内镜鼻颅底肿瘤切除和颅底功能重建手术的三维影像解剖研究  

3D image study on intranasal endoscopic skull base tumor resection and functional reconstruction

作　　者：卢晓清[1] 吴建[1] 

机构地区：[1]上海长征医院耳鼻咽喉科,上海200003

出　　处：《上海医学》2015年第6期516-518,F0003,共4页Shanghai Medical Journal

基　　金：上海市科学技术委员会西医引导重点科研项目(14411960400);上海市科学技术委员会产学研项目(14DZ1940103)资助

摘　　要：目的应用计算机三维影像重建和三维打印技术对鼻窦及其相邻的颅底结构进行影像解剖学研究,探讨计算机三维技术应用于内镜下鼻颅底肿瘤切除和颅底功能重建手术的临床价值。方法分别对4例正常成人和6例鼻颅底肿瘤患者行鼻窦冠状位CT扫描后再行计算机三维重建。应用计算机测量正常成人前鼻棘至蝶窦口、鞍底,以及筛板前、中、后部的距离,测量前鼻棘至这些结构连线与鼻底所成的角度;根据鼻颅底肿瘤患者的CT影像学资料制作三维打印模型。结果健康体格检查者前鼻棘至蝶窦口的距离为(60.8±2.5)mm,角度为(36.0±1.2)°;前鼻棘至鞍底的距离为(80.1±3.6)mm,角度为(26.7±1.3)°;前鼻棘至筛板前部的距离为(49.8±2.3)mm,角度为(69.9±3.2)°;前鼻棘至筛板中部的距离为(54.3±2.2)mm,角度为(56.6±2.3)°;前鼻棘至筛板后部的距离为(62.5±2.4)mm,角度为(45.7±2.6)°。三维打印模型清晰显示颅底的正常骨质,以及被肿瘤破坏的颅底骨质缺损的大小和形状;并能清晰显示眼眶的眶顶和内侧壁骨质立体结构,以及被肿瘤破坏的眶内侧壁骨质缺损的大小和形状。结论计算机三维影像重建和打印技术有助于内镜下鼻颅底肿瘤切除和颅底功能重建手术的手术径路、颅底缺损修补材料大小和形状的选择,从而减少颅内手术并发症的发生。Objective To conduct 3D image reconstruction and 3D printing on the nasal sinus and adjacent skull base, and to explore the value of 3D technology in intranasal endoscopic skull base tumor resection and functional reconstruction. Methods 3D reconstruction was carried out in 4 healthy adults and 6 patients with nasal skull base tumor after nasal sinus coronal CT scan. The distance from anterior nasal spine to aperture of sphenoidal sinus, the bottom of saddle and sieve plate in normal adults was measured by computer. And the angle between those lines and floor of nose was also detected. 3D printing was performed in 6 patients with nasal skull base tumor according to （3T results. Results The distance from anterior nasal spine to aperture of sphenoidal sinus, the bottom of saddle, the front of sieve plate, the centre of sieve plate, the posterior of sieve plate of the healthy adults was （60.8±2.5） mm, （80. 1 ± 3.6） mm, （49.8±2.3） mm, （54.3± 2.2） mm, and （62.5 ± 2.4） mm,respectively. The angle between these lines and floor of nose of the healthy adults was （36.0± 1.2）°, （26.7± 1.3）°, （69.9±3,2）°, （56.6±2.3）°, and （45.7±2.6）°, respectively. The model of 3D printing clearly showed the size and appearance of the bone defect of skull base and medial orbital wall destroyed by tumor. Conclusion 3D reconstruction and 3D printing technology is helpful for the choice of intranasal endoscopic skull base surgical approach and the selection of repair materials of skull base defect, which can reduce the incidence of complications.

关 键 词：三维技术 内镜鼻颅底手术 影像解剖 

分 类 号：R739.6[医药卫生—肿瘤]