以導航系統輔助的鼻竇內視鏡手術－某區域醫院經驗

Navigation-assisted Endoscopic Sinus Surgery-The Experience in a Regional Hospital

吳威龍(Wei-Lung Wu) ； 沈炳宏(Ping-Hung Shen) ； 賴仁淙(Jen-Tsung Lai)

《台灣耳鼻喉頭頸外科雜誌》 47卷3期 (2012/06) Pp. 191-198

https://doi.org/10.6286/2012.47.3.191

摘要

背景：隨著微創內視鏡鼻竇手術的不斷發展，近年來以影像導航系統輔助的外科手術正逐漸普及，此文將針對本院施行以導航系統輔助的鼻竇內視鏡手術作分析。方法：採用回溯性研究方式，調閱病歷自2008年12月至2011年08月間，接受以導航系統輔助的鼻竇內視鏡手術，紀錄其病患性別、年齡、術後診斷、主要手術方式、手術時間、術中出血量、住院天數、門診追蹤日數，及術後併發症加以記錄分析。結果：此次研究總共收集66名，都接受同1名醫師施行以導航系統輔助的鼻竇內視鏡手術，包含男性41名、女性25名，手術時平均年齡47.4歲（7～77歲），術中出血量平均84 ml（10~550 ml），手術時間平均118分（20～370分），住院天數平均6.02天（2～27天，中位數4天，眾數2天），術後平均追蹤223.2天（4~855天）。鼻竇炎合併瀰漫性鼻息肉接受首次鼻竇內視鏡手術有7例，再次鼻竇內視鏡手術有22例，額竇手術有15例，顱底腫瘤有6例，修補腦脊髓液鼻漏有2例，黴菌性蝶竇炎併頸動脈血管瘤有1例，復發性鼻咽癌有5例，良性或惡性鼻和鼻竇腫瘤有5例，篩竇黏液囊腫有1例，翼管神經切除術有2例。除了1例腦下垂體手術術後腦脊髓液漏外，其餘皆無主要併發症發生。結論：對於具經驗的內視鏡鼻科手術者，正確的使用調校良好導航系統基本上是有幫助的，可提高手術醫師的自信心，並且避免傷害到鄰近的重要器官，可以廣泛應用在較複雜困難的鼻竇內視鏡手術。

關鍵字

導航 ； 影像導引 ； 鼻竇內視鏡手術 ； 併發症

並列摘要

BACKGROUND: With regard to the rapid advancement of endoscopic sinus surgery (ESS) techniques, utilizing image-guided surgery (IGS) during ESS has become more and more popular in recent years. We would like to share the experiences in utilizing image-guided (navigation) surgery during ESS in our hospital.METHODS: Retrospective study was performed for cases of navigation-assisted ESS between December 2008 and August 2011. Using chart review, we collected and analyzed the patient's age, sex, postoperative diagnosis, main sinonasal operation method, the operative time, the amount of intra-operative bleeding, the duration of hospitalization, the days of postoperative outpatient following, and postoperative complications.RESULTS: 66 patients were included in this study and all operations were performed by the same surgeon. Of 66 patients, 41 were male and 25 were female. The mean age was 47.4 years (7~77). The mean operative time was 118 minutes (20~370 mins), the mean amount of intra-operative bleeding was 84 ml (10~550 ml), the mean days of hospitalization was 6.02 days (2~27 days), the mean follow-ups were 223.2 days (4~855 days). Post-operative diagnoses were: 7 patients of CRS with diffuse polyposis underwent primary ESS, 22 cases underwent revision ESS, 15 cases underwent frontal sinus surgeries, 6 cases were skull base tumors, 2 cases were CFS rhinorrheas, one case was sphenoid fungal sinusitis with carotid mycotic aneurysm, 5 cases with recurrent NPCs, 5 cases were benign or malignant sinonasal tumors, one case was ethmoid mucocele, and 2 cases underwent vidian neurectomies. Minor complications noted in 11 cases (16.67%), including 7 cases of synechia, one case of facial numbness, 2 cases of frontal ostium stenosis, and one case of postop bleeding. Major complication occurred in one case (1.52%), which was postoperative CSF rhinorrhea.CONCLUSIONS: General speaking, utilizing the well-calibrated navigation system with a correct manner is helpful to most of the rhinologists and give surgeons confidence. The main advantages of navigation-assisted ESS are to avoid complications, and speed the learning curve for surgeons as well.

並列關鍵字

navigation ； image-guided ； endoscopic sinus surgery ； complication