CAJ | 학술논문

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.
목적:회고분석진균성비두염환자술전CT,제출비특정성적림상표현,이제고술전진단적준학성.방법:술후병리진단위진균성비두염환자CT 176례,술전균행비두CT검사급비내경검사.소유환자균경비내경하비두개방술,술중청리두내병변병경병리검사증실위진균감염.기중단순접두35례,단순상합두84례,사두상합두49례,전조비두3례,사두접두5례.관찰이상각조술전CT제병변개화특정이외적비특정성표현.결과:본조환자공176례179측,기중단측173례,쌍측3례(전조비두감염).CT적비특정성개변포괄:두내병변밀도균균증고,두내병변밀도불균균증고,수루비두내측벽가유골질흡수.병리증실179측중,단순접두조CT병변개화27측,CT병변비특정성개변8측,기중두내균균밀도증고5측,불균균밀도증고3측;단순상합두조병변개화72측,병변비특정성개변12측,기중두내균균밀도증고8측,불균균밀도증고4측,반유골질흡수5측;사두상합두조병변개화36측,병변비특정성개변13측,기중두내균균밀도증고9측,불균균밀도증고4측,반유골질흡수6측;전조비두조병변개화6측;사두접두조병변개화5례.두내병변개화체81.56%.결론:두내병변적개화피시위진균성비두염CT적특정성표현.단재림상공작중가관찰도부분진균성비두염술전CT적비특정성개변.당결핍CT적특정성표현시,부통과CT상불능작출진균성비두염적술전진단,수기타검사수단래주감별진단,심지수경수술탐사후적병리진단래학진.
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 fungal 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 ethmoid 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 unifom 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. 5 cases showed uniforra.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 derise,4 cases showed uneven dense and 5 cases had boRe 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.