影像导航下的鼻内镜手术

目的　通过影像导航下进行的 5 3例鼻内镜手术分析 ,就不同类型耳鼻咽喉影像导航系统在鼻内镜手术中应用的有关问题进行探讨。方法　慢性鼻窦炎、鼻息肉 2 4例 ,鼻咽纤维血管瘤 4例 ,垂体腺瘤 8例 ,鼻窦骨化纤维瘤 9例 ,鼻咽混合瘤 2例 ,鼻腔平滑肌瘤 1例 ,霉菌性鼻窦炎 3例 ,鼻腔内翻性乳头状瘤 2例 ,分别在 3种类型的影像导航系统导航下进行鼻内镜手术。结果　影像导航术前准备时间 15～ 30min ,平均 2 6min。影像标志与实体指示之间误差 <1mm的范围包括鼻窦、颅底等手术区域。其中 3例患者术中出现较明显误差 ,均及时发现。 5 3例均手术过程顺利 ,无术中、术后并发症。手术时间与传统的鼻内镜手术相比无明显差异。结论　不同类型影像导航系统均能与鼻内镜配合 ,但各有优缺点。鼻腔、鼻窦及颅底解剖变异 ,肿物伴眶、颅底侵犯 ,有鼻科手术史解剖标志缺失的患者 ,是进行影像导航手术的指征。导航技术可以帮助医师在手术中确认鼻及颅底的局部及相邻解剖标志 ,提高手术的精确性 ,增加医师的信心 ,在未来鼻 颅底微创外科中有良好应用前景

Imaging-navigated endoscopic sinus surgery

Objective To evaluate the advantages and disadvantages of different type of image guidance system in endoscopic sinus surgery Methods Fifty three endoscopic sinus surgery were performed under different type of image guidance system, there were 24 chronic sinusitis with or without nasal polyp, 4 juvenile nasopharyngeal angiofibroma, 8 pituitary adenoma, 9 ethmoid ossifying fibroma, 2 nasopharyngeal mixed tumor, 1 nasal leiomyoma, 3 fungal sinusitis, and 2 inverting papilloma Results In all cases, the preoperative time was 15 30 minutes,the registration rate were 1 3 2 0, the localization accuracy was within 1mm Compared with the traditional endoscopic sinus surgery, the operating time was similar, without obvious difference No complication occurred Conclusion All types of image guidance system could work well with endoscopic system, each of them had its own shortages Every type of image guidance system could identify the borders and critical anatomical structures in the corresponding CT data, especially in cases in which anatomical landmarks were no longer present, with anatomical variation, intranasal and anterior skull base tumor Combined with endoscopic surgery, the image guided endoscopic surgery provided accurate tumor resection while preserving normal tissue, increased surgical effectiveness, decreased overall surgical complications It is believed that the image guidance system is a useful tool for endoscopic sinus surgery