鼻竇黴菌球以內視鏡手術治療之經驗

背景：鼻竇黴菌球是單側慢性鼻竇炎其中一種常見的原因，屬於非侵犯性黴菌性鼻竇炎。本篇研究主要探討本院鼻竇黴菌球之處理經驗。方法：回溯性收集自2005年7月至2013年12月期間，在本院因鼻竇黴菌球接受鼻竇內視鏡手術之病患共計88名，納入分析。結果：本研究中62名為女性，26名為男性，接受手術時之平均年紀為54.6歲。上頜竇為最常受影響之鼻竇(75/88，85.2%)，其次為蝶竇(9/88，10.2%)。所有病患皆以經鼻內視鏡手術治療，術後無主要併發症產生。針對上頜竇黴菌球，我們合併使用上頜竇抓取鉗、紗布推擠技術以及生理食鹽水沖洗將黴菌球自上頜竇中鼻道造口完全移除。在我們的病例之中，未曾施行犬齒窩穿刺之抽吸沖洗或Caldwell-Luc手術。術後門診追蹤中有5名病人在鼻竇中仍有殘餘病灶，接受第二次手術後均無疾病之再發。組織病理學之檢查顯示只有黴菌移生，但無案例有組織的侵犯。本研究發現具有多發性鼻竇黴菌球病灶的病患中，有顯著較高比例的糖尿病(p = 0.0016)。結論：經鼻鼻竇內視鏡手術是一個對於鼻竇黴菌球安全且有效的治療方法，紗布推擠技術及生理食鹽水沖洗可應用於上頜竇黴菌球之清除。糖尿病的病患較容易產生多發性鼻竇黴菌球病灶。

關鍵字

鼻竇內視鏡手術；黴菌球；黴菌性鼻竇炎；鼻及鼻竇疾病

並列摘要

BACKGROUND: Sinus fungal ball is one of the principal causes of unilateral chronic sinusitis. It is a form of fungal sinusitis defined as noninvasive chronic fungal sinusitis without inspissated allergic mucin and occurs in immunocompetent hosts. Our aim is to present our experience in the management of sinus fungal ball. METHODS: Eighty eight patients who were diagnosed with sinus fungal ball and underwent endoscopic sinus surgery from July 2005 to December 2013 were included. Clinical features, surgical techniques, operative findings, bacterial and fungal cultures, postoperative results, and complications were analyzed retrospectively. RESULTS: In this study, 62 were female and 26 were male. Their age at surgery ranged from 25 to 87 years, with a mean of 54.6. The most frequently involved site was the maxillary sinus (75/88, 85.2%), followed by the sphenoid sinus (9/88, 10.2%). All patients were treated successfully by transnasal endoscopic sinus surgery. No postoperative complications were observed. For fungus balls of the maxillary sinus, antrum grasping forceps, gauze-assisted technique, and saline irrigation were applied for complete removal of the fungus materials from the middle meatal antrostomy. Neither canine fossa puncture nor Caldwell-Luc operation was performed in our cases. Five patients were found to have residual lesions during postoperative follow-ups, and all of them were successfully treated by revision endoscopic sinus surgery. Histology showed fungal colonization but there was no invasion in all cases. Patients with multifoci fungal ball had higher incidence of diabetes mellitus ( p = 0.0016). CONCLUSIONS: Transnasal endoscopic sinus surgery is a safe and effective treatment for fungal ball of the paranasal sinuses. Gauze-assisted technique and saline irrigation can be applied to remove the fungus materials in the maxillary sinus. Patients with diabetes mellitus are more prone to have multi-foci fungal ball.

並列關鍵字

endoscopic sinus surgery ； fungus ball ； fungal sinusitis ； sinonasal disease

國際替代計量

鼻竇黴菌球以內視鏡手術治療之經驗

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