影像导航鼻内镜系统在鼻内翻性乳头状瘤和鼻窦骨瘤中的应用

The application of an image guidance endoscopic system for nasal inverted papilloma and sinus osteoma

目的分析采用影像导航进行鼻内翻性乳头状瘤、鼻窦骨瘤鼻内镜手术与传统鼻内镜手术的疗效。方法 73例鼻腔内翻性乳头状瘤、鼻窦骨瘤患者被分成导航组与非导航组,导航组采用影像导航下鼻内镜手术,非导航组采用传统鼻内镜手术。分析两组患者的手术时间、麻醉时间、术中出血量、并发症及术后疗效情况。结果导航组与非导航组患者麻醉时间比较,差异无统计学意义(P>0.05),手术时间、术中出血量比较,差异有统计学意义(P<0.05)。鼻腔内翻性乳头状瘤导航组与非导航组Ⅰ、Ⅱ级复发率比较,差异无统计学意义(P>0.05),而在Ⅲ、Ⅳ级中复发率比较,差异有统计学意义(P<0.05)。鼻窦骨瘤中非导航组有1例复发,导航组未见复发病例。鼻腔内翻性乳头状瘤中导航组与非导航组鼻内并发症比较,差异有统计学意义(P<0.05),Ⅰ、Ⅱ级鼻内并发症导航组与非导航组的发生率比较,差异无统计学意义(P>0.05),而在Ⅲ、Ⅳ级鼻内并发症的发生率比较,差异有统计学意义(P<0.05)。在鼻窦骨瘤中导航组与非导航组鼻内并发症比较,差异有统计学意义(P<0.05)。结论对于鼻窦骨瘤及Ⅲ、Ⅳ级鼻腔内翻性乳头状瘤,影像导航下鼻内镜手术优于传统鼻内镜手术,特别在术前评价和确保手术中的安全性方面起到了有价值的辅助作用,使得肿瘤切除更彻底,复发率更低。

Objective To evaluate the clinical effect of image guided navigation system（IGNS） and traditional methods for nasal inverted papilloma and sinus osteoma. Methods 73 cases of nasal inverted papilloma and sinus osteoma patients were divided into the navigation group and the non-navigation group, the navigation group was given image guidance endoscopic sinus surgery, the non-navigation group was given traditional endoscopic sinus surgery, operative time, the anesthesia time, amount of bleeding, compli cations and postoperative effects of the two groups were analyzed. Results The anesthesia time of the two groups had no significant difference（P〉0.05） ,the operative time,blood loss had significant difference（P〈0.05）. I , II level recurrence rate of the two grups in nasal inverted papilloma had no significant difference（P〉0.05）, while in stage III , IV, the difference of recurrence rate had significant difference（P〈0.05）. In sinus osteoma, 1 case of recurrence in the non-navigation group, the navigation group had no re- currence. In nasal inverted papilloma, the complications of the two grouos had significant differenee（P〈0.05）, there was no signifi cantly difference in stage I , 1I （P〉0.05） ,while had significant different in stage III , IV （P〈0.05）. In the sinus osteoma,the com- plications of the two grouos had significant difference（P〈0.05）. Conclusion For sinus osteoma and III , IV level of nasal inverted papilloma,IGNS could work well with endoscopic system,improve operation accuracy and reduce complications. IGNS is of a useful tool for endoscopy sinus surgery and would make a great important development in future.