影像导航系统在鼻内窥镜手术中的应用

目的通过28例在影像导航下进行的鼻内窥镜手术，探讨耳鼻咽喉影像导航系统在鼻内窥镜手术中应用的有关问题。方法慢性鼻窦炎、鼻息肉10例，鼻咽血管纤维瘤4例，垂体腺瘤6例，鼻窦骨化纤维瘤3例，鼻咽混合瘤2例，鼻腔平滑肌瘤1例，霉菌性鼻窦炎1例，鼻腔内翻性乳头状瘤1例，均在影像导航系统导航下进行鼻内窥镜手术。结果术前准备时间15～30min，平均26min。配准系数在1.3～2.0之间，平均1.9；影像与实体指示之间误差小于1mm的范围包括鼻窦、颅底等手术区域。28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窥镜手术相比差异无显著性。结论影像导航系统能与鼻内窥镜配合。鼻腔、鼻窦及颅底解剖变异，肿瘤伴眶、颅底侵犯，有鼻科手术史正常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，提高手术的精确性，在未来鼻-颅底微创外科中有良好的应用前景。

Application of an image-guidance system in endoscopic sinus surgery

Objective To evaluate the advantages of image guidance system in endoscopic sinus surgery. Methods Twenty eight endoscopic sinus surgery procedures were performed with the help of image guidance system. There were 11 cases of chronic sinusitis with/or without nasal polyps, 4 juvenile nasopharyngeal angiofibromas, 6 pituitary adenomas, 3 ethmoid ossifying fibromas, 2 nasopharyngeal mixed tumors, 1 nasal leiomyoma, 1 fungal sinusitis, and 1 inverted pipilloma. Results In all cases, the preoperative operation would take 15 30 minutes, the registration rate was 1.3 2.0, the localization accuracy was within 1 mm.Compared with the traditional endoscopic sinus surgery, the operative time did not differ obviously. No complication occurred. Conclusions The image guidance system could identify the operative borders and critical anatomical structures together with the corresponding CT data, especially in cases with anatomical variations, unidentified anatomical landmarks, and intranasal or anterior skull base tumors. Endoscopic sinus surgery, combined with the image guidance system, provided accurate tumor resection while preserving normal tissue. It could increase surgical effectiveness and decrease overall surgical complications. We believe that the image guidance system is a useful tool for endoscopic sinus surgery.