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目的探讨老年蝶窦真菌球的临床特征及鼻内镜手术的疗效。方法回顾性分析2003年至2009年经治的15例老年蝶窦真菌球的临床资料和鼻内镜手术的随访结果。结果 15例老年性蝶窦真菌球中,男5例,女10例;年龄60～72岁,平均年龄70.4岁。临床表现为头痛12例,部位以前额,枕部和球后为主;涕中带血3例;合并鼻涕倒流,伴有刺激性咳嗽3例;冠状位和轴位CT检查单侧蝶窦(左侧9例,右侧6例)内均有均匀性混浊呈结节状软组织团块影(其中13例呈现类金属密度的颗粒状密度影),骨壁增厚,未见明显的骨质破坏。15例均在鼻内镜下手术,手术均经嗅裂蝶窦前壁自然口区域进人蝶窦。未见术中及术后并发症。患者术后随访6～24个月,入院前症状均消失。术腔粘膜恢复良好,无一例复发。结论头痛和涕中带血是蝶窦真菌球最常见的临床症状,CT扫描存在特征性的表现,是诊断蝶窦真菌球的主要影像学方法。鼻内镜经蝶窦前壁自然口的蝶窦手术,具有微创和疗效好的特点,是首选的治疗方法。
Objective To investigate the clinical features of fungal sphenoid balls in elderly patients and the efficacy of endoscopic sinus surgery. Methods The clinical data of 15 elderly patients with sphenoid sinus fungus from 2003 to 2009 were retrospectively analyzed and the follow-up results of endoscopic sinus surgery were retrospectively analyzed. Results 15 cases of senile sphenoid sinus fungal ball, 5 males and 10 females; aged 60 to 72 years, with an average age of 70.4 years. Clinical manifestations of headache in 12 cases, the site of the forehead, occipital and ball-based; tears in 3 cases of blood; combined with nasal discharge reflux, accompanied by irritating cough in 3 cases; coronal and axial CT examination unilateral sphenoid sinus 9 cases on the left and 6 cases on the right) showed homogenous turbid nodular soft tissue mass (13 cases showed granular density of metalloid density), thickening of the bone wall, no obvious bone damage. All 15 cases underwent endoscopic sinus surgery. All surgically passed into the sphenoid sinus through the natural ostium of olfactory sphenoid sinus anterior wall. No intraoperative and postoperative complications. Patients were followed up for 6 to 24 months, symptoms disappeared before admission. Surgical mucosa recovered well without any recurrence. Conclusions Headache and bloody runny nose are the most common clinical symptoms of sphenoid sinus fungal ball. CT scan has the characteristic manifestation and is the main imaging method for diagnosing sphenoid sinus fungal ball. Nasal endoscopic transsphenoidal anterior sinus sphenoid sinus surgery, with minimally invasive and good efficacy characteristics, is the preferred method of treatment.