影像导航在骨性外耳道闭锁手术的应用  

Image-guided surgery in congenital bony aural atresia

作　　者：龙海珊[1] 韩德民[2] 戴海江[2] 夏寅[2] 赵守琴[2] 郑雅丽[2] 程继龙[2] 郭继周[2] 王桂生[2] 范尔钟[3] 李颖[3] 

机构地区：[1]首都医科大学,2004级博士研究生北京100069 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730 [3]北京市耳鼻咽喉科研究所,北京100005

出　　处：《中国耳鼻咽喉头颈外科》2007年第2期91-94,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：北京市自然科学基金(重点项目)资助项目(7031001)

摘　　要：目的观察影像导航(image-guided surgery,IGS)下行外耳道骨性闭锁手术的应用效果。方法分析2001～2004年患C型(Schuknecht分类)先天性小耳畸形病例36耳。试验组(IGS组)18耳,年龄12～29岁,术后随访6个月～1年;对照组(非IGS组)18耳,年龄10～27岁,术后随访6个月～3年。两组均采用鼓窦径路听力重建,由同一手术组完成;比较两组手术时间、术者感觉和听力学改变。结果所有患者外耳道完全骨性闭锁,骨链畸形,鼓室发育不全,面神经畸形。术前颞骨CT未充分显示畸形的水平半规管,术中导航得以证实。IGS组手术准备时间增加20分钟(15～30分钟),实际手术时间(2小时32分钟)减少25分钟,总时间IGS组则减少5分钟。IGS配准率在0.6mm～1.3mm之间,平均0.84mm。确保术野所见与IGS影像完美结合,使术者感觉更安全。IGS组1例,非IGS组3例术后出现部分外耳道再狭窄。两组均未出现面瘫和术后全聋,均获得明显的听力改善(平均听阈:IGS=31.8dB,非IGS=30.5dB)。结论IGS可用于C型外耳道骨性闭锁手术,对术者是一种有益的辅助手段,尤其当解剖标志变异,手术入路受限时,有助于明确手术方向,减少并发症;但IGS仅能明确术腔情况,其技术本身对提高听力无明显作用。OBJECTIVE Congenital aural atresia repair is difficult owing to unpredictable anatomy. Benefits may be gained from image-guided surgery （IGS）. its exact role and surgery indication were defined. METHODS From 2001 to 2004, 36 ears with bony type C （Schuknecht classification） congenital atresia were performed. In the IGS group （n=18）, repair surgery was performed with IGS, while in the control group （Non-IGS, n=18）, similar intervention was applied without IGS. IGS group： aged from 12-29 years, follow-up from 6 months to 1 year. Non-IGS group： aged from 10-27 years, follow-up from 6 months to 3 years. Intra- and post-operative clinical and audiometric findings were compared. RESULTS All of the patients had congenital bony aural atresia, ossicles malformation, tympanic cavity hypoplasia and facial nerve malformation. IGS revealed a malformed horizontal semicircular canal hidden in the bony atresia plate during the operation while computed tomography （CT） did not show preoperatively. IGS computed tomography images correlated well with intraoperative findings, gave the surgeon more security and reduced operative time （2 hours and 24 minutes） by 25 minutes. The prepare time increased 20 minutes （15-30 minutes）, but total time decreased 5 minutes in IGS group. The registration accuracy was 0.6-1.3 ram, average 0.84 mm, which was suitable for the otologic surgery. There were 1 case in IGS group and 3 cases in Non-IGS group happened local aural restenosis after operation. But there were no facial nerve paralysis and hearing injury happened in both groups, and all of the patients got the satisfactory hearing after the hearing reconstruction （the air-bone gap with an average of IGS is 31.8dB, Non-IGS is 30.5dB）. CONCLUSION In our estimation, IGS is valuable for type C congenital aural atresia repair. It serves as an educational tool and a guide both for the experienced and inexperienced surgeons in critical situations where anatomical landmarks are distorted and approach is limited. There

关 键 词：外科手术 计算机辅助 耳道 耳外科手术 

分 类 号：R764[医药卫生—耳鼻咽喉科]