外科导航技术在治疗茎突综合征中的应用

摘要/Abstract

摘要： 目的评估采用术中实时导航技术,经口内或口外小切口截除过长茎突以治疗茎突综合征的可行性、准确性与便利性,并评价导航外科技术治疗茎突综合征的临床效果。方法选取12例有明显临床症状并已确诊的茎突综合征患者。术前将患者头颅影像学Dicom数据输入导航系统工作站,进行标记和手术设计;术中在导航实时辅助下,经口内咽旁入路（保留扁桃体）或颈部小切口入路,按设计精确切除过长茎突。术后对手术出血量、手术时间、住院时间、茎突切除长度等进行记录与测量,与以往未采用导航辅助的经典术式的相应指标进行比较;对患者进行为期3个月的随访,运用视觉模拟量表（visual analog sclaes,VAS）对导航辅助下切除茎突的患者于术前、后症状进行比较,评估手术效果。采用SPSS 19.0软件包对数据进行统计学分析。结果在计算机导航技术辅助下,采用咽旁入路和颈部小切口入路成功截除12例患者的17个过长茎突,未出现明显并发症。手术中平均出血量为(22.50±8.54) mL,平均手术时间为(40.35±11.81) min,茎突切除长度平均为(21.93±14.26) mm。平均出血量和平均手术时间均显著低于未采用导航辅助茎突切除的患者。经术后3个月随访,VAS量表统计显示,所有患者的临床症状均明显减轻,其中10例患者症状明显好转,2例患者症状改善。结论导航外科技术可用于经小切口辅助精确截除过长茎突以治疗茎突综合征,可以使切除过程更加精准,避免切除扁桃体及损伤重要邻近组织,手术创伤小,出血量少,手术时间短,患者术后症状明显改善,是一种更为安全有效的治疗方法。

关键词: 茎突过长综合征, 外科导航技术, 口腔颌面外科, 计算机辅助外科, 咽旁入路

Abstract: PURPOSE: To evaluate the feasibility, accuracy and clinical effect of intra-operative navigation for resection of elongated styloid process (ESP) in Eagle's syndrome. METHODS: Twelve patients with Eagle's syndrome with clinically and radiologically established diagnosis of ESP were enrolled. Preoperatively, the patients' Dicom data of skulls were input into the navigation system workstation to mark the ESP and make surgical plan in advance. During surgery, the intraoperative navigation was performed on all patients to excise the ESP accurately through both intraoral (without tonsillectomy) and extraoral approach following the operative plan. Postoperatively, the amount of bleeding, duration of operation and hospitalization and the length of resected SP were measured and compared with those through traditional styloidectomy without assistance of surgical navigation. A questionnaire and a simple visual analogue scale (VAS) was also used to assess patient's satisfaction and the surgical effect 3 months after surgery using SPSS 19.0 software package. RESULTS: In total, 17 styloid processes from 12 patients were precisely resected by intraoral parapharyngeal approach and small cervical approach with aid of surgical navigation. No severe surgical complications occurred in all patients. The length of resected styloid processes was (21.93±14.26) mm. The average amount of bleeding and duration of operation were (22.50±8.54) mL and (40.35±11.81) min, respectively, which are lower than traditional operation without aid of surgical navigation. VAS analysis showed that discomfort in all patients were relieved, while 10 patients' symptoms were improved obviously and 2 patients had some improvement. CONCLUSIONS: The high accuracy of surgery, lesser amount of bleeding, shorter duration of surgery and hospitalization, minimal complications and improved subjective symptoms certify that surgical navigation is a more effective and minimally invasive surgical procedure to treat Eagle's syndrome.

Key words: Elongation of styloid process, Surgical navigation, Oral and maxillofacial surgery, Computer aided surgery, Parapharyngeal route

中图分类号:

R782.2

窦庚, 张宇, 田磊. 外科导航技术在治疗茎突综合征中的应用[J]. 中国口腔颌面外科杂志, 2016, 14(3): 244-248.

DOU Geng, ZHANG Yu, TIAN Lei. Application of surgical navigation in treatment of Eagle's syndrome[J]. China J Oral Maxillofac Surg, 2016, 14(3): 244-248.

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