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目的:探讨老年淋巴瘤患者化疗后鼻窦真菌感染的诊断及治疗。方法:1例老年淋巴瘤患者化疗后出现右侧头痛头晕、眼胀、流泪、视力减退,头颅磁共振成像示右蝶窦炎症,累及右侧海绵窦可能;右眼眶内及右视神经异常改变,炎症可能。全身麻醉下行经鼻内镜右蝶窦开放术及真菌培养。结果:术中见窦内多量干酪样物,真菌培养为曲霉菌。病理:大量成团的曲霉样菌丝结构(有分隔及45°分支)真菌。确诊为鼻窦侵袭性曲霉菌感染。给予卡泊芬净及伏立康唑治疗后,真菌得到控制。结论:老年淋巴瘤患者化疗后鼻窦真菌感染需及早获得组织学证据,从而确诊。药物联合手术治疗是最有效的方法。
Objective: To investigate the diagnosis and treatment of fungal sinus infection in elderly patients with lymphoma after chemotherapy. Methods: One patient with senile lymphoma showed right headache with dizziness, dilation of eyes, tearing, vision loss, cranial magnetic resonance imaging showing right sphenoid sinus inflammation involving the right cavernous sinus, abnormalities of right orbital and right optic nerve, inflammation may. Transnasal endoscopic right sphenoid sinus surgery and fungal culture under general anesthesia. Results: A large amount of sinusoids were found during operation, and the fungi were cultured as Aspergillus. Pathology: Large groups of aspergillus-like hyphae (separated and 45 ° branched) fungi. Confirmed as sinus aspergillosis infection. After administration of caspofungin and voriconazole, the fungus was controlled. Conclusion: The diagnosis of nasal sinus fungal infection in elderly patients with lymphoma should be confirmed by histological evidence as soon as possible. Drug surgery combined with surgery is the most effective way.