导航手术在头颈肿瘤切除及重建中的临床应用  

Clinical Application of Navigation-Assisted Surgery in Head and Neck Tumor Resection and Reconstruction

作　　者：闫志伟 李欢 杨子桧 孙杨 杨向明 王维戚 杨新杰 杨耀武 魏建华 Yan Zhiwei;Li Huan;Yang Zihui;Sun Yang;Yang Xiangming;Wang Weiqi;Yang Xinjie;Yang Yaowu;Wei Jianhua(State Key Laboratory of Military Stomatology,the Fourth Military Medical University,Xi’an 710032,Shaanxi,China;National Clin ical Medicine Center for Oral Disease,School of Stomatology,the Fourth Military Medical University,Xi'an 710032,Shaanxi,China;Shaanxi Clinical Research Center for Oral Diseases,School of Stomatology,the Fourth Military Medical U-niversity,Xi’an 710032,Shaanxi,China;Department of Oral and Maxillofacial Surgery,School of Stomatology,the Fourth Military-Medical University,Xi'an 710032,Shaanxi,China)

机构地区：[1]空军军医大学军事口腔医学国家重点实验室,西安710032 [2]空军军医大学第三附属医院口腔疾病国家临床医学研究中心,西安710032 [3]空军军医大学第三附属医院陕西省口腔疾病临床医学研究中心,西安710032 [4]空军军医大学第三附属医院颌面外科,西安710032

出　　处：《肿瘤预防与治疗》2021年第12期1123-1130,共8页Journal of Cancer Control And Treatment

基　　金：军事口腔国家重点实验室自主研究课题(编号:2019ZA03、2018ZA03);空军军医大学军事医学“珠峰工程”(编号:2019ZFB010);空军军医大学第三附属医院医疗新技术新业务项目(2020)(编号:41742921212、4142Z13118、41742921320)。

摘　　要：目的:探讨导航手术在头颈肿瘤切除及重建中的实用性及价值。方法:选择历年接受导航辅助头颈部肿瘤切除及修复的10例病例,所有病例均利用Brainlab导航系统行术前规划,术中配准引导术者对肿瘤进行优化的专业处理,包括减少入路损伤、加速术区定位及明晰切除范围等。术后对切缘、出血量、并发症、术后住院时间及患者主观评价等情况进行评估。结果:颅底肿瘤组切缘阳性率仅3.3%;骨纤维异常增殖组手术范围标准客观明确,术后患者均对组织损伤程度及治疗效果感到满意;骨瓣修复组导航辅助移植骨精确就位,可同期义齿种植并成功恢复咬合,患者满意度高。结论:导航手术可定位头颈部肿瘤位置、边界及邻近的重要血管神经等结构,显著提高肿瘤手术的精准性,减少损伤,降低相关的并发症,确保手术的安全,具有一定的应用价值。Objective:To introduce the practicality and value of navigation-assisted surgery in head and neck tumor resection and reconstruction.Methods:Ten cases of head and neck tumor guided by computer-aided navigation for resection and repair were selected in recent years.Preoperative surgical plans were made for all cases by using the Brainlab navigation system.The treatment was professionally optimized guided by intraoperative registration to reduce entry access injuries,help locate the surgical area,define the resection boundary,etc.Resection margins,blood loss,complications,postoperative length of stay and patients'feedback were evaluated after surgery.Results:The positive margin rate was 3.3% in patients with skull base tumor.The criteria for the surgery scope were objective and clear in patients with fibrous dysplasia.All patients were satisfied with the therapeutic effects and the degree of tissue injuries.Bone grafts were precisely in place in the navigation-assisted bone flap reconstruction,and successful dentures were successfully implanted during the same period,with high satisfaction.Conclusion:Computer-aided navigation is applicable in that it can help locate the position,boundary and adjacent important vessels/nerves of head and neck tumors,significantly improve the accuracy of surgery,ensure the safety of surgery,and reduce complications and damage on patients.

关 键 词：外科手术 计算机辅助 头颈部肿瘤 最小侵入性外科手术 安全 

分 类 号：R617[医药卫生—外科学] R782.05[医药卫生—临床医学]