and none demonstrated histologic evidence of tissue invasion Two patients remained disease free during follow up ranging for a mean of 16 months, 1 patient reccurred 17 months after operation and symptom free for 2 months after re cleaning of the sinus cavity Conclusion Diagnosis of AFS required a high index of suspicion A confirmatory diagnosis was made from the inspissated mucus, clinical and CT findings along with careful communication with mycologists and immunologists about the possibilities of fungal growth and allery Costly and lengthy courses of antibiotics, aggressive surgery should be avoided Surgical debridement and systemic corticosteroids followed by intranasal corticosteroids might provide long term control of AFS
出处
《中华耳鼻咽喉科杂志》
CSCD
北大核心
2002年第3期169-172,共4页
Chinese Journal of Otorhinolaryngology
