- 期刊
以鼻竇功能性內視鏡手術治療非侵犯性麴菌性鼻竇炎
Functional Endoscopic Sinus Surgery in he Treatment of Non-invasive Aspergillus Sinusitis
摘要
利用鼻竇功能性內視鏡手術治療非侵犯性鼻竇炎是近年來的趨勢；但至今關於術前的檢查，疾病的特性與術後的復原，黏膜的正常化等的相關性則未有報告。本文乃前瞻性研究，選取28名非侵犯性麴菌性鼻竇炎的病患，施行內視鏡手術，而探討上述之問題。術前每名病患均予問取病史、症狀，並施行皮膚試驗、電腦斷層掃描、糖精時間測試等而進行評估。手術依照Stamm-berger的方法進行。這些病例分成：1)慢性無痛性鼻竇炎，2)麴菌瘤，3)過敏性麴菌性鼻竇炎等3群。術後每週至少在門診以內視鏡觀察和治療一次。最常見且難馴的症狀是鼻涕倒流。頭痛、血絲鼻漏和惡臭嗅覺等症狀多於術後2週內緩解。過敏測試結果和放射線的檢查均與術後的恢復情形無重要關係。術前糖精時間測試超過30分鐘者和病史超過2年者均為恢復不好的預徵。本系列大多數病人罹患慢性無痛性鼻竇炎，其中之56%在術後的第9至12週內得到全癒。所有麴菌瘤的病人在手術後第8週內均全癒。然而過敏性麴菌性鼻竇炎的病人大部只在術後得到數週緩解，之後又症狀復發。
並列摘要
It has been a trend to treat non-invasive aspergillus sinusitis (NIAS) by functional endoscopic sinus surgery (FESS) in recent years. No previous data of NIAS treated by FESS have been mentioned about the relevance among the preoperative evaluations, disease entities, and the reversibility of symptoms and sinus mucoas. The prospective study of 28 patients with NIAS, treated by endoscopy, was designed to solve the above puzzles. The history, allergic skin test, saccharin time test and CT scan were investigated preoperatively. The operative procedures were taken following Stammberger’s methods. These cases were classified into 3 distinct entities: chronic indolent sinusitis, aspergilloma and allergic aspergillus sinusitis. All patients were followed postoperativeily once a week by endoscopy. The most frequent and refractory symptom was postnasal dripping. The symptoms of foul odor, bloody rhinorrhea and headache usually got relief before the 2nd week of post-FESS course. The skin test and radiological findings had no correlation with their recovery. Prolonged saccharin time and history more than 2 years were the warning sings of poor recovery. Most patients belonged to chronic indolent sinusitis and 56% of them got complete recovery during the 9th to 12th week of post-FESS course. The majority of allergic aspergillus sinusitis patients manifested a recurrent course within weeks following a post-FESS silent period. All patients with aspergilloma got complete recovery before the 8th week of post-FESS course.