影像导航系统在鼻内镜手术中的应用  

Use of image-guidance navigation system in nasal endoscopic surgery

作　　者：肖立智[1] 郑静[1] 陈劲海[1] 卢颖深[1] 卢珊[1] 张孝文[1] 

机构地区：[1]广州医学院第一附属医院耳鼻咽喉一头颈外科,510120

出　　处：《中华生物医学工程杂志》2011年第4期347-350,共4页Chinese Journal of Biomedical Engineering

摘　　要：目的 总结影像导航技术在鼻内镜手术中的应用经验。方法 回顾性分析本院2007年5月至2010年9月采用美敦力Stealth Station LandmarX导航系统实施鼻内镜手术的患者33例（导航组），包括慢性鼻窦炎、鼻息肉21例，孤立性蝶窦炎4例，额窦炎3例，鼻内翻性乳头状瘤2例，上颌窦骨瘤1例，鼻窦骨性纤维结构不良2例（额窦、蝶窦各1例）。同时根据术中患者头部固定架的不同又分为神经外科专用三钉式头架固定组（A组，15例）和鼻内镜专用头带式无创参考架固定组（B组，18例），并以同时期常规鼻内镜手术组43例为对照组，包括慢性鼻窦炎、鼻息肉30例，孤立性蝶窦炎4例，额窦炎6例，鼻内翻性乳头状瘤3例。评估影像导航的精确性。对比分析A、B两组的准备及注册时间、导航组和对照组的总手术时间、出血量及术后出血等并发症发生情况。结果影像导航可准确定位解剖标志。A组的准备及注册时间长于B组[（50.67±19.26）min比（21.67±12.90）min，P＜0.05]。导航组平均手术时间、出血量与对照组差异无统计学意义[（61.67±18.53）min比（63.84±16.93） min，（123.18±53.31）ml比（127.79±63.59）ml，P＞0.05]。蝶窭炎、额窦炎及鼻肿瘤手术时间在导航组平均为（55.00±23.55）min，比对照组（70.38±18.45）min明显缩短（P＜0.05）。导航组与对照组患者均无术后出血等并发症发生。结论 影像导航系统与内镜结合，可在术中准确定位鼻腔、鼻窦及前颅底的解剖结构。Objective To summarize the experiences of the use with image-guidance navigation system in endoscopic nasal surgery. Methods Thirty-three cases （navigation group） undergoing endoscopic nasal surgery with image- guidance navigation system （Stealth Station Lanmar X, Medtronics） were reviewed, including 21 cases of chronic rhinosinusitis with or without nasal polyps, 4 of isolated sphenoid sinus, 3 of frontal sinusitis, 2 of nasal inverted papilloma, 1 of maxillary sinus osteoma, and each 1 of osteofibrous dysplasia of the frontal sinus and the sphenoid sinus. Depending on the head fixation device during procedure, the 33 patients were allocated to group A （n=15） using Mayfield 3-pin head clamp and group B （n=18） using noninvasive head frame. A contemporary cohort receiving traditional endoscopic sinus surgery were recruited as control group（n=43）, including 30 cases of chronic rhinosinusitis with or without nasal polyps, 4 of isolated sphenoid sinus, 6 of frontal sinusitis, and 3 of nasal inverted papilloma. The precision of image-guidance navigation was evaluated. Moreover, the preparation （image registration） time of A and B groups, operation time, estimated blood loss and postoperative complications of navigation and control groups were compared. Results Anatomical landmarks were well localized by image- guidance navigation system. Group A required longer image registration and preparation time as compared with group B [（50.67±19.26） min vs （21.67±12.90） min, P〈0.05]. There were no significant differences in operation time[（61.67±18.53） min vs （63.84±16.93） min, P〉0.05]and blood loss[（123.18±53.31） ml vs （127.79±63.59） ml, P〉0.05]between navigation group and the control group. For treatment of sphenoid sinusitis,frontal sinusitis and nasal neoplasms, navigation-guided surgery required remarkably shorter operation time than the traditional option[（55.00±23.55） min vs （70.38±18.45） min, P〈0.05]. Postoperative bleeding and other serious complic

关 键 词：外科手术 计算机辅助 内窥镜检查 耳鼻喉外科手术 立体定位技术 治疗效果 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]