鼻腔扩容术量化虚拟手术的气流动力学研究  

Study on the computer fluid dynamics of quantitative virtual surgery for nasal cavity ventilation expansion

作　　者：暴继敏 孟大为 李哲 马云鹏 李奇洙 梁大帅 李贵民 臧洪瑞[2] BAO Jimin;MENG Dawei;LI Zhe;MA Yunpeng;LI Qizhu;LIANG Dashuai;LI Guimin;ZANG Hongrui(Department of Otolaryngology,Liaoning Jinqiu Hospital,Shenyang,Liaoning,110016,China;Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing,100730,China)

机构地区：[1]辽宁省金秋医院耳鼻咽喉科,辽宁沈阳110016 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730

出　　处：《中国耳鼻咽喉头颈外科》2020年第3期153-157,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：辽宁省科学技术计划项目(2015225021)。

摘　　要：目的借助于计算流体力学数值模拟,分析鼻腔扩容术对上气道气流动力学的影响。方法选取鼻科住院男性中度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者1例,主诉交替性鼻堵伴睡眠时打鼾4年余。接受高分辨率螺旋CT扫描并存储结果。借助于mimics 13.0软件进行虚拟手术,建立鼻腔扩容术不同的手术范围的手术模型并进行计算流体力学数值模拟。结果鼻中隔矫正术+双侧下鼻甲外移术虚拟手术后,鼻腔截面和咽腔截面的平均负压绝对值和平均气流速度降低,但鼻腔和咽腔的气流分布无明显改变;双侧中鼻道对称性虚拟开放后,气流速度和压力梯度变化趋于平缓、均匀,且咽腔最狭窄平面的平均负压值进一步降低。非对称性虚拟手术后,双侧鼻腔压力分布和最大气流速度分布不对称,咽腔最狭窄平面平均气流速度较原始模型无明显变化,平均负压绝对值甚至超过原始模型。结论鼻腔扩容术一定程度上改善由于呼吸气流运动造成的咽腔塌陷趋势。双侧中鼻道对称性开放使鼻腔气流重新分布,进一步降低咽腔管腔内负压。非对称性手术导致双侧鼻腔压力和气流速度分布不对称,甚至可能升高咽腔负压绝对值,提示了鼻腔扩容术双侧对称性开放的必要性。OBJECTIVE To analyze aerodynamic changes of the upper airway after nasal cavity ventilation expansion surgery by means of Computer Fluid Dynamics(CFD).METHODS A male patients who was diagnosed with moderate OSAHS according to pre-operative polysomnogram(PSG)examination was candidate for this section.He always complained with sense of nasal obstruction and snoring during sleep.He was given upper airway high-resolution CT scan and data was imported into Mimics 13.0 Software package in order to perform virtual surgery.The original model and models after virtual surgery were imported into ANSYS 14.0 to perform numerical simulation.RESULTS Septoplasty with three high-tension lines virtual resection and lateral virtual displacement and fixation of the inferior turbinate increased nasal airflow volume of the common meatus,reduced the airflow velocity and absolute value of negative pressure of the nasal and pharyngeal sections.However,the distribution of airflow velocity and negative pressure were not changed.After symmetrical bilateral virtual ethmoidectomy and maxillary sinus surgery,nasal airflow was redistributed.The distribution of airflow velocity and negative pressure became gentler and more even.The negative pressure at the narrowest pharyngeal plan further reduced.After asymmetry virtual nasal surgery,the distribution of maximum airflow velocity and negative pressure were different between two sides of nasal cavity.The absolute value of average negative pressure at the narrowest plan even more than that of the original model.CONCLUSION Nasal cavity ventilation expansion surgery decrease nasal and pharyngeal airflow velocity and absolute value of negative pressure.The decreased absolute value of negative pressure reduces the pharyngeal transm ural pressure and relieves pharyngeal collapse which was partially caused by aerodynamics abnormality.Asymmetric nasal surgery should be avoided,because it might cause higher negative pressure at the pharyngeal narrowest plan.

关 键 词：睡眠呼吸暂停 阻塞性 气道阻力 压力 最大呼气流速 计算机模拟 鼻阻力 鼻腔扩容术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]