慢性鼻窦炎手术患者非侵袭性真菌性鼻窦炎的发生率

M. Gumussoy
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Aspirated secretions from the sinuses and removed surgical tissues were examined microbiologically and histopathologically. Results: 68 females, 215 males, totally 283 patients with a mean age of 41 had sinus surgery; 11 (40.74%) females and 16 (59.26%) males, totally 27 (9.54%) patients had non-invasive fungal sinusitis. 18 (6.36%) of the cases were microbiologically reported as allergic fungal sinusitis while 9 (3.18%) of them reported as mycetoma. Nasal obstruction (19, 70.37%) and headache (13, 48.14%) were the most common clinical findings. Eosinophilic mucus was detected in the sinus material of the patients with allergic fungal sinusitis. According to their prevalence, Aspergillus, Penicillium, and Candida were the most prevalent in the patients with allergic fungal sinusitis, respectively; Aspergillus fumigatus and Aspergillus flavus were the most prevalent in the patients with allergic fungal sinusitis, respectively. Radiologically, fungal balls localized at the maxillary sinuses in six patients, the sphenoid sinuses in two patients, and the ethmoid sinus in one patient. As a treatment, sinus surgery was performed as a complete evacuation of the mucus and removal of pathological and polypoid tissues. The follow-up periods of the patients ranged between 7-31 months; the mean duration of follow-ups was 17 months. Non-invasive fungal infections were not treated with antifungal therapy, no recurrence was observed. Conclusions: In this study, non-invasive fungal sinus infection was detected 9.54% of patients. Nasal examination, radiological, and immunological examination should be applied to patients as additional examinations on the suspicion of pre-operative fungal rhinosinusitis; samples should be taken from the sinuses during surgery and should be examined for fungus microbiologically and histopathologically. Antifungal therapy was not administered to patients with non-invasive fungal infection. 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引用次数: 1

摘要

背景:在本研究中,我们调查了在我们诊所诊断为慢性鼻窦炎的患者中接受内窥镜鼻窦手术的非侵袭性真菌性鼻窦炎的存在。方法:选取2008-2018年在我院行功能性鼻内窥镜手术治疗慢性鼻窦炎的患者283例,年龄在18岁及以上,无侵袭性真菌性鼻窦炎及肿瘤。采用鼻内窥镜和计算机断层扫描检查鼻窦病理。测定患者外周血中嗜酸性粒细胞计数、总IgE和特异性IgE水平。采用Messerklinger技术在全身和局部麻醉下进行鼻窦手术。从鼻窦吸出的分泌物和切除的手术组织进行微生物学和组织病理学检查。结果:女性68例,男性215例,共283例,平均年龄41岁;女性11例(40.74%),男性16例(59.26%),非侵袭性真菌性鼻窦炎27例(9.54%)。微生物学报告过敏性真菌性鼻窦炎18例(6.36%),足菌肿9例(3.18%)。鼻塞19例(70.37%)、头痛13例(48.14%)是最常见的临床表现。在变应性真菌性鼻窦炎患者的鼻窦材料中检出嗜酸性粘液。在变应性真菌鼻窦炎患者中,曲霉、青霉菌和念珠菌的患病率分别最高;变应性真菌性鼻窦炎患者中以烟曲霉和黄曲霉最常见。放射学上,真菌球位于上颌窦6例,蝶窦2例,筛窦1例。作为一种治疗方法,进行鼻窦手术以完全清除粘液并去除病理和息肉样组织。随访时间7 ~ 31个月;平均随访时间为17个月。非侵袭性真菌感染未接受抗真菌治疗,无复发。结论:本组非侵袭性真菌性鼻窦感染检出率为9.54%。术前疑似真菌性鼻窦炎的患者应进行鼻检查、影像学检查和免疫学检查;手术过程中应从鼻窦采集样本,并进行真菌微生物学和组织病理学检查。非侵袭性真菌感染患者不接受抗真菌治疗。鼻内窥镜手术是治疗非侵袭性真菌性鼻窦炎的一种成功方法。
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Frequency of non-invasive fungal sinusitis in patients undergoing surgery for chronic rhinosinusitis
Background: In this study, we investigated the presence of non-invasive fungal sinusitis in patients who underwent endoscopic sinus surgery with the diagnosis of chronic rhinosinusitis in our clinic. Methods: A total of 283 patients who underwent functional endoscopic sinus surgery for chronic rhinosinusitis in our clinic between 2008-2018, who were at the ages of 18 or above, and who did not have invasive fungal sinusitis and tumor were included in the study. Sinus pathology was examined by routine examination using nasal endoscopy and computed tomography. Eosinophil count, total, and specific IgE levels were measured in the peripheral blood samples of the patients. Sinus surgery was performed under general and local anesthesia with the Messerklinger technique. Aspirated secretions from the sinuses and removed surgical tissues were examined microbiologically and histopathologically. Results: 68 females, 215 males, totally 283 patients with a mean age of 41 had sinus surgery; 11 (40.74%) females and 16 (59.26%) males, totally 27 (9.54%) patients had non-invasive fungal sinusitis. 18 (6.36%) of the cases were microbiologically reported as allergic fungal sinusitis while 9 (3.18%) of them reported as mycetoma. Nasal obstruction (19, 70.37%) and headache (13, 48.14%) were the most common clinical findings. Eosinophilic mucus was detected in the sinus material of the patients with allergic fungal sinusitis. According to their prevalence, Aspergillus, Penicillium, and Candida were the most prevalent in the patients with allergic fungal sinusitis, respectively; Aspergillus fumigatus and Aspergillus flavus were the most prevalent in the patients with allergic fungal sinusitis, respectively. Radiologically, fungal balls localized at the maxillary sinuses in six patients, the sphenoid sinuses in two patients, and the ethmoid sinus in one patient. As a treatment, sinus surgery was performed as a complete evacuation of the mucus and removal of pathological and polypoid tissues. The follow-up periods of the patients ranged between 7-31 months; the mean duration of follow-ups was 17 months. Non-invasive fungal infections were not treated with antifungal therapy, no recurrence was observed. Conclusions: In this study, non-invasive fungal sinus infection was detected 9.54% of patients. Nasal examination, radiological, and immunological examination should be applied to patients as additional examinations on the suspicion of pre-operative fungal rhinosinusitis; samples should be taken from the sinuses during surgery and should be examined for fungus microbiologically and histopathologically. Antifungal therapy was not administered to patients with non-invasive fungal infection. Endoscopic sinus surgery is a successful method in the treatment of non-invasive fungal rhinosinusitis.
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