导航系统在头面部外伤深部异物取出术中的应用

Application of navigation system in removal of traumatic foreign body in deep head and face

目的探讨计算机辅助导航技术在头面部深部异物取出术中应用及推广的可能性.方法本次研究收录了上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科于2015年9月~2018年5月收治的6例头面部外伤深部异物的患者.其中,男5例,女1例.鼻腔、鼻窦异物2例、头面部枪击伤异物1例、咽后间隙异物1例、舌根异物2例.所有病例均于急诊行局部清创止血等初步处理,并予局部换药、全身应用抗生素预防感染,入院后根据术前CT资料设计个体化手术方案,于全麻下行实时导航下头面部深部异物取出术.结果本组患者共取出鼻腔、鼻窦金属异物2例、头面部枪击伤金属散弹异物1例、咽后间隙金属异物1例、舌根鱼刺异物2例.所有患者术中均未伤及重要血管及神经,异物完整并安全取出.术后随访3个月,复查CT,所有患者均未出现手术并发症,异物无残留.结论对于头面部外伤异物残留的患者,术前设计个体化手术方案、术中实时导航有利于快速精准地找到异物并完整安全地取出,同时可避开周围重要的血管神经,避免近期及远期手术并发症.

Objective To explore the application of computer-assisted navigation and feasibility of generalizing this technique in removal of traumatic foreign body in deep head and face region. Methods Clinical data of 6 patients suffering from traumatic foreign body in deep head and face region treated in our department from Sept. 2015 to May 2018 were analyzed retrospectively. Of them, 5 were male and one was female. As for the location of foreign body, 2 were located in nasal cavity and sinus,1 in head and face due to gunshot,1 in retropharyngeal space and 2 in tongue root. All patients received first treatment such as local debridement and hemostasis, as well as prophylactic antibiotics. Computerized tomography(CT) scans were performed and data were saved in digital imaging and communications in medicine(DICOM) format. The foreign body was located, measured and displayed by preoperative individualized design. Removal of foreign body was performed under the guidance of navigation system in all patients.Results Foreign body was removed completely and safely in all patients without injury of important blood vessels and nerves. Postoperative 3-month follow-up and CT reexamination revealed neither surgical complications nor residual foreign body in all patients.Conclusion For patients with foreign body in nasal and facial trauma, preoperative individualized surgical plan and intraoperative real-time navigation are conducive to identify the foreign body rapidly and accurately and remove the foreign body completely and safely. Intraoperative real-time navigation can help the surgeon to avoid the damage of important blood vessels and nerves so that to reduce short-term and long-term surgical complications.