单侧鼻经蝶入路垂体手术安全距离和角度的头颅CT图像重建及测量

Reconstruction and measurement of cranial CT images of safety distance and angle in unilateral nasal transsphenoidal approach for pituitary surgery

目的：通过对重建头颅CT图像的测量，阐明单侧鼻经蝶入路垂体手术操作的安全范围。方法：随机选择100名正常人垂体头颅CT图像，以垂直和平行于两眼球边缘的CT图像为准线进行三维重建，分别在鼻道正中矢状面上和经鼻尖与鞍背两端平面上测量单侧鼻经蝶入路垂体手术的角度和距离，确定安全范围；研究对象按性别和年龄进行分组，比较测量的不同性别和年龄的角度和距离。结果：在鼻道正中的矢状面上测得的角度 A1（矢状面上鼻尖与鞍结节和鞍背根部连线所形成的夹角）为（11.22±1.35）°，95％置信区间为8.92°～13.76°，距离D1（角度 A1所在平面与鞍底形成的交线上鞍结节与鞍背根部之间的距离）为（16.71±2.07）mm，95％置信区间为13.11～19.93 mm。在鼻尖与鞍背两端所确定的平面上测得的角度 A2（鼻尖与鞍背两端连线所形成的夹角）为（8.91±1.19）°，95％置信区间为7.12°～10.72°，距离D2（角度 A2所在平面与鞍底形成的交线上鞍背两端之间的距离）为（14.23±2.09）mm，95％置信区间为10.81～17.92 mm。以上4个参数值均服从正态分布，不同性别和年龄间比较差异无统计学意义（P＞0.05）。结论：单侧鼻经蝶入路垂体手术操作在鼻道正中的矢状面上的移动角度应小于（11.22±1.35）°，移动距离应小于（16.71±2.07）mm；在鼻尖与鞍背两端所构成的平面上的移动角度应小于（8.91±1.19）°，移动距离应小于（14.23±2.09）mm。

Objective To measure the reconstructed cranial CT images,and to clarify the safety range of unilateral nasal transsphenoidal approach for pituitary surgery.Methods 100 normal pituitary cranial CT images were randomly selected,and the three-dimensional reconstruction was performed by using the CT images of perpendicular and parallel to the edge of the two eyes as base line, and the distance and angle in unilateral nasal transsphenoidal approach for pituitary surgery from the sagittal plane in the middle of the nasal meatus and the plane through the tip of the nose and both ends of dorsum sellae were measured,respectively. The angles and distances were compared＆amp;nbsp;when grouped the data by gender and age. Results Angle A1 （the angle between the tip of the nose and the tuberculum sellae and saddle back root line in the sagittal plane）in the sagittal plane of the middle nasal meatus was （11.22±1.35）°,95% confidence interval was 8.92°-13.76°degrees;the distance D1（the distance on the line between tuberculum sellae and saddle back root, and the line was formed by the plate contained the angle A1 and sellar floor）was （16.71 ± 2.07）mm,95% confidence interval was 13.11-19.93 mm.Angle A2 （the angle between the tip of the nose and the saddle back ends）which was in the plane through the tip of the nose and both ends of dorsum sellae was （8.91±1.19）°,95% confidence interval was 7.12°-10.72°;the distance D2（the distance on the line between the saddle back ends,and the line was formed by the plate contained the angle A2 and sellar floor）was （14.23±2.09）mm,95% confidence interval was 10.81-17.92 mm. The four parameter data was normally distributed,and there was no significantly statistic difference between different gender and ages （P〉0.05）.Conclusion The angle of the movement for unilateral nasal transsphenoidal approach for pituitary surgery operation in the sagittal plane in the middle of the nasal meatus should be less than （11.22 ± 1.35）°,and the distance of the movement should be less than （16.71±2.07）mm. The angle of the movement in the plane through the tip of the nose and both ends of dorsum sellae should be less than （8.9 1 ± 1.1 9 ）°, and the distance of the movement should be less than （14.23±2.09）mm.