目的 觀察鼻內鏡下三種不同微創手術治療非侵襲型真菌性上頜竇炎的療效及氟康唑沖洗術腔的臨床意義。 方法 回顧性分析我科2006年1月－2010年12月收治的284例非侵襲型真菌性上頜竇炎住院患者資料。患者分別采用單純鼻內鏡下上頜竇竇口開放術（術式1）、鼻內鏡下上頜竇竇口開放聯合經唇齦溝上頜竇前壁開窗（術式2）、以及鼻內鏡下上頜竇竇口開放聯合下鼻道開窗（術式3）進行治療；術式3治療的患者術后定期換藥時，分別使用生理鹽水或氟康唑反復沖洗鼻腔和上頜竇。所有患者門診隨訪至少半年。 結果 在本組接受術式1、術式2和術式3治療的患者分別有51例、45例和188例。上述三種術式治療的患者中，分別有15例，9例和6例患者出現復發，復發率分別為29.6%、20.0%和3.2%；其中術式3治療的患者復發率顯著性低于術式1或術式2治療的患者（P＜0.05）。在術式3治療的患者中，生理鹽水和氟康唑沖洗的傷口愈合時間分別為3.8周和 3.7周，兩種沖洗方式對傷口的愈合影響差異無統計學意義（P＞0.05）。 結論 鼻內鏡下上頜竇竇口開放聯合下鼻道開窗是治療非侵襲型霉菌性上頜竇炎的最佳方式，且傷口愈合時間與沖洗液種類無關。
目的 觀察非侵襲性真菌性鼻竇炎鼻內鏡手術治療效果及圍手術期治療對療效的影響。 方法 回顧性分析2008年6月－2010年12月診治的86例非侵襲性真菌性鼻竇炎患者的臨床特征，總結鼻內鏡手術治療效果及圍手術期抗生素、黏液促排劑、鼻噴激素、鼻沖洗等綜合治療的作用。 結果 86例患者均一次治愈，隨訪1～3年，無復發；圍手術期綜合治療有利于減少術中出血，減輕術后黏膜水腫、減少分泌物，縮短病程。 結論 鼻內鏡下徹底清除病灶是非侵襲性真菌性鼻竇炎安全、有效的一種治療方法；合理的圍手術期綜合治療具有其積極的作用。
摘要:目的:探討鼻內鏡術治療非侵襲型真菌性鼻竇炎的療效。方法:對76例行鼻內鏡術治療非侵襲型真菌性鼻竇炎的臨床資料進行總結分析。結果:76例非侵襲型真菌性鼻竇炎均治愈,隨訪1～５年無復發。結論:鼻內鏡術治療非侵襲型真菌性鼻竇炎效果良好。
目的：探討慢性非侵襲性真菌性鼻竇炎(NIFS)的治療要點。方法：分析11 例NIFS 患者，全部施行鼻內鏡手術，術后定期隨訪。結果：術后隨訪2年，全部治愈。結論：以鼻內鏡手術治療為主的綜合治療，療效好，復發率低。
ObjectiveTo observe the clinical characteristics of patients with visual impairment caused by fungal sphenoid sinusitis and analyze the influencing factors related to visual prognosis. Methods A retrospective clinical study. From January 2006 to December 2020, 44 patients (55 eyes) with visual impairment caused by fungal sphenoid sinusitis confirmed by imaging and pathological examination in the Department of Ophthalmology of Beijing Tongren Hospital were included in the study. Patients was first diagnosed in the Department of Ophthalmology due to monocular or binocular vision loss, or binocular diplopia, limited eye movement and ptosis. All patients underwent visual acuity examination and fundus color photography. CT examination of paranasal sinus or orbit was performed in 37 cases; magnetic resonance imaging (MRI) of paranasal sinus, brain or orbit was performed in 34 cases. All patients underwent endoscopic sinus opening combined with intrasinus lesion clearance; 14 cases were treated with antifungal drugs after operation. The average follow-up time was 59.61±37.70 months. Comparison of clinical characteristics between invasive and non-invasive fungal sphenoid sinusitis were by χ2 test or Fisher exact test. The influencing factors with P＜0.2 in univariate analysis were selected for multivariate regression analysis. ResultsAmong the 44 patients, there were 19 males and 25 females; the ratio of male to female was 1:1.3; the average age of visual symptoms was 61.48 ± 12.17 years; 23 cases (52.3%, 23/44) suffered from immune dysfunction, including 21 cases of diabetes mellitus. The visual acuity decreased in 33 cases (44 eyes) (75.0%, 33/44). There were 15 cases of binocular diplopia with eye movement disorder (34.0%, 15/44), including 6 cases with visual impairment. The visual acuity of the affected eye was no light perception-0.8. There were 35 cases with headache (79.5%, 35/44). Nasal symptoms were found in 14 cases (31.8%, 14/44). There were 40 and 4 cases of Aspergillus and Mucor infection in sphenoid sinus, respectively. Among the 37 cases who underwent CT examination of paranasal sinus or orbit, there were soft tissue filling in the sinus cavity, including 19 cases of high-density calcification in the sinus cavity (51.4%, 19/37); bone defect of sinus wall were in 24 cases (64.9%, 24/37). There were 26 cases (70.3%, 26/37) of sinus wall osteosclerosis. MRI of paranasal sinus, brain or orbit was performed in 34 cases. T1WI of sphenoid sinus lesions showed low signal, high signal and equal signal in 14, 10 and 9 cases, respectively; T2WI showed high signal, low signal and equal signal in 13, 16 and 2 cases respectively. After enhancement, the lesions were strengthened in 11 cases, no obvious enhancement in 23 cases, and the surrounding mucosa was thickened and strengthened. The lesions involved the orbital apex and cavernous sinus in 18 and 16 cases, respectively; orbital apex and cavernous sinus were involved in 12 cases. Six months after operation, visual acuity was significantly improved in 27 eyes (65.9%, 27/41); visual acuity did not improve in 14 eyes (34.1%, 14/41). Multivariate regression analysis showed that the change of sinus wall osteosclerosis was associated with higher visual acuity improvement rate (odds ratio= 0.089, 95% confidence interval 0.015-0.529, P=0.008). ConclusionsFungal sphenoid sinusitis related visual impairment is relatively common in elderly female patients with low immune function; monocular vision loss with persistent headache is the most common clinical symptom; imaging findings of sphenoid sinus lesions are an important basis for diagnosis. Sphenoid sinus opening combined with sinus lesion clearance is an effective treatment. After operation, the visual acuity of most patients can be improved. The prognosis of visual acuity was relatively good in patients with hyperplasia and sclerosis of sphenoid sinus wall bone.
Objective To investigate the risk factors for end-stage liver disease (ESLD) complicated with fungal esophagitis (FE). Methods The clinical data of ESLD patients who underwent gastroscopy during their hospitalization in the Second Affiliated Hospital of Chongqing Medical University between January 1, 2017 and December 31, 2023 were retrospectively analyzed. The ESLD patients with FE were selected as the study group, and the ESLD patients without FE during the same period were included as the control group by 1∶2 propensity score matching method. Multivariate logistic regression model was used to analyze the risk factors of ESLD complicated with FE. Results A total of 75 ESLD patients with FE and 150 ESLD patients without FE were enrolled. There was no significant difference in age, gender, decompensated cirrhosis, liver cancer, diabetes mellitus, or etiology of ESLD between the two groups (P>0.05). Multivariate logistic regression analysis showed that longer hospital stay [odds ratio (OR)=1.115, 95% confidence interval (CI) (1.069, 1.164)], with invasive procedures [OR=10.820, 95%CI (4.393, 26.647)], and higher total bilirubin [OR=1.015, 95%CI (1.005, 1.024)] were risk factors for ESLD complicated with FE (P<0.05). In the study group, 41 patients were treated with antifungal drugs, and 4 of them developed invasive fungal infection. Among the 34 patients who did not receive antifungal drugs, 10 developed invasive fungal infection. Conclusions ESLD patients with longer hospital stay, worse liver function, and invasive procedures are more likely to develop FE, and regular gastroscopy should be performed. Once FE is found, active antifungal treatment should be taken to reduce the occurrence of invasive fungal infection and improve the prognosis of patients.