山东大学耳鼻喉眼学报 ›› 2016, Vol. 30 ›› Issue (6): 24-28.doi: 10.6040/j.issn.1673-3770.0.2016.253

• 论著 • 上一篇    下一篇

3D技术在鼻内镜手术精准治疗鼻前颅底恶性肿瘤中的应用

吴建,范静平,刘环海,郎军添,卢晓清,徐亚平   

  1. 上海长征医院耳鼻咽喉科, 上海 200003
  • 收稿日期:2016-06-06 出版日期:2016-12-16 发布日期:2016-12-16
  • 通讯作者: 吴建. E-mail:jianwu2008@126.com E-mail:shenli_pig@sohu.com
  • 基金资助:
    上海市科学技术委员会西医引导重点科研项目(14411960400,14411960401);上海市科学技术委员会产学研重点项目(14DZ1940103);第二军医大学教学重点项目(RZJYA201504)资助

3D technology for accurate treatment of transnasal endoscopic nasal skull base neoplasm resection and the functional reconstruction.

WU Jian, FAN Jingping, LIU Huanhai, LANG Juntian, LU Xiaoqing, XU Yaping   

  1. Department of Otolaryngology, Shanghai Changzheng Hospital, Shanghai 200003, China
  • Received:2016-06-06 Online:2016-12-16 Published:2016-12-16

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摘要： 目的 探讨3D技术在鼻内镜手术精准治疗鼻前颅底恶性肿瘤及颅底功能重建手术中的作用。 方法 对21例鼻颅底恶性肿瘤患者术前行鼻窦冠状位CT或MRI扫描,并行3D影像重建及模型打印,根据3D成像及模型了解鼻颅底恶性肿瘤侵及范围、颅底及眶壁骨质的缺损大小形状,制定鼻内镜手术术式、肿瘤精准切除范围及颅底功能精准重建方法。 结果 患者肿瘤均一次手术全切除,其中6例行颅底功能精准重建术,无脑脊液鼻漏及颅内感染并发症。术后病理示鳞癌9例,嗅母细胞瘤5例,腺样囊腺癌3例,横纹肌肉瘤4例。术后行正规放疗,横纹肌肉瘤患者加化疗。经平均随访36个月,未发现肿瘤复发及与本肿瘤相关的死亡。 结论 3D成像及打印模型能清楚显示鼻颅底恶性肿瘤范围、颅底及眶壁骨质缺损的大小及形状,并有助于术者选择最佳内镜手术入路及手术方案,有重要临床指导作用。

关键词: 3D技术, 鼻颅底恶性肿瘤, 鼻内镜外科手术, 精准治疗

Abstract: Objective To explore the value of 3D technology for accurate treatment of transnasal endoscopic nasal skull base neoplasm resection and the functional reconstruction of the nasal skull base surgery. Methods A total of 21 cases of nasal skull base neoplasm were carried out sinus coronal CT/MRI scan parallel 3D reconstruction and 3D printing. The invasion scope of the nasal skull base neoplasm and the size/shape of the bony defect of the skull base and orbital wall were read according to 3D reconstruction and 3D model, then the surgery path and the accurate resection range and the accurate reconstruction method were determined. Results All patients neoplasm had been removed in the first operation. 6 cases had been performed accurate functional reconstruction of the skull base surgery without cerebrospinal fluid(CSF)leak and intracranial infection happened. Post-operative pathology indicated that there were 9 cases of squamous cell carcinoma, 5 esthesioneuroblastoma, 3 adenoid cystic carcinoma and 4 rhabdomyosarcoma. Patients accepted radiotherapy after surgery. Within a follow-up of 36 months on average, no neoplasm relapsed and no death that is connect whit the neoplasm appeared. Conclusion 3D reconstruction and 3D model could show the invasion scope of the nasal skull base neoplasm and the size/shape of the bony defect of the skull base and the orbital wall clearly. Also 3D reconstruction and 3D model could help surgeons to make the best operative schemes. 3D imaging and 3D printing technology has important guiding significance for accurate treatment of transnasal endoscopic nasal skull base neoplasm resection and the functional reconstruction of the nasal skull base surgery.

Key words: Nasal skull base neoplasms, Transnasal endoscopic surgical procedures, operative, Accurate treatment, Three-dimensional technology

中图分类号: 

  • R739.63
[1] 曹荣萍,吴皓,黄琦,等.鼻内镜下经鼻前颅底手术的探讨[J].临床耳鼻咽喉科杂志,2006,20(23):1057-1059. CAO Rongping, WU Hao, HUANG Qi,et al. Endoscopic transnasal surgery for anterior skull base lesions[J]. J Clin Otolaryngol Head Neck Surg, 2006, 20(23):1057-1059.
[2] Kasemsiri P, Carrau R L, Prevedello D M, et al. Principles of anterior skull base resection: open and endoscopic techniques[J]. Oper Tech Otolaryngol Head Neck Surg, 2013, 24(4):197-207.
[3] 郭涛,孙敬武,汪银凤,等.鼻内镜下鼻前颅底恶性肿瘤的外科治疗[J].临床耳鼻咽喉头颈外科杂志,2012,26(14):644-646. GUO Tao, SUN Jingwu, WANG Yinfeng, et al. Endoscopic endonasal surgery for cranial base tumor[J]. J Clin Otolaryngol Head Neck Surg, 2012, 26(14):644-646.
[4] 周晓,李武,曾勇,等.3D打印在肿瘤整形外科的应用前景分析[J].中国耳鼻咽颅底外科杂志,2016,22(2):157-160.
[5] 卢晓清,吴建.内镜鼻颅底肿瘤切除和颅底功能重建手术的三维影像解剖研究[J].上海医学,2015,38(6):516-518. LU Xiaoqing, WU Jian. 3D image study on intranasal endoscopic skull base tumor resection and functional reconstruction[J]. Shanghai Med J, 2015, 38(6):516-518.
[6] 刘坤,张虹,吴宇平,等. 内镜联合应用在前颅底沟通性肿瘤切除中的作用研究[J].四川医学,2015,36(1):83-85. LIU Kun, ZHANG Hong, WU Yuping, et al. Endoscope-assisted surgery for extracranial-intracranial tumors of anterior skull bases[J]. Sichuan Med J, 2015, 36(1):83-85.
[7] Qiuhang Z, Hongchuan G, Feng K, et al. Resection of the intracavernous sinus tumors using a purely endoscopic endonasal approach[J]. J Craniofac Surg, 2014, 25(1):295-302.
[8] Zhang Q, Wang Z, Guo H, et al. Resection of anterior cranial base meningiomas with intra- and extracranial involvement via a purely endoscopic endonasal approach[J]. ORL J Otorhinolaryngol Relat Spec, 2012, 74(4):199-207.
[9] 吕洁瑜,何炽辉,黄戈,等. 鼻内镜下前颅底病变手术治疗16例临床观察[J]. 中国眼耳鼻喉科杂志,2016,16(1):36-39. LÜ Jieyu, HE Chihui, HUANG Ge, et al. Clinical observation of endoscopic transnasal surgery for anterior skull base lesion in 16 cases[J]. Chin J Ophthalmol Otorhinolaryngol, 2016, 16(1):36-39.
[10] 张秋航.内镜技术在颅底外科领域的拓展[J].中国微侵袭神经外科杂志,2010,15(9):385-387.
[11] Castelnuovo P, Dallan I, Battaglia P, et al. Endoscopic endonasal skull base surgery: past, present and future[J]. Eur Arch Otorhinolaryngol, 2010, 267(5):649-663.
[12] 危维,张秋航,严波,等.内镜经鼻手术治疗前中颅底神经内分泌癌[J].中华耳鼻咽喉头颈外科杂志,2015,50(5):357-361. WEI Wei, ZHANG Qiuhang, YAN Bo, et al. Endoscopic endonasal surgery for anterior and middle skull base neuroendocrine carcinoma[J]. Chin J Otorhinolaryngol Head Neck Surgery, 2015, 50(5):357-361.
[13] Cantu G, Solero C L, Miceli R, et al. Anterior craniofacial resection for malignant paranasal tumors: a monoinstitutional experience of 366 cases[J]. Head Neck, 2012, 34(1):78-87.
[14] Castelnuovo P, Battaglia P, Turri-Zanoni M, et al. Endoscopic endonasal surgery for malignancies of the anterior cranial base[J]. World Neurosurg, 2014, 82(6):S22-S31.
[15] Schmalbach C E, Webb D E, Weitzel E K. Anterior skull basereconstruction: a review of current techniques[J]. Curr Opin Otolaryngol Head Neck Surg, 2010, 18(4):238-243.
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