流体力学方法测量全鼻窦开放对鼻腔鼻窦气流的影响  

Effect of endoscopic sinus surgery on airflow of the nasal cavity and paranasal sinuses： a computational fluid dynamics study

作　　者：熊观霞[1] 黎建峰[2] 江广理[1] 詹杰民[2] 容亮湾[2] 许庚[1] 

机构地区：[1]中山大学附属第一医院耳鼻咽喉科医院中山大学耳鼻咽喉科研究所,广州510080 [2]中山大学应用力学与工程系

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第11期911-917,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广东省自然科学基金（8151008901000205）;中山大学5010计划（180002）

摘　　要：目的从流体力学角度探讨全鼻窦开放术对鼻腔鼻窦气流的影响，比较鼻腔鼻窦气流走向、速度、压力和分布以及鼻腔鼻窦气流交换在手术前后的差异。方法在1例健康成年女性鼻窦CT扫描基础上，使用Fluent 6．1．22软件模拟出正常人鼻腔鼻窦结构，并在此基础上再模拟出鼻内镜下全鼻窦开放手术后的鼻腔鼻窦模型，利用Navier—Stokes方程计算、比较手术前后气流流速、压力、分布和迹线。结果①全鼻窦开放术后鼻腔总鼻道气流量明显减少，中鼻道和开放的筛窦连通区域的气流量增加，在稳态吸气时增加10％，呼气时增加9％；②全鼻窦开放术后相当于原窦口鼻道复合体的手术区域的气流速度提高，鼻腔流场的最大速度发生了变化，手术后吸气时左侧鼻腔出现了2个高速区域，一是与手术前一致的下鼻甲前端的高速区域，另一区域在中鼻道的前端，相当于原钩突与中鼻道之间的区域，速度为5．03m／s；③全鼻窦开放术后气流在鼻前庭、总鼻道、下鼻道、鼻咽等位置的迹线与手术前大致相近，但手术区域的气流轨迹发生了较大变化，上颌窦、筛窦连通区域和蝶窦内形成大范围的涡旋；④全鼻窦开放术后鼻腔的总体压强逐渐降低，鼻腔中部压强降低较为明显；⑤全鼻窦开放术后各鼻窦内气流均有不同程度增加，上颌窦最多，蝶窦次之，额窦气流增加不明显。结论全鼻窦开放术后鼻腔以中鼻道为主的手术区域的气流速度、流量和迹线都有可能发生变化；各鼻窦的气流增加，上颌窦最为明显。Objective To study the airflow velocity, trace, distribution, pressure, as well as the airflow exchange between the nasal cavity and paranasal sinuses in a computer simulation of nasal cavity pre and post virtual endoscopic sinus surgery （ESS）. Methods Computational fluid dynamics （CFD） technique was applied to construct an anatomically and proportionally accurate three-dimensional nasal model based on a healthy adult woman＇s nasal CT scans. A virtual ESS intervention was performed numerically on the normal nasal model using Fluent 6.1.22 software. Navier-Stokes and continuity equations were used to calculate and compare the airflow characteristics between pre and post ESS models. Results （~）After ESS flux in the common meatus decreased significantly. Flux in the middle meatus and the connected area of opened ethmoid sinus increased by 10% during stable inhalation and by 9% during exhalation. @）Airflow velocity in the nasal sinus complex increased significantly after ESS. （~） After ESS airflow trace was significantly changed in the middle meatus. Wide-ranging vortices formed at the maxillary sinus, the connected area of ethmoid sinus and the sphenoid sinus. （~）Total nasal cavity resistance was decreased after ESS. （~）After ESS airflow exchange increased in the nasal sinuses, most markedly in the maxillary sinus. Conclusions After ESS airflow velocity, flux and trace were altered. Airflow exchange increased in each nasal sinus, especially in the maxillary sinus.

关 键 词：呼吸力学 气流 鼻腔 鼻窦 内窥镜检查 耳鼻喉外科手术 

分 类 号：R686[医药卫生—骨科学]