摘要： 目的·评估手术导航系统这一实时立体定向引导技术应用于头颈部危险区域低流量脉管畸形病灶硬化治疗的可行性和安全性。方法·回顾性纳入2017年5月—2019年9月在上海交通大学医学院附属第九人民医院整复外科接受了手术导航系统辅助硬化治疗的头颈部低流量脉管畸形患者。术前将患者计算机断层扫描图像和磁共振图像融合后，进行穿刺路径设计。术中利用导航系统，按预先设计的路径进行穿刺，通过数字减影血管造影验证穿刺结果。统计穿刺成功率和患者术后并发症情况。结果·共纳入10例头颈部低流量脉管畸形患者（6例眼眶内、4例咽部）30处病灶，治疗19次。初次治疗的平均年龄为20.9岁。穿刺成功率达到80.0％（24/30）；除1次治疗后患者因硬化剂导致声门溃疡，继而引发肺炎外，未观察到其他并发症。结论·手术导航系统对头颈部危险区域低流量脉管畸形的硬化治疗是可行且安全的辅助技术。
关键词: 手术导航系统, 图像融合, 脉管畸形, 硬化治疗, 头颈部 Abstract: Objective·To evaluate the feasibility and safety of image-guided surgical navigation, a real-time stereotactic guidance technique, in sclerotherapy of low-flow vascular malformations in the risky regions of head and neck.
Methods·The patients with low-flow vascular malformations in the heads or necks who underwent surgical navigation-assisted sclerotherapy in the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively included. The preoperative CT images and magnetic resonance images were fused to design the puncture trajectory. During the operation, the navigation system was used to puncture according to the designed path, and the results were verified by digital subtraction angiography. The technical success rate of intralesional needle placement and postoperative complications were analyzed.
Results·A total of 19 procedures for 30 lesions performed on 10 patients with low-flow vascular malformations (6 cases with intraorbital lesions, and 4 cases with pharyngeal lesions) were included. The average age of initial procedure was 20.9 years. The technical success rate was 80.0% (24/30). No other complications were observed except a case of pneumonia caused by sclerosing agent-induced glottic ulcer after one procedure.
Conclusion·Image-guided surgical navigation is a feasible and safe auxiliary technique for the lesions in the risky regions of head and neck.
Key words: surgical navigation, image fusion, vascular malformation, sclerotherapy, head and neck PDF全文下载地址:
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