影像导航技术在鼻及颅底和鼻眼相关疾病内镜手术中的应用

目的 对影像导航技术在鼻及颅底和鼻眼相关疾病内镜手术中的实际应用进行评价。 方法 回顾性分析使用影像导航系统的751例实施鼻内镜手术的病例,其中565例应用美敦力Stealth Station^TM红外线导航系统,186例应用美敦力Fusion电磁导航系统。对导航系统的精确性、 术前导航准备时间、 术者对使用导航辅助的价值认知度、 导航手术中发生的不良事件,以及术中、 术后的并发症进行详细记录。 结果 红外线导航应用解剖标志法注册可提供0.5~2.0 mm的定位误差,电磁导航应用轮廓(Tracer)注册法均能达到<1 mm的注册误差。应用VAS评分评价术者对导航辅助的价值认知度为(8.3±1.2)分。其中,额窦、视神经管、颈内动脉管被认为是应用导航辅助价值最大的解剖部位。导航手术中发生的不良事件主要为影像漂移、定位器械无法实时定位、注册失败。全部病例均能顺利手术,无颅内和眶内并发症出现。 结论 影像导航与内镜手术的结合,为术者提供了更精确的解剖指引;能辅助提高内镜手术的准确性,消除内镜下可能出现的解剖错觉,尤其是在处理涉及额窦、视神经、颈内动脉的鼻颅底及眼眶手术中。导航手术中不良事件的发生率较低,此时术者的设备操作经验和内镜手术经验尤为重要。

The clinical application of image-guided endoscopic technique in the management of nasal sinus,skull base and orbital disease

Objective To evaluate the clinical application of image-guided endoscopic techniques in the management of nasal sinus,skull base and orbital disease.Methods Retrospective review was performed in 751 transnasal endoscopic surgeries with the help of the image navigation system,including 565 cases with Medtronic Stealth StationTM optical based system and 186 cases with Medtronic Fusion electromagnetic system.The accuracy of image navigation system,preoperative registration time,benefits and undesirable problems of intra-operative navigation and surgical complications were analyzed.Results Both platforms had been shown to be accurate to within 2 mm.The benefits of navigational technology were evaluated by VAS scores,which decreased to (8.3 ± 1.2).The anatomic sites were frontal sinus,optic nerve and carotid artery,which the best guided effects applied by navigational orientation.The major undesirable problems in navigation procedures were image-drifting,failing to real-time orientation,and failing to registration.All surgeries completed successfully without any complications.Conclusion The image-guided techniques can assist endoscopic surgeons to identify surgical markers with precision and eliminate anatomic illusion possible under endoscopy.The incidence of undesirable problems in navigation procedures was low.The experience of surgeon for endoscopic and navigational operation was very important under this situation.