导航在鼻内镜下蝶窦手术的应用

Application of an image-guided system in endoscopic sinus surgery in treatment of sphenoid sinus lesions

目的探讨影像导航系统在鼻内镜下蝶窦病变手术的应用及优势。方法我们应用影像导航系统结合鼻内镜对37例蝶窦病变行手术,其中单纯蝶窦炎21例,干酪性蝶窦炎6例,蝶窦囊肿10例(其中黏液囊肿6例,黏膜囊肿4例)。患者均采用气管插管全麻,全麻后通过导航定位注册成功,根据手术中的需要标定探针或吸引器作为术中的定位设备,在鼻内镜下,通过使用导航定位设备以判断术中器械到达的具体位置、了解局部解剖关系,确定蝶窦位置,开放蝶窦,清除病变;针对蝶窦囊肿,则仅切除囊肿前壁或前下壁,凿孔孔径约1cm×0.5cm,勿需清除所有囊壁;蝶窦黏膜囊肿则需将囊肿完全清除。结果37例手术均取得了成功,无术中、术后并发症发生。结论影像导航系统结合鼻内镜治疗蝶窦病变可以有效地提高手术疗效和避免并发症的发生。

Objective To explore and estimate the value of an image-guided system in endoscopic sinus surgery for sphenoid sinus lesions. Methods 37 cases of sphenoid sinus diseases, involving 21 cases of sphenoid sinusitis, 6 of caseous rhinitis and 10 sphenoid sinus cyst （6 patients with mucocele and 4 patients with mucosa cyst） accepted treatments with an image-guided system in endoscopic sinus surgery. All were operated on with general anesthesia with tracheal intubation, guidance of the image-guided system to calibrate the probes or aspirators, and endoscopy to remove the lesions. For cases with sphenoid sinus mucocele, the anterior or the anterior inferior wall was perforated by a hole of 1 cm x 0. 5 cm. For cases with mucosa cyst of the sphenoid sinus, the cyst was removed. Results All the 37 patients were successfully cured without serious complications during and after the operations. Conclusions The image-guided system in endoscopic sinus surgery can be effectively used to remove sphenoid sinus lesions for improving surgical curative effect and avoiding complications.