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摘要


背景:慢性侵襲型黴菌性鼻竇炎早期症狀大都不具特異性,晚期若造成周圍重要組織如眼眶、顱底甚至顱內侵犯,則治療困難且預後差。而早期電腦斷層與術中發現,與非侵襲型並無明顯差異,若無病理切片可能造成診斷困難。本研究目的針對慢性侵襲型黴菌性鼻竇炎的症狀、特徵、診斷及治療結果加以分析。方法:回溯性收集2003至2012年間,共187例在本院經診斷並接受治療的黴菌性鼻竇炎患者,8例病理切片確定診斷為慢性侵襲型黴菌性鼻竇炎,分析病患特徵、診斷、治療與預後。結果:8名病患,3名男性,5名女性,年齡分佈41至77歲,平均年齡47.5 ± 10.17歲,症狀以濃黃鼻涕、鼻塞為主,均於術前安排鼻竇內視鏡及電腦斷層檢查,之後接受鼻竇內視鏡手術清創,術中僅2名病患有明顯黴菌質嵌入鼻竇黏膜,病理切片為侵襲型黴菌性鼻竇炎,5例為Aspergillus;5名患者於術後合併抗黴菌藥物,4例Voriconazole及1例Itraconazole,追蹤至今8名病患皆無復發現象。結論:慢性侵襲型黴菌性鼻竇炎治療以鼻竇內視鏡手術清創效果良好預後佳,但因術前電腦斷層、臨床症狀與術中發現並無法診斷,故所有黴菌性鼻竇炎病患於術中建議將鼻竇黏膜做病理切片及黴菌培養,以幫助確診及治療,至於是否須輔以全身性抗黴菌藥物仍待更進一步的研究。

並列摘要


BACKGROUND: The process of chronic invasive fungal sinusitis is more than 4 weeks and the initial presentation is non-specific. Invading to the surrounding tissue of paranasal sinuses, such as orbit, skull base, or intracranial extension, make treatment more difficult and has poor prognosis. However, in the early stage, the images of computer tomography and intra-operative findings are similar to non-invasive fungal sinusitis. The aim of this study is to analyze symptoms, characteristics, diagnosis, and the results of therapy.METHODS: In this retrospective study, we evaluated 187 fungal sinusitis patients from 2003 to 2012. Eight patients were diagnosed of chronic invasive fungal sinusitis. Patients' age, sex, symptoms, underlying medical disease, diagnosis, treatment and outcome were analyzed.RESULTS: A total of 8 cases of chronic invasive fungal sinusitis were included. There were 3 men and 5 women, with a mean age of 47.5 ± 10.17 years (range, 41-77 years). The most common symptoms are purulent rhinorrhea and nasal obstruction, and are refractory to oral antibiotics. Some patients complained of paranasal tenderness and headache. All patients received sinoscopy and computer tomography preoperatively, and underwent endoscopic sinus surgery for debridement. Pathology confirmed chronic invasive fungal sinusitis. Five cases were Aspergillus infection. Five patients received systemic anti-fungal agent postoperatively. Voriconazole 200 mg twice daily for 2 to 8 weeks was prescribed in 4 patients, and itraconazole 200 mg daily for 4 weeks was prescribed in 1 patient. All patients were free of disease during follow-up period.CONCLUSIONS: Endoscopic sinus surgery for debridement has good outcome in early stage of chronic invasive fungal sinusitis. However, the images of computer tomography and intra-operative findings are similar to non-invasive fungal sinusitis, which may result in under diagnosis. Therefore, biopsy of the mucosa of sinus and fungal culture are necessary to confirm the diagnosis. Prescription of postoperative systemic antifungal agent was still controversial. A long-term follow-up is required to prevent and identify recurrence.

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