鼻-眶-脑毛霉菌病(ROCM)治疗中眼眶剥除术的作用-一项前瞻性分析研究

Niranjan Kumar, Malarvizhi Raman, Yogeswari Alagappan
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引用次数: 0

摘要

毛霉病是一种罕见的机会性真菌感染。鼻眶毛霉菌病治疗中最关键的决定是何时建议拔除。本研究旨在了解在COVID - 19大流行中毛霉菌病流行的情况下,进展并广泛累及整个眶腔并伴有轻度颅内伸展需要拔除术作为挽救生命措施的病例模式。怀疑或诊断为侵袭性眼眶毛霉菌病的患者来我院就诊并纳入研究。所有患者均行CT带眶的PNS检查,有颅内扩散及视神经受累者行MRI颅脑带眶检查。患者开始使用两性霉素B脂质体静脉注射(5mg/kg/天)和眼眶内两性霉素B注射,并密切监测临床进展。所有患者均接受FESS检查,组织病理学检查为毛霉病阳性。在需要进行眼窝剜除的病例中,在确认没有光感并获得精神病学咨询的知情同意后,将患者进行眼窝剜除。保留眼睑切除是首选的方法。696例患者中41例(5.89%)进行了拔除,其中21例(51.2%)为右侧,20例(48.8%)为左侧。12名患者(29.2%)没有COVID - 19检测阳性/症状史。1例(2.4%)未患糖尿病。所有患者(100%)均有鼻窦受累(一个或多个鼻窦受累),眶腔受累程度不同。41例患者中有4例(9.75%)病情恶化,需要ICU护理。1例患者因多重合并症死亡(2.4%)。其中2例(4.87%)患者的毛霉病组织病理检查为阴性。32例(78.04%)患者眼眶愈合良好,5例(12.1%)患者有脱臼,需行2次及以上脱臼手术。由于毛霉是一种血管侵入性、快速进行性、高致命性的感染,密切监测其侵入眶尖和颅内扩散等结构,对于及时干预和决定是否进行拔除至关重要。这对阻止进展和挽救生命至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role of orbital exenteration in management of rhino-orbito-cerebral mucormycosis (ROCM) - A prospective analytical study
Mucormycosis is an uncommon, opportunistic fungal infection. The most crucial decision in the management of rhino-orbital mucormycosis is when to advise exenteration. This study aims at understanding the pattern of cases which progressed and had extensive involvement of the entire orbital cavity with mild intra cranial extension requiring exenteration as life salvage measure in the setting of epidemic of mucormycosis in a pandemic of COVID – 19. Patients suspected or diagnosed with invasive orbital mucormycosis visiting our hospital were admitted and included in the study. CT PNS with orbit were done for all patients and MRI brain with orbit were done in patients in whom intracranial spread and involvement of optic nerve were present. Patients were started on liposomal intravenous amphotericin B (5mg/kg/day) and intraorbital amphotericin B injection when indicated and closely monitored for clinical progression. All patients were taken up for FESS and if positive for mucormycosis on histopathological examination. In cases wherever exenteration was indicated, after confirming that there was no perception of light and obtaining informed consent with psychiatric counselling patient was taken up for orbital exenteration. Lid sparing exenteration was the method of choice. A total of 41 patients out of 696(5.89%) underwent exenteration out of which 21(51.2%) were right sided and 20(48.8%) were left sided. 12 patients (29.2%) of those who had undergone exenteration did not have a history of being tested positive/ been symptomatic for COVID 19. 1 patient (2.4%) was not diabetic. All patients (100%) had sinonasal involvement (Involvement of one or more paranasal sinuses) with involvement of orbital cavity to different degrees. 4 out of 41(9.75%) patients had deteriorated and required ICU care. 1 patient succumbed to death (2.4%) due to multiple comorbidities. On histopathological examination of exenteration specimen, 2(4.87%) patients turned out to be negative for mucormycosis. In 32(78.04%) of them the socket healed well while 5(12.1%) had slough who required 2 or more sittings of sloughectomy. As mucor is angio invasive rapidly progressive highly fatal infection close monitoring for invasion into structures like apex of orbit and intra cranial spread is essential for timely intervention and decision to perform exenteration. This is crucial for arrest of progress and life salvage.
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