Fusion影像导航在鼻内镜手术中的应用体会

Experience of Fusion image guided system in endonasal endoscopic surgery

目的:总结Fusion电磁波感应型影像导航辅助鼻内镜手术,探讨影像导航技术在鼻内镜微创和精准手术中的应用价值。方法:回顾分析60例鼻内镜手术中应用Fusion情况,包括复发性慢性鼻-鼻窦炎伴鼻息肉10例,真菌性鼻窦炎5例,视神经减压术16例,鼻腔鼻窦乳头状瘤9例,蝶窦骨化纤维瘤1例,鼻腔鼻窦恶性肿瘤9例,脑脊液鼻漏5例,眶尖血管瘤2例,眶整复3例。结果:60例手术顺利,无颅内和眶内并发症。术中能准确定位额窦、上颌窦、蝶窦的窦口以及纸样板和颅底;CT与CTA、MRI和MRA的融合,能准确定位视神经、颈内动脉;CT与MRI融合,有助于对肿瘤范围的判断。在克服学习曲线后术前导航的准备时间为(7.13±1.358)min,术中均能达到<1mm的注册误差。术中没有出现因器械被遮挡而无法实时定位或因患者追踪器松动需要重新注册的问题。结论:Fusion影像导航使鼻内镜手术实现真正意义上的微创和精准,术前准备时间短,注册精确度高,能提高手术的安全性,并减少并发症的发生。

Objective.. To review endonasal endoscopic surgeries aided by Fusion image guided system, and to explore the application value of Fusion image guided system in endonasal endoscopic surgeries. Method：Retrospec- tive research. Sixty cases of endonasal endoscopic surgeries aided by Fusion image guided system were analysed in- cluding chronic rhinosinusitis with polyp （n= 10）, （n=16）, inverted papilloma of the paranasal sinus fungus sinusitis （n=5）, endoscopic optic nerve decompression （n=9）, ossifying fibroma of sphenoid bone （n =1）, malig- nance of the paranasal sinus （n = 9）, cerebrospinal fluid leak（n = 5）, hemangioma of orbital apex （n= 2）and orbital reconstruction （n=3）. Result.. Sixty cases of endonasal endoscopic surgeries completed successfully without any complications. Fusion image guided system can help to identify the ostium of paranasal sinus, lamina papyracea and skull base. Fused CT-CTA images, or fused MR-MRA images can help to localize the optic nerve or internal carotid artery . Fused CT-MR images can help to detect the range of the tumor. It spent （7.13±1. 358） minutes for image guided system to do preoperative preparation and the surgical navigation accuracy reached less than lmm after proficient. There was no device localization problem because of block or head set loosed. Conclusion^Fusion image guided system make endonasal endoscopic surgery to be a true microinvasive and exact surgery. It spends less preoperative preparation time, has high surgical navigation accuracy, improves the surgical safety and reduces the surgical complications.