【摘要】：目的：本文探討鼻內(nèi)鏡下手術(shù)治療真菌球型鼻竇炎的療效，分析其發(fā)病原因及治療方法。方法：本文總結(jié)2009年10月至2011年06月收治的17例真菌球型鼻竇炎患者的臨床資料，同時(shí)復(fù)習(xí)既往行傳統(tǒng)柯-路氏手術(shù)治療的真菌球型鼻竇炎患者臨床資料，對(duì)二者療效進(jìn)行統(tǒng)計(jì)學(xué)分析。所有的患者術(shù)前均經(jīng)鼻內(nèi)鏡檢查、鼻竇冠狀位或水平位CT(computertomography, CT)和病理和（或）真菌涂片確診為真菌球型鼻竇炎。均為單側(cè)發(fā)病，其中病變僅位于上頜竇14例，病變同時(shí)位于上頜竇及篩竇3例；其中女性病例13例，男性病例4例，年齡38-62歲。 患者以涕中帶血為主訴入院8例，以膿涕入院3例，頭痛為主訴入院1例，以面部麻木及（或）牙齒麻木為主訴入院2例，嗅覺(jué)減退2例，涕中帶有真菌團(tuán)塊入院1例。 術(shù)前所有患者均行CT冠狀位、水平位平掃檢查、鼻內(nèi)鏡檢查，排除免疫缺陷病人，所有病例術(shù)前均未接受過(guò)抗真菌治療。手術(shù)使用STORZ手術(shù)影像系統(tǒng)（karl-storz endoscopy inctuttlingen，germany）及STORZ鼻竇手術(shù)器械，影像記錄采用重慶人從眾公司的內(nèi)窺鏡圖像采集及處理軟件。所有患者均在全身麻醉氣管插管下行ESS，術(shù)中以1:10000鹽酸腎上腺素注射液棉條收縮術(shù)區(qū)鼻腔黏膜，以0o鼻內(nèi)鏡檢查鼻腔，如有鼻中隔彎曲影響手術(shù)入路，，則先行鼻中隔黏膜下矯正術(shù)，所有手術(shù)按照Messerklinger術(shù)式進(jìn)行，于0o鼻內(nèi)鏡下切除鉤突，若術(shù)前發(fā)現(xiàn)篩竇亦有炎癥或真菌存在，則一并切除，開(kāi)放并擴(kuò)大上頜竇自然孔至1.5cm-2.5cm，更換30~o或70~o鼻內(nèi)鏡，觀察竇腔情況，以直角吸引器吸出竇腔內(nèi)分泌物，可見(jiàn)竇腔內(nèi)存留黑褐色泥沙樣物，所有病例均見(jiàn)到黑色樣或黃褐色樣團(tuán)塊物，若真菌團(tuán)塊較大，于上頜竇開(kāi)口無(wú)法順利取出，則鼻竇咬切鉗切割團(tuán)塊，分次取出。盡量保護(hù)正常的竇腔黏膜。以生理鹽水于直角吸引器反復(fù)加壓沖洗竇腔至無(wú)膿性分泌物流出，30~o或70~o鼻內(nèi)鏡反復(fù)檢查無(wú)真菌團(tuán)塊存留。術(shù)區(qū)以美敦力公司生產(chǎn)的高膨脹止血海棉填塞止血。待患者全麻蘇醒后送回病房。 術(shù)后給予頭孢菌素類(lèi)抗生素靜脈點(diǎn)滴7天，術(shù)后第2天撤出鼻腔填塞物后給予鼻腔生理鹽水每日沖洗同時(shí)清除血痂。術(shù)后1個(gè)月、3個(gè)月、6個(gè)月、12個(gè)月定期鼻內(nèi)鏡復(fù)查，6個(gè)月行CT鼻竇平掃及鼻內(nèi)鏡復(fù)查。按照1997年�？跇�(biāo)準(zhǔn)，以術(shù)后第6個(gè)月鼻內(nèi)鏡復(fù)查結(jié)果評(píng)價(jià)手術(shù)效果。結(jié)果：17例真菌球型上頜竇炎患者，13例患者均達(dá)到臨床治愈，3例患者好轉(zhuǎn)，1例患者復(fù)發(fā)鼻竇炎（非真菌性鼻竇炎，僅為慢性鼻竇炎復(fù)發(fā)）。對(duì)比既往行柯—路氏手術(shù)治療真菌球型鼻竇炎患者資料，統(tǒng)計(jì)學(xué)分析無(wú)明顯差異。結(jié)論如下：鼻內(nèi)鏡手術(shù)在內(nèi)鏡下處理上頜竇內(nèi)病變，視野清楚，與傳統(tǒng)柯-路氏手術(shù)比較，損傷小，在完整清除病灶同時(shí)最大程度上保留鼻腔正常黏膜，對(duì)恢復(fù)鼻腔的正常生理功能有重要作用。由于真菌性鼻竇炎其病灶僅限于竇腔黏膜內(nèi)，黏膜表面并無(wú)菌絲生長(zhǎng)，故術(shù)中可通過(guò)反復(fù)沖洗清除較小的菌絲，正常黏膜可保留，另外術(shù)后鼻腔給予生理鹽水沖洗既可清潔鼻腔，加速黏膜生理功能的恢復(fù)。鼻內(nèi)鏡手術(shù)對(duì)治療真菌球型鼻竇炎有效、安全、微創(chuàng)。
[Abstract]:Objective: To investigate the curative effect of endoscopic surgery for fungal spherical cholangitis, and to analyze its causes and treatment methods. Methods: From October 2009 to June 2011, the clinical data of 17 patients with spherical hepatitis B were retrospectively reviewed. All patients underwent nasal endoscopic examination, coronal or horizontal CT (CT) and pathology and/ or fungal smears were diagnosed as fungal spheroids. All of them were unilateral. Among them, the lesions were only located in 14 cases of maxillary incisors, and the lesions were located in 3 cases of maxillary incisors and sieves. Among them, 13 cases were female, 4 cases were male, 38-62 years old. The patient was admitted to the hospital with blood as the main complaint, the hospital was admitted to the hospital in 3 cases, the headache was the main complaint, the admission was 1, the numbness of the face and (or) numbness of the teeth as the main complaint, 2 cases of hospital admission, 2 cases with decreased smell of smell, and the admission of fungus lumps in the hospital. 1 case. All patients before operation underwent CT coronal, horizontal scanning, nasal endoscopy, and immune deficiency patients. All cases were not accepted before operation. Antifungal therapy. The surgical use of the STORZ surgical image system (karl-storz endoscoptutlingen, GERMANY), and the STORZ surgical instrument, the image record was collected by Chongqing people from the company's endoscope image and processing software. All patients were intubated in the descending ESS of the whole-body anesthesia endotracheal tube, and the nasal mucosa of the nasal mucosa was checked with a 1: 10000 hydrochloric acid epinephrine injection in the operation, and the nasal cavity was examined with a 0o nasal endoscope. If the nasal mucosa was bent to affect the surgical access, then the nasal mucosa was first mucked. Under membrane surgery, all procedures were performed according to Messerklinger, and the hooks were cut off at 0o nasal endoscope. If the sifter was found to have inflammation or fungi before operation, it was excised, opened and expanded to 1. 5cm-2.5cm, and 30 ~ o or 70 ~ o nasal endoscope was replaced. Check the cavity condition, suck the secretions in the uterine cavity with a right-angle suction device, and see the black-brown sediment sample in the cavity of the maxillary cavity. All cases shall be black-like or tan-like mass. If the fungus mass is large, the opening of the maxillary gland can not be taken out successfully, then the cut-off forceps shall be used to cut the lump. Then take it out. Try to protect it as much as possible. The mucous membrane of the nasal cavity of the nasal cavity was repeatedly pressurized with physiological saline at a right-angle aspirator to wash the nasal cavity to no pus discharge, and 30 ~ o or 70 ~ o nasal endoscopic repeated examination was not true. A high-expansion hemostatic sponge produced by Medtronic Inc. in the area of the bacteria. Hemostasis is padded with cotton. It is to be recovered by general anesthesia of patients. It was sent back to the ward. After the operation, it was given intravenous drip for 7 days. After the second day of the operation, the nasal cavity was withdrawn. The nasal cavity was treated with normal saline. Blood flow was cleared at the same time. 1 month, 3 months, 6 months, 12 months' regular nasal endoscopic review, 6 months CT scan. Purging and nasal endoscopic review. Follow-up to the Haikou criteria for 1997 to review endoscopic sinus surgery at the 6th month of the procedure Results: The operative results were evaluated. Results: 17 cases of fungal spherical maxillary proinflammatory disease, 13 patients achieved clinical cure, 3 patients improved, 1 patient had recurrent dysphagia (non-Hodgkin's disease, only A comparative study of data, statistics, The results are as follows: Endoscopic surgery in the endoscopic treatment of the lesions of the upper maxilla, the visual field is clear, compared with the traditional Kirschner's operation, the injury is small, the normal mucosa of the nasal cavity is retained to the maximum extent at the same time, and the normal birth of the nasal cavity is restored. Due to the fact that the lesion of the nasal cavity is limited to the mucous membrane of the uterine cavity, the surface of the mucosa does not grow, so that the small hypha can be cleared by repeated washing, the normal mucosa can be preserved, Restoration of the physiological function of the membrane. The nasal endoscopic procedure is used for the treatment of the spherical surface of the fungus.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R765.4

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