电磁导航技术在鼻颅底手术中的应用  

Application of electromagnetic navigation system in nasal skull base surgery

作　　者：张俊杰 马士崟[2] 李慧[2] 王晓敏[2] 张明洁[2] 陈德尚[2] ZHANG Jun-jie;MA Shi-yin;LI Hui;WANG Xiao-min;ZHANG Ming-jie;CHEN De-shang(Graduate School of Bengbu Medical College,Bengbu 233030,China;Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院研究生部,安徽蚌埠233030 [2]蚌埠医学院第一附属医院耳鼻咽喉头颈外科,安徽蚌埠233004

出　　处：《中国耳鼻咽喉颅底外科杂志》2019年第6期630-634,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：安徽省自然科学基金(1608085MH236)

摘　　要：目的探讨电磁导航技术在鼻颅底手术中的临床应用。方法收集2017年8月-2019年2月应用电磁导航技术行15例鼻颅底手术,患者病变范围涉及蝶窦、鞍区、咽旁隙、颈静脉孔区、筛顶、蝶骨平台等解剖区域。术前均完善CT、MRI等影像学资料,录入导航系统行三维重建,鼻内镜下进行手术,涉及复杂、重要解剖结构时使用导航系统进行定位。结果15例手术中1例鼻颅底纤维血管瘤术中出血约1000 ml,余手术出血均可控。15例手术术中均未出现重要结构损伤,术后无严重并发症。15例患者术后随访3~20个月,1例鼻颅底腺样囊性癌患者术后12个月复查考虑肿瘤复发。结论电磁导航技术应用于鼻颅底手术中,安全、精准,手术并发症少,特别适用于解剖结果变异、修正鼻内镜手术、病变广泛的恶性肿瘤患者。Objective To explore the clinical application of electromagnetic navigation system in nasal skull base surgery.Methods From Aug 2017 to Feb 2019,15 patients undertook nasal skull base surgery in our department using magnetic navigation system.The surgical lesions included sphenoid sinus,sella area,parapharyngeal space,jugular vein foramen area,ethmoidal roof,sphenoid plateau and others.The preoperative computerized tomography(CT),magnetic resonance imaging(MRI)were performed,and the data were imported into the navigation system for three-dimensional(3 D)reconstruction.All the surgical procedures were performed under nasal endoscope,and the electromagnetic navigation system was adopted for positioning when the complex,important anatomical structures were involved.Results The intraoperative bleeding was controllable except hemorrhage of about 1000 ml in one case of nasal-skull fibroangioma.None of the 15 cases had significant structural damage or serious complications.They were followed up for 3 to 20 months postoperatively,and tumor recurrence was suspected in one of nasal skull base adenoid cystic carcinoma at 12 months after operation.Conclusion With advantages of high safety and accuracy as well as few surgical complications,the electromagnetic navigation system is suitable for the surgical procedures of nasal skull base,especially those with anatomical variations,revision endoscopic sinus surgery,and malignant tumors with extensive lesions.

关 键 词：鼻颅底手术 电磁导航系统 精准治疗 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]