非侵襲性真菌性鼻竇炎

1、,非侵襲性真菌性鼻竇炎 許雄輝 方煒燁,目錄,病因,aspergillus、penicillium、monilia,,,,,Click To Edit Title Style,,Invasive,Non-invasive,,,Sinus fungal ball,Sequestration

2、 of fungal elements within a sinus without invasion or granulomatous changesgrow while evading host immune system (no invasion)Aspergillus most common speciesMaxillary sinus most often involved (70-80% of cases),,Diag

3、nosis CT Scan:Single sinus in 59-94% of cases (maxillary)Complete or subtotal opacification of sinusBony sclerosis; destruction is rare (3.6-17% of cases)Biopsy = fungal elements,,,,TreatmentComplete surgical re

4、moval of fungal ballIrrigation of involved sinusesAntifungal therapyOnly if patient is high risk for invasive disease (very rare)Severely immunocompromisedContinued recurrence of disease despite proper medical/surgi

5、cal managementConsider topical antifungal irrigation first and then systemic therapy if no improvement,Allergic Fungal Sinusitis,Fungal colonization resulting in allergic inflammation without invasionDiagnostic Criteri

6、aEosinophlic mucin(組織病理學 黏蛋白)Nasal polyposis（鼻息肉或哮喘）Radiographic findings（典型影像學）Allergy to fungi（對霉菌過敏）,,,,,,,,TreatmentSurgicalRemove all mucinProvide permanent drainage and ventilation of affected sinuses(鼻竇開放)

7、Systemic +/- topical steroids（糖皮質(zhì)激素） - Immunotherapy,SOUCE,楊秀敏, 劉銘. 100 例真菌性鼻竇炎的病原菌分析[J]. 耳鼻咽喉: 頭頸外科, 2000, 7(1): 9-13. 李永奇. 真菌性鼻竇炎的診療進展[J]. 國外醫(yī)學: 耳鼻咽喉科學分冊, 2003, 27(3): 162-166. 薛康. 鼻內(nèi)鏡手術(shù)治療非侵襲性真菌性鼻竇炎 42 例[J]. 臨床耳鼻

8、咽喉頭頸外科雜志, 2008, 22(17): 804-805. 張書文, 孫士銘. 真菌性鼻竇炎的 CT 與臨床診斷[J]. 臨床放射學雜志, 2002, 21(10): 778-780. GB/T 7714劉銘, 周兵, 劉華超, 等. 變應(yīng)性真菌性鼻竇炎[J]. 中華耳鼻咽喉科雜志, 2002, 37(3): 169-172.周兵, 劉銘, 韓德民, 等. 變應(yīng)性真菌性鼻竇炎 CT 影像特征[J]. 中華耳鼻咽喉頭頸外科雜志

9、, 2006, 41(7): 493-496. 錢進, 孫建軍, 郭紅光, 等. CT 檢查在真菌性鼻竇炎術(shù)前診斷的意義[J]. 中國耳鼻咽喉頭頸外科, 2005, 11(5): 313-315. 常京文, 王曉珊, 李聲凱. 鼻內(nèi)鏡手術(shù)治療非侵襲性真菌性鼻竇炎[J]. 臨床耳鼻咽喉頭頸外科雜志, 2008 (20). 李源, 顧之燕. 變應(yīng)性真菌性鼻竇炎[J]. 見: 顧之燕, 韓志剛, 劉志連. 耳鼻咽喉科變應(yīng)性和免疫性疾病.