非侵袭性真菌性鼻窦炎--培训课件.pptVIP

非侵袭性真菌性鼻窦炎 许雄辉 方炜烨 目录 病因 1 临床表现 2 特征 3 诊断 4 治疗 5 病因 真菌性鼻窦炎 环境因素 气候、职业 全身因素 糖皮质激素、免疫力低下 局部因素 鼻腔鼻窦通气引流障碍 病原菌 aspergillus、penicillium、monilia Click To Edit Title Style Classification Chronic invasive fungal sinusitis Acute fulminant invasive fungal sinusitis Allergic fungal sinusitis Sinus fungal ball Invasive Non-invasive Sinus fungal ball Sequestration of fungal elements within a sinus without invasion or granulomatous changes grow while evading host immune system (no invasion) Aspergillus most common species Maxillary sinus most often involved (70-80% of cases) Diagnosis CT Scan: Single sinus in 59-94% of cases (maxillary) Complete or subtotal opacification of sinus Bony sclerosis; destruction is rare (3.6-17% of cases) Biopsy = fungal elements Treatment Complete surgical removal of fungal ball Irrigation of involved sinuses Antifungal therapy Only if patient is high risk for invasive disease (very rare) Severely immunocompromised Continued recurrence of disease despite proper medical/surgical management Consider topical antifungal irrigation first and then systemic therapy if no improvement Allergic Fungal Sinusitis Fungal colonization resulting in allergic inflammation without invasion Diagnostic Criteria Eosinophlic mucin(组织病理学 黏蛋白) Nasal polyposis（鼻息肉或哮喘） Radiographic findings（典型影像学） Allergy to fungi（对霉菌过敏） Treatment Surgical Remove all mucin Provide permanent drainage and ventilation of affected sinuses(鼻窦开放) Systemic +/- topical steroids（糖皮质激素） - Immunotherapy SOUCE 杨秀敏, 刘铭. 100 例真菌性鼻窦炎的病原菌分析[J]. 耳鼻咽喉: 头颈外科, 2000, 7(1): 9-13. 李永奇. 真菌性鼻窦炎的诊疗进展[J]. 国外医学: 耳鼻咽喉科学分册, 2003, 27(3): 162-166. 薛康. 鼻内镜手术治疗非侵袭性真菌性鼻窦炎 42 例[J]. 临床耳鼻咽喉头颈外科杂志, 2008, 22(17): 804-805. 张书文, 孙士铭. 真菌性鼻窦炎的 CT 与临床诊断[J]. 临床放射学杂志, 2002, 21(10): 778-780. GB/T 7714刘铭, 周兵, 刘华超, 等. 变应性真菌性鼻窦炎[J]. 中华耳鼻咽喉科杂志, 2002, 37(3): 169-172.