中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2014年
9期
726-732
,共7页
严波%张秋航%吕海丽%张名霞%曹连杰%危维%李谱%苏金霏
嚴波%張鞦航%呂海麗%張名霞%曹連傑%危維%李譜%囌金霏
엄파%장추항%려해려%장명하%조련걸%위유%리보%소금비
颅底%内窥镜检查%外科手术,计算机辅助
顱底%內窺鏡檢查%外科手術,計算機輔助
로저%내규경검사%외과수술,계산궤보조
Skull base%Endoscopy%Surgery,computer-assisted
目的 探讨影像导航技术在内镜颅底外科治疗中的作用.方法 回顾性分析2010年3月至2013年3月,由同一术者实施的影像导航系统辅助下内镜颅底手术患者75例的临床资料,统计分析术前导航准备时间、解剖结构定位情况、并发症发生情况、肿瘤全切情况以及术后随访结果.结果 影像导航术前准备时间为8 ～ 15 min,平均11 min.手术过程均顺利,术中对颈内动脉管、视神经管、鸡冠、鞍底、圆孔、卵圆孔、破裂孔、斜坡、颈静脉孔、硬脑膜等重要解剖标志均能精确导航定位.对肿瘤患者,可帮助定位颅底重要解剖标志及肿瘤的边界.未出现术中、术后严重并发症.13例前颅底肿瘤患者,均手术全切除;28例蝶鞍区肿瘤,全切除21例,次全切除7例;20例岩斜区肿瘤,全切除12例,次全切除5例,部分切除3例;14例翼腭窝及颞下窝肿瘤患者,全切除11例,次全切除3例.75例患者中失访6例,其余69例随访6 ～ 39个月,中位数随访时间26个月,均获得了满意的临床效果.结论 内镜颅底外科中应用影像导航可以提高手术疗效、降低并发症发生率,扩大微侵袭手术的范围.
目的 探討影像導航技術在內鏡顱底外科治療中的作用.方法 迴顧性分析2010年3月至2013年3月,由同一術者實施的影像導航繫統輔助下內鏡顱底手術患者75例的臨床資料,統計分析術前導航準備時間、解剖結構定位情況、併髮癥髮生情況、腫瘤全切情況以及術後隨訪結果.結果 影像導航術前準備時間為8 ～ 15 min,平均11 min.手術過程均順利,術中對頸內動脈管、視神經管、鷄冠、鞍底、圓孔、卵圓孔、破裂孔、斜坡、頸靜脈孔、硬腦膜等重要解剖標誌均能精確導航定位.對腫瘤患者,可幫助定位顱底重要解剖標誌及腫瘤的邊界.未齣現術中、術後嚴重併髮癥.13例前顱底腫瘤患者,均手術全切除;28例蝶鞍區腫瘤,全切除21例,次全切除7例;20例巖斜區腫瘤,全切除12例,次全切除5例,部分切除3例;14例翼腭窩及顳下窩腫瘤患者,全切除11例,次全切除3例.75例患者中失訪6例,其餘69例隨訪6 ～ 39箇月,中位數隨訪時間26箇月,均穫得瞭滿意的臨床效果.結論 內鏡顱底外科中應用影像導航可以提高手術療效、降低併髮癥髮生率,擴大微侵襲手術的範圍.
목적 탐토영상도항기술재내경로저외과치료중적작용.방법 회고성분석2010년3월지2013년3월,유동일술자실시적영상도항계통보조하내경로저수술환자75례적림상자료,통계분석술전도항준비시간、해부결구정위정황、병발증발생정황、종류전절정황이급술후수방결과.결과 영상도항술전준비시간위8 ～ 15 min,평균11 min.수술과정균순리,술중대경내동맥관、시신경관、계관、안저、원공、란원공、파렬공、사파、경정맥공、경뇌막등중요해부표지균능정학도항정위.대종류환자,가방조정위로저중요해부표지급종류적변계.미출현술중、술후엄중병발증.13례전로저종류환자,균수술전절제;28례접안구종류,전절제21례,차전절제7례;20례암사구종류,전절제12례,차전절제5례,부분절제3례;14례익악와급섭하와종류환자,전절제11례,차전절제3례.75례환자중실방6례,기여69례수방6 ～ 39개월,중위수수방시간26개월,균획득료만의적림상효과.결론 내경로저외과중응용영상도항가이제고수술료효、강저병발증발생솔,확대미침습수술적범위.
Objective To investigate the feasibility of image navigation technology in endoscopic skull base surgery.Methods This study consisted of 75 patients who underwent the endoscopic operations with the help of the image navigation system by the same surgeon between March 2010 and March 2013.The time to prepair image navigation system,identifying anatomical structure,complications,tumor resection,and follow-up results were analysed.Results The application of image navigation technology in the endoscopic skull base operations was both safe and reliable for delineation of tumors and identification of vital structures hidden or encased by the tumors,such as interual carotid artery,optic canal,comb,saddle bottom,foramen rotundum,foramen ovale,foramen lacerum,jugular foramen,cerebral dura mater.The tumor was removed completely,subtotally,or partially.All patients were successfully registered with accuracy,and the preoperative time was 8-15 minutes for preparation,11 minutes in average.The target error was less than or equal to 1.5 mm.With guidance of the image navigation system,all patients were successfully operated on without serious complication.There were 13 cases with anterior skull base tumor,all were removed completely.There were 28 cases with sella region tumor,21 totally resected,7 subtotally resected.There were 20 cases with petroclival region tumor,12 totally resected,5 subtotally resected,3 partially resected.There were 14 cases with pterygopalatine fossa and/or infratemporal fossa region tumor,11 totally resected,3 subtotally resected.All patients were available for follow-up (mean =26 months) except 6 cases.Conclusion Image navigation technology can be applied in endoscopic skull base operations with advantages of accurately locating,clearly marking,significantly decreasing incidence of complications,and maximally removing the lesions.
