影像导航技术在鼻眼相关内镜手术中的应用  

Application of image guided technique in rhino-orbital related endoscopic surgery

作　　者：薛金梅[1] 李元惠 张艳廷[1] 关芳灵[1] 段李禾[1] 赵长青[1] 

机构地区：[1]山西医科大学第二医院耳鼻咽喉头颈外科,太原030001 [2]山西医科大学

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第2期125-128,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：山西省归国留学人员基金(No:2016-121);山西省留学人员科技活动择优资助重点项目(No:201710);山西省归国人员重点资助项目(No:2014-重点3);山西省重点研发计划项目(No:201703D121003)

摘　　要：目的:总结影像导航系统辅助下进行的6例鼻眼相关内镜手术的经验,探讨影像导航技术在鼻眼内镜手术中的适应证及其应用价值。方法:采用回顾性研究方法分析6例鼻眼相关疾病患者鼻内镜手术中应用Fusion电磁波感应型导航的情况,包括鼻眼贯通异物1例,视神经减压术2例,眶尖血管瘤1例,筛额窦囊肿1例,眶内肿物活检术1例。记录每例患者导航系统的准备时间,术中定位的精准度及手术连贯性,术中及术后手术并发症的发生情况。结果:患者的导航平均准备时间仅为(8.13±1.858)min。6例患者在导航术中均能精准定位鼻窦窦口、眶纸板、颅底、视神经、颈内动脉等重要结构,术中注册误差均小于1mm。6例患者的导航手术顺利,连贯性好,不存在因术中误伤所致颅内、眶内并发症。结论:影像导航外科技术使内镜下鼻眼相关手术实现真正意义上的微创和精准。导航系统的准备时间短,注册精准度高、手术连贯性好,能够提高手术的安全性、减少手术并发症的发生。然而,其仍然是一种辅助工具,并不能代替术者的解剖知识、手术培训及临床经验。Objective：To review retrospectively six cases of rhino-orbital related endoscopic surgeries aided by Fusion electromagnetic system,to explore the indications and clinical value of image guided technique in endonasal endoscopic surgery.Method：Retrospective research methods were used.In this study,six cases of nasal endoscopic sinus surgery using Fusion electromagnetic system were analyzed,including 1 nasal penetrating foreign body,2 optic nerve decompressions,1 orbital apex hemangioma,1 sieve frontal sinus cyst,1 intraorbital mass biopsy.The preparation time of navigation system,the accuracy of intraoperative positioning and surgical coherence,intraoperative and postoperative complications of surgery were recorded.Result：The average preparation time was（8.13 ± 1.858）min.In the navigation,the sinus ostium,orbital cardboard,skull base,optic nerve,internal carotid artery and other important structures can be accurately located in all patients,while registrations had been accurate within 1 mm.Six patients were successfully operated by image guided technique.There was no intracranial or intraorbital complications due to intraoperation error.Conclusion：Image guided technique allows for a truely microinvasive and accurate rhino-orbital related endoscopic surgeries.It requires less preoperative preparation time,has high surgical navigation accuracy,improves the surgical coherence and safety,and reduces the surgical complicationgs.However,as an auxiliary tool,it can not replace the surgeon＇s anatomical knowledge,surgical training and clinical experience.

关 键 词：影像导航 鼻内镜手术 鼻眼相关疾病 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]