导航下经鼻内镜治疗上颌骨囊肿的疗效观察

Application of navigation system with nasal endoscope in the treatment of maxillary cyst

目的探讨影像导航技术联合鼻内镜在上颌骨囊肿治疗中的临床应用价值。方法回顾性分析2018年1月~2021年7月在我科接受影像导航鼻内镜下上颌骨囊肿切除术的28例患者的临床资料,术前常规检查及鼻窦薄层CT扫描,并导入影像导航系统。全麻后术中进行导航器械配准和注册。鼻内镜下进行手术操作,遇到需要定位的结构时,利用定位导航手术器械进行定位。所有患者术前、术后3月和术后6月分别复查颌面部CT平扫,针对颌面部胀痛症状采用视觉模拟量表(visual analogue scale,VAS)进行评估,并进行统计学分析。结果导航下经鼻内镜均顺利切除上颌骨囊肿,并获得良好引流,无严重并发症发生,术后随访3~24个月,20例初治患者仅1例术后6个月左右复发,8例复发后再手术的患者有2例在术后6个月左右再次复发。VAS评分的结果提示导航下经鼻内镜治疗上颌骨囊肿可有效缓解术前存在的颌面部胀痛。结论影像导航技术有助于在鼻内镜下上颌骨囊肿治疗中准确定位正常结构和病灶,降低手术并发症,缓解颌面部胀痛,提高手术效果,尤其对复发上颌骨囊肿的治疗有较高推荐价值。

Objective To discuss the clinical value of image navigation technique in nasal endoscopic treatment of maxillary cyst.Methods Retrospectively analyse the clinical data of 28 cases with maxillary cyst underwent nasal endoscopy from January 2018 to July 2021.All 28 patients underwent preoperative routine examination and Thin-layer sinus CT scan.The CT data were inputted navigation system for reconstruction.During the operation,head marker registration and facial contour registration were done after general anesthesia.When endoscopic surgery was performed,a positioning navigation surgical instruments was placed at a target and positioned on a navigation display when a structure was required to be positioned.All patients underwent CT scan before operation,3 months and 6 months after operation.Visual analogue scale(VAS)was used to evaluate the symptom of maxillofacial swelling and pain,and statistical analysis was performed.Results All patients received successful resection of maxillary cyst under imaging-guided nasal endoscopy without any serious complications,and the cavity was fully drained.During the 3 to 24 months of follow-up visits,recurrence occurred in about 6 months in 1 naive patient(total 20 cases)and 2 recurrent cases(total 8 cases).Conclusion Imaging navigation technology is helpful to accurately identify normal structures and lesions in the operation of maxillary cyst under nasal endoscopy,reduce surgical complications,relieve maxillofacial swelling and pain,and improve surgical outcome,especially for the treatment of recurrent maxillary cyst.