摘要
白黴病（mucormycosis）為一種急性且死亡率極高的伺機性黴菌感染，多發生在有潛在性疾病（underlying disease）的虛弱病人。鼻腦型白黴菌庚（rhinocerebral mucormycosis）為白黴菌病中最多的一種，大部分發生在有糖尿病或免疫不全的病人。 臺中榮民總醫院自1984年9月至1991年10月8年間，經病理切片診斷為白黴菌病有13個病例，12例為鼻腦型，另一例為皮膚型。12名鼻腦型白黴菌病病人中，11名有完整病歷記錄。其中8名（72.8％）為糖尿症病人，2名有急性淋巴性白血病，1名為尿毒症病人。年齡層分佈為12至72歲，平均為49.6歲；男性有5名，女性占6名。臨床表徵以腭部潰瘍（palatal ulcer）9名、鼻甲變黑（black turbinate）7名、與單側臉部麻木或感覺異常、眼球凸出、和眼外肌麻痺（external ophthalmoplegia）各5名為多。9名病人接受副鼻竇電腦斷層攝影，8名有眼眶部病灶，主要表現為眼內直肌外移、視神經變大，和眶尖部密度增加（increased density of the orbitalapex）。11名中，8名接受外科手術及抗黴藥物amphotericin B治療者，有4名存活，另3名只接受短暫amphotericin B治療即死亡，總存活率為4/11（36.4％），追踨時間平均16個月（6個月至3年半）。
並列摘要
Mucormycosis is an acute and fatal opportunistic fungus infection, mostly occurs in a debilitated patient with underlying diseases. Rhinocerebral mucormycosis is the most common type of mucormycosis, which mostly occurs in diabetic or immunocompromised patients. Thirteen cases of mucormycosis were proved histopathologically at Taichung Veterans General Hospital between September 1984 and October 1991. Twelve cases were rhinocerebral mucormycosis, and the other one was cutaneous mucormycosis. Eleven cases of rhinocerebral mucormycosis were analyzed in detail. Eight patients had diabetes, 2 acute lymphocytic leukemia, and the other one uremia. The most common clinical manifestations included: palatal ulcer (9), black turbinates turbinates (7), numbness or paresthesia of the face (5), and external ophthalmoplegia (5), and external ophthalmoplegia (5). CT scanning of the paranasal sinus was done in 9 cases, which disclosed that 8 had orbital involvement. The predominant orbital findings were lateral displacement of the medial rectus muscles, enlargement of the optic nerve, and increased density of the orbital apex. Eight patients received surgery and amphotericin B treatment, 4 of them survived, the other 3 patients who only received short course of amphotericin B treatment expired. The total survival rate was 36.4%. From our series of 11 cases, it reveals that combined surgery and amphotericin B can increase survival rate no matter how extensively it involves or no matter what underlying diseases it has.
延伸閱讀
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