摘要
目的:回顾分析真菌性鼻窦炎患者术前CT,提出非特征性的临床表现,以提高术前诊断的准确性。方法:术后病理诊断为真菌性鼻窦炎患者CT 176例,术前均行鼻窦CT检查及鼻内镜检查。所有患者均经鼻内镜下鼻窦开放术,术中清理窦内病变并经病理检查证实为真菌感染。其中单纯蝶窦35例,单纯上颌窦84例,筛窦上颌窦49例,全组鼻窦3例,筛窦蝶窦5例。观察以上各组术前CT除病变钙化特征以外的非特征性表现。结果:本组患者共176例179侧,其中单侧173例,双侧3例(全组鼻窦感染)。CT的非特征性改变包括:窦内病变密度均匀增高,窦内病变密度不均匀增高,受累鼻窦内侧壁可有骨质吸收。病理证实179侧中,单纯蝶窦组CT病变钙化27侧,CT病变非特征性改变8侧,其中窦内均匀密度增高5侧,不均匀密度增高3侧;单纯上颌窦组病变钙化72侧,病变非特征性改变12侧,其中窦内均匀密度增高8侧,不均匀密度增高4侧,伴有骨质吸收5侧;筛窦上颌窦组病变钙化36侧,病变非特征性改变13侧,其中窦内均匀密度增高9侧,不均匀密度增高4侧,伴有骨质吸收6侧;全组鼻窦组病变钙化6侧;筛窦蝶窦组病变钙化5例。窦内病变钙化达81.56%。结论:窦内病变的钙化被视为真菌性鼻窦炎CT的特征性表现,但在临床工作中可观察到部分真菌性鼻窦炎术前CT的非特征性改变。当缺乏CT的特征性表现时,仅通过CT尚不能作出真菌性鼻窦炎的术前诊断,需其他检查手段来做鉴别诊断,甚至需经手术探查后的病理诊断来确诊。
Objective：This article was a retrospective analysis on the preoperative CT scan of fungal sinusitis patients. The non-distinctive clinic feature was suggested to improve the accuracy of preoperative diagnosis. Method：A retrospective analysis was made for 176 patients with fungal sinusitis,which were confirmed by postoperative pathologic disanosis from January 2000 to January 2008. Every patient was performed both CT examination and nasalendoscopy preoperatively. All patients underwent endoscopic sinus surgery and the lesions in sinus were cleared and confirmed fungal infection by pathology. Thirty-five cases fungaI infection located in sphenoid sinus, 84 cases in maxillary sinus, 49 cases in both maxillary and ethmoid sinus, 3 cases in all sinus, 5 cases in both eth- mold and sphenoid sinus. There were 179 sinuses in 176 patients were infected. Result：This group totally had 175 cases（179 sides）. One hundred and seventy-three cases had unibilateral lesion,3 cases had bilateral lesion. The CT scan showed non-distinctive features including uniform dense, uneven dense in the sinus and bone resorption of the inner side bone wall. Five cases in sphenoid sinus lesion were found calcification in CT scan but 8 cases didn＇t show such features. Among these cases, 5cases showed uniform dense and 3 cases showed uneven dense. In 84 cases maxillary sinus lesion, there were 12 cases without distinctive change, among these cases, 8 cases showed uniform dense, 4 cases showed uneven dense and 5 cases had bone resorption. In 49 cases both ethmoid and maxillary sinus lesion, 13 cases didn＇t show distinctive change, among these cases, 9 cases showed uniform dense, 4 cases showed uneven dense and 6 cases had bone resorption. Five cases had calcification in the both sphenoid and ethmoid sinus. Totally 81.56% of these patients had calcification feature in the CT scan. Conclusion：The calcification in the lesion of sinus is usually featured as characteristic manifestation of fungal sinusitis. But in clinic, the calcification does not exit in some patient＇s CT scan. When being absent of the featured sign in CT scan, the fungal sinusitis have to be diagnozed by other detecting means,even postoperative pathology.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2009年第23期1069-1070,1073,共3页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
真菌
鼻窦炎
CT
fungal
sinusitis
computerized tomography
