侵袭性真菌性鼻窦炎引发的颅脑并发症的临床诊治
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首都医科大学宣武医院耳鼻咽喉头颈外科

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Clinical diagnosis and treatment of craniocerebral complications caused by invasive fungal sinusitis with literature review
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Department of Otolaryngology-Head and Neck Surgery,Skull Base Surgery Center,Xuanwu Hospital,Capital Medical University

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    摘要:

    目的 探讨侵袭性真菌性鼻窦炎(invasive fungal rhinosinusitis,IFRS)引发颅脑并发症的临床表现、诊断、鼻内镜手术治疗及预后的可行性。 方法 报道3例侵袭性真菌性鼻窦炎引发颅脑并发症的病例,包括额叶脑脓肿、脑膜炎、海绵窦血栓性静脉炎,并总结相关文献报道。 结果 本组3例患者均行鼻内镜手术,病理确诊为毛霉菌(mucor)感染,术后与神经内科协作进行规范的抗真菌药物治疗及定期鼻内镜复查,局部换药、鼻腔深海盐水冲洗等治疗后,均治愈。结论 侵袭性真菌性鼻窦炎引发颅脑并发症临床罕见,易漏诊、误诊,治疗十分棘手,鼻内镜手术彻底清除鼻窦原发灶,结合全身抗真菌治疗是非常有效的治疗策略。

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    Objective To explore the feasibility of clinical manifestations, diagnosis, transnasal endoscopic surgical treatment and prognosis of craniocerebral complications caused by invasive fungal sinusitis. Methods Clinical data of 3 cases suffed from craniocerebral complications caused by invasive fungal sinusitis were reported, including cerebral abscess of frontal lobe 1 case, meningitis and cavernous sinus thrombophlebitis each 1 case, and relevant literature reports were summarized. Results All 3 patients in this group underwent transnasal endoscopic surgery, pathology confirmed mucor mycosis infection, and were cured after regular endoscopic debridement, deep-sea saline irrigatioin of nasal cavity in cooperation with standard antifungal therapy by neurologist. Conclusions Craniocerebral complications caused by invasive fungal sinusitis were rare and misdiagnosed easily. Transnasal endoscopic surgery combined with systemic antifungal therapy may be an effective treatment strategy

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  • 收稿日期:2022-07-25
  • 最后修改日期:2022-09-05
  • 录用日期:2022-09-07
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