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

doi:10.6040/j.issn.1673-3770.0.2017.086

摘要/Abstract

摘要： 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。

关键词: 鼻内镜外科手术, 鼻窦, 颅底, 眼眶, 治疗,计算机辅助

Abstract: 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 Station^TM 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.

Key words: Endoscopic surgical procedures, operative, Skull base, Paranasal sinuses, Therapy, computer-assisted, Orbit

中图分类号:

R765.9

邸斌,吴彦桥,李军,李晓明. 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[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 25-30.

参考文献

[1] Laborde G, Gilsbach J, Harders A, et al. Computer assisted localizer for planning of surgery and intra-operative orientation[J]. Acta Neurochir(Wien), 1992, 119(1-4):166-70.
[2] 韩德民, 周兵, 葛文彤, 等. 影像导航系统在鼻内窥镜手术中的应用[J]. 中华耳鼻咽喉科杂志, 2001, 36(2):126-128. HAN Demin, ZHOU Bing, GE Wentong, et al. Application of an image-guidance system in endoscopic sinus surgery[J]. Zhonghua Er Bi Yan Hou Ke Za Zhi, 2001, 36(2):126-128.
[3] 吴彦桥. 导航辅助鼻内镜下复发性鼻窦炎全组鼻窦开放策略[J]. 中国医学文摘-耳鼻咽喉科学, 2014, 29(4):197-200.
[4] Pruliere-Escabasse V, Coste A. Image-guided sinus surgery[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2010, 127:33-39.
[5] 贾欢, 陈祁, 曹荣萍, 等. 表面配准与解剖标志配准在鼻内镜导航手术中的应用比较[J]. 临床耳鼻咽喉头颈外科杂志, 2010, 24(2):49-56. JIA Huan, CHEN Qi, CAO Rongping, et al. A comparison between anatomical landmark registration and surface registration for computer-assisted endoscopic sinus surgery[J]. J Clin Otolaryngol Head Neck Surg(China), 2010, 24(2):49-56.
[6] 乔莉, 邱建华, 陈福权, 等. 影像导航系统在复杂鼻内镜手术中的作用和评价[J]. 临床耳鼻咽喉头颈外科杂志, 2007, 21(11):489-493. QIAO Li, QIU Jianhua, CHEN Fuquan, et al. Effect and evaluation of image guided navigation system in complex endoscopic endonasal surgery[J]. J Clin Otolaryngol Head Neck Surg(China), 2007, 21(11):489-493.
[7] 张庆泉, 宋西成, 张华. 内镜下影像导航技术在 1250例鼻颅底手术中的应用[J]. 山东大学学报(医学版), 2012, 50(7):114-116. ZHANG Qingquan, SONG Xicheng, ZHANG Hua, et al. A retrospective analysis of 1250 nasal skull base operations under guide of image navigation technology[J]. J Shandong Univ(Health Sci), 2012, 50(7):114-116.
[8] Kent JS, Allen LH, Rotenberg BW. Image-guided transnasal endoscopic techniques in the management of orbital disease[J]. Orbit, 2010, 29(6):328-333.
[9] Hepworth EJ, Bucknor M, Patel A, et al. Nationwide survey on the use of image-guided functional endoscopic sinus surgery[J]. Otolaryngol Head Neck Surg, 2006, 135(1):68-73.
[10] Justice JM, Orlandi RR. An update on attitudes and use of image-guided surgery[J]. Int Forum Allergy Rhinol, 2012, 2(2):155-159.
[11] 周兵. 影像导航技术与鼻颅底外科[J]. 中国医学文摘-耳鼻咽喉科学, 2014, 29(4):185-188.
[12] Dalgorf DM, Sacks R, Wormald PJ, et al. Image-guided surgery influences perioperative morbidity from endoscopic sinus surgery: a systematic review and meta-analysis[J]. Otolaryngol Head Neck Surg, 2013, 149(1):17-29.

相关文章 15

[1]	冯思聪,于晓岚,娄丹. 基于囊泡组织Ki67、GM-CSF表达评估Messerklinger中鼻甲成形术对慢性鼻-鼻窦炎合并鼻息肉的效果[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 31-39.
[2]	翟雪纯,边欣,陈敬彩,邓家钰,叶子,杨萍丽. 慢性额窦炎患者焦虑抑郁特点及横断面研究[J]. 山东大学耳鼻喉眼学报, 2026, 40(2): 35-43.
[3]	唐嘉骏,后婕,窦鑫,俞晨杰. 鼻腔框架结构畸形影响鼻腔结构及鼻窦气化的CT研究进展[J]. 山东大学耳鼻喉眼学报, 2026, 40(2): 102-110.
[4]	卢朝阳, 翟兆雪, 王慧康, 邵丽婷, 张宇. 新冠肺炎治疗引发糖尿病酮症酸中毒合并鼻眶脑型毛霉菌病1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 90-94.
[5]	朝博,苏优勒,郭若宇,付嘉越,吕宪利. 侧颅底硬脑膜动静脉瘘的特点及治疗[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 1-7.
[6]	李赞,卢奇,申卫东,侯昭晖,吴南. 坏死性外耳道炎临床诊治18例[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 17-22.
[7]	李阳松,袁发洋,杨艳,张田,喻国冻. 基于Web of Science进行生物制剂治疗慢性鼻窦炎文献计量学分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 54-64.
[8]	杜康丽,郑振宇,徐战将,张宇,陈露,卢梦垚. 鼻中隔偏曲并发慢性鼻窦炎风险预测模型的构建与验证[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 78-86.
[9]	熊琴, 张砚, 乌日娜, 李锋, 唐力行. 鼻用糖皮质激素在儿童中的应用[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 160-167.
[10]	黄焕,华红利,邓玉琴,江承洋,王雨薇,杨星海. 儿童过敏性鼻炎、扁桃体腺样体肥大和鼻窦炎之间相关性及其对临床指导价值[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 34-41.
[11]	张家齐,袁野,洪陈,顾敏,程雷,陆美萍. 基于孟德尔随机化的肠道菌群与慢性鼻窦炎鼻息肉的因果关系及代谢物中介研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 49-60.
[12]	王再兴,唐志元,李定波,石照辉,曾宪海,张秋航. 鼻咽癌放疗后肿瘤复发及颅底骨坏死引起颈内动脉破裂的治疗方案[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 49-58.
[13]	孙芳,谢楚波,邱前辉. 营养指标对鼻咽癌放射性颅底坏死患者创面修复影响的回顾性分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 59-68.
[14]	姜知临,朱瑞楷,邱前辉. 基于影像学对咽旁颈内动脉走行的观察与分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 69-76.
[15]	吴家荣,邱前辉. 颅底筋膜组织在早期复发性鼻咽癌内镜手术中的临床意义[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 108-113.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed