本文選題：真菌球型 + 雙徑路�。� 參考：《鄭州大學(xué)》2012年碩士論文

【摘要】：目的和背景 非侵襲性真菌性鼻-鼻竇炎(noninvasive fungal rhinosinusitis, NIFRS)屬于非特異性真菌感染,多為單竇發(fā)病,易侵犯上頜竇,最常見類型為真菌球型上頜竇炎。NIFRS發(fā)病原因分為：①抗生素、免疫抑制劑、抗腫瘤藥物,放療等的廣泛應(yīng)用；②鼻腔解剖結(jié)構(gòu)變異及竇口鼻道復(fù)合體的阻塞,如：鼻中隔偏曲、泡狀中甲、潴留囊腫、鼻腔狹窄、上頜竇竇口息肉等；③慢性消耗性疾病和自身免疫缺陷性疾病,如：血管炎、糖尿病等；④免疫缺陷性疾病,如：感染艾滋病等；⑤環(huán)境因素。真菌球型上頜竇炎的特征為：(1)鼻內(nèi)鏡下查病竇腔見淡綠色或暗褐色干酪樣物；(2)鼻竇CT示上頜竇內(nèi)高密度軟組織影似毛玻璃狀,其中散在高密度鈣化斑影；(3)組織病理學(xué)檢查及真菌檢測為干酪樣或泥土樣物內(nèi)見大量真菌菌絲聚集纏繞成團(tuán),主要是曲霉菌和煙曲菌,但真菌未侵犯病竇黏膜。真菌球型上領(lǐng)竇炎的治療原則是徹底清除竇腔內(nèi)真菌團(tuán)塊,解除竇口鼻道復(fù)合體處的解剖結(jié)構(gòu)異常和阻塞,提高竇口通氣引流,消除真菌賴以生存的低氧低酸厭氧性環(huán)境。術(shù)后定期鼻竇沖洗及內(nèi)鏡檢查。手術(shù)術(shù)式包括鼻內(nèi)鏡下單徑路術(shù)和聯(lián)合徑路術(shù),鼻內(nèi)鏡下單徑路手術(shù)包括：中鼻道開窗,下鼻道開窗,紗條輔助下的中鼻道開窗等。聯(lián)合徑路術(shù)包括：內(nèi)鏡下中鼻道開窗術(shù)聯(lián)合尖牙窩小視窗徑路,內(nèi)鏡下中鼻道開窗聯(lián)合下鼻道開窗徑路等。 本文通過對鼻內(nèi)鏡下中鼻道開窗術(shù)和內(nèi)鏡下中鼻道開窗聯(lián)合尖牙窩小視窗雙徑路術(shù)術(shù)后療效差異進(jìn)行統(tǒng)計學(xué)分析,探討真菌球型上頜竇炎手術(shù)方式的選擇。 方法 1.臨床資料：搜集鄭州大學(xué)第一附屬醫(yī)院耳鼻咽喉科2008年1月-2010年8月中50例確診為真菌球型上頜竇炎的患者資料,隨訪時間為1-2年,平均1.5年。所有患者病例隨訪資料完整。 2.手術(shù)方式及療效評定：50例患者中25例采用內(nèi)鏡下中鼻道開窗聯(lián)合尖牙窩小視窗雙徑路術(shù)(治療組),另25例采用單純鼻內(nèi)鏡下中鼻道開窗術(shù)(對照組)。術(shù)后平均隨訪1.5年,定期鼻內(nèi)鏡檢查及鼻竇沖洗。療效評定標(biāo)準(zhǔn)按照1997年�？跇�(biāo)準(zhǔn)執(zhí)行。 3.病原學(xué)檢測：50例患者術(shù)后均行上頜竇竇腔分泌物的真菌檢測,將真菌進(jìn)行分類。病竇內(nèi)容物及黏膜行HE染色檢測。 4.統(tǒng)計學(xué)分析：采用SPSS17.0軟件包進(jìn)行秩和檢驗,檢驗水準(zhǔn)a=0.05。 結(jié)果 真菌及HE染色檢測：鼻腔鼻竇分泌物真菌檢測率為78%,其中曲霉菌28例(56%),毛霉菌3例(6%),青霉菌1例(2%),其他霉菌7例(14%)。HE染色結(jié)果：鼻竇粘膜炎性水腫,黏膜及分泌物中大量嗜酸性粒細(xì)胞浸潤,未見真菌侵犯黏膜。干酪樣物中可見大量真菌菌絲聚集并纏繞成團(tuán)。 術(shù)后疾病轉(zhuǎn)歸：治療組治愈22例(88%),好轉(zhuǎn)2例(8%),無效復(fù)發(fā)1例(4%),有效率96%；對照組治愈16例(64%),好轉(zhuǎn)3例(12%),無效復(fù)發(fā)6例(24%),有效率76%。兩組進(jìn)行統(tǒng)計學(xué)分析,χ2=4.268,p0.05,差異有統(tǒng)計意義。 結(jié)論 1、真菌球型上頜竇炎最常見致病菌為曲霉菌,且真菌球僅存在于病竇竇腔內(nèi),病竇黏膜未見真菌侵犯。 2、真菌球型上領(lǐng)竇炎患者治療原則是手術(shù)徹底清除霉菌團(tuán)塊。對于經(jīng)鼻內(nèi)擴(kuò)大自然口困難者可加用唇齦溝小切口、尖牙窩小開窗以利徹底檢查和清除病變,這樣不會給患者帶來面部麻木等痛苦。單徑路鼻內(nèi)鏡手術(shù)治療真菌性上頜竇炎,只要徹底清除竇口復(fù)合體區(qū)病變,足夠擴(kuò)大骨性上頜竇自然口,術(shù)中徹底去除病變,沖洗術(shù)腔,同樣可達(dá)到治愈目的。
[Abstract]:Background and purpose
Non invasive fungal rhinosinusitis (noninvasive fungal rhinosinusitis, NIFRS) is a non specific fungal infection, most of which are single sinus and easily invading the maxillary sinus. The most common types of fungal spherical maxillary sinusitis are divided into.NIFRS: (1) extensive application of antibiotics, immunosuppressant, antitumor drugs, radiotherapy and so on; (2) nasal solution Caesarean section variation and sinus orifice complex obstruction, such as: nasal septum deviation, alveolar medium a, retention cyst, nasal stenosis, maxillary sinus and oral polyps, etc.; 3. Chronic consumptive disease and self immunodeficiency diseases such as vasculitis, diabetes and so on; (4) immunodeficiency diseases, such as infection of AIDS, and so on; 5. The characteristics of the ball type maxillary sinusitis were: (1) light green or dark brown cheese in the sinus cavity under the nasal endoscopy; (2) the high density soft tissue in the sinus of the sinus CT showed a glasslike appearance in the maxillary sinus, which scattered in the high density calcified plaque; (3) a large number of fungal mycelium gathered in the histopathological and fungal samples. It is mainly Aspergillus and Aspergillus fumigatus, but fungi do not infringe on the sinus mucosa. The treatment principle of fungal spherical upper sinusitis is to remove the fungal mass in the sinus cavity thoroughly, remove the anatomic structure abnormality and obstruction at the sinus orifice complex, improve the ventilation and drainage of the sinus mouth, and eliminate the hypoxic and low acid anaerobic environment on which the true bacteria live. Endoscopic sinus irrigation and endoscopic examination. Surgical procedures include nasal endoscopy single path and combined approach. Endoscopic sinus surgery includes: the middle nasal tract opening, the lower nasal passages, and the middle nasal passages assisted by the yarn. The combined approach includes the endoscopic sinus opening combined with the canine fossa path, and the endoscopes. Open the window and open the window for the lower nose.
In this paper, the difference in the curative effect of the middle nasal tract open window and the middle nasal tract open window combined with the small window of the canine fossa under endoscopy was analyzed statistically, and the selection of surgical methods for the fungal ball type maxillary sinusitis was discussed.
Method
1. clinical data: the data of 50 cases of fungal spherical maxillary sinusitis diagnosed in the Department of Otolaryngology, the First Affiliated Hospital of Zhengzhou University, January 2008 -2010 year 8, were followed up for 1-2 years on an average of 1.5 years. All patients were followed up with complete follow-up data.
2. mode of operation and evaluation of curative effect: 25 cases of 50 cases were treated by endoscopic sinus opening window combined with canine fossa small window double path (treatment group), and the other 25 cases were treated with simple nasal endoscope window opening (control group). The average follow-up was 1.5 years after operation, regular nasal endoscopy and nasal sinus rinsing. The evaluation standard was according to the Haikou standard in 1997. That's ok.
3. etiological examination: 50 patients underwent fungal examination of the secretions of the maxillary sinus cavity after operation. Fungi were classified. The contents of the sick sinus and mucosa were examined by HE staining.
4. statistical analysis: using SPSS17.0 software package for rank sum test, test level a=0.05.
Result
Fungi and HE staining test: the fungal detection rate of nasal sinus secretions was 78%, including 28 cases of Aspergillus (56%), 3 cases of Trichoderma (6%), 1 cases of Penicillium (2%), 7 cases (14%) of other moulds (14%).HE staining results: sinus mucositis, large amount of eosinophilic granulocyte infiltration in mucous and secretions, no fungal invasion of mucous membrane. A large number of cheese samples were seen. Fungal mycelium congregates and twine into a mass.
Postoperative disease outcome: the treatment group was cured in 22 cases (88%), improved in 2 cases (8%), 1 cases (4%) and 96% of invalid recurrence, 16 cases (64%) in the control group, 3 cases (12%), 6 cases (24%), and the effective 76%. two group were statistically analyzed, X 2=4.268, P0.05, the difference has statistical significance.
conclusion
1, the most common pathogen of fungal ball type maxillary sinusitis is Aspergillus, and fungus ball only exists in sinus sinus cavity, and no fungus invasion is found in the sinus mucosa.
2, the treatment principle of the fungal sphere upper sinusitis is to remove the mildew lump thoroughly. For those who have the difficulty of enlarging the natural mouth, the small incision can be added with the lip gingival groove, the small opening of the canine fossa to thoroughly check and clear the lesions, so that the patient will not suffer from the pain of facial numbness, and the single path endoscopic sinus surgery for the fungal maxillary sinusitis is treated by a single path endoscopic sinus surgery. As long as the lesions in the ostium complex area can be thoroughly removed, the natural orifice of the maxillary sinus can be enlarged sufficiently, and the lesions can be removed thoroughly and the cavity can be washed in operation.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R765.42

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