内镜下影像导航技术在1250例鼻颅底手术中的应用  

A retrospective analysis of 1 250 nasal skull base operations under guide of image navigation technology

作　　者：张庆泉[1] 宋西成[1] 张华[1] 王强[1] 孙岩[1] 陈秀梅[1] 姜绍红[1] 

机构地区：[1]烟台毓璜顶医院耳鼻咽喉-头颈外科,山东烟台264000

出　　处：《山东大学学报（医学版）》2012年第7期114-116,共3页Journal of Shandong University:Health Sciences

摘　　要：目的探讨应用内镜下影像导航技术施行鼻腔鼻窦、前中颅底的手术,避免颅底周围重要的神经血管组织的损伤,降低手术并发症,提高手术疗效。方法应用内镜下影像导航技术共施行鼻腔鼻窦、前中颅底手术1 250例,其中鼻息肉/鼻窦炎549例,鼻窦炎256例,鼻窦囊肿68例,后鼻孔闭缩及粘连14例,外伤性眶壁、视神经管骨折29例,脑脊液鼻漏19例,前中颅底肿瘤315例,其中垂体瘤32例、良性肿瘤250例、恶性肿瘤33例。结果1 250例均顺利、准确地配准(部分病例在配准时因计算机原因延迟至30 min),内镜下均能顺利找到骨折部位、瘘口或者窦口位置,顺利确定肿瘤边界,明确周围重要结构位置,避免了损伤。结论内镜下影像导航在前中颅底外科手术中有定位准确、标志清楚、降低手术并发症、可最大限度地切除病变等优点,可以弥补单纯鼻内镜下操作缺乏层次感的局限性。配准精确是导航手术的关键,一旦对应关系破坏将出现严重后果,所以术中应定时检查配准情况。Objective To explore feasibility of the nose, the nasal sinus, and the anterior and middle skull base opera- tions with the help of image navigation technology, so as to avoid the vital neuro and vascular tissues of the skull base, decrease the incidence of complications and increase therapeutic effect of the operations. Methods 1 250 cases were performed the operations with help of the image navigation system. Of them, 549 cases were nasal polyps sinusitis, 256 sinusitis, 68 sinus cystoma, 14 choanal atresia or adhesions, 29 traumatic orbital wall fracture or optical canal fracture, 19 CSF rhinorhea, and 315 anterior and middle skull base tumors. Results All were successfully registered with accu- racy, and some were delayed up to 30 minutes. With guidance of the image navigation system, all cases were success- fully operated on without implications. Conclusion Image navigation technology can be applied in anterior and middle skull base operations with advantages of accurately locating, clearly marking, significantly decreasing incidence of com- plications, and maximally removing the lesions. Accurate registering is key for success operations, therefore registering status should be checked from time to time during the surgeries.

关 键 词：鼻-颅底外科手术 影像导航技术 鼻内镜外科手术 并发症 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]