Oeken J, Törpel J
Kopf- und Halschirurgie, Klinik für HNO-Heilkunde, Flemmingstrasse 2, 09116 Chemnitz.
HNO. 2008 Feb;56(2):151-4, 156-7. doi: 10.1007/s00106-007-1580-2.
Over the last few years, navigation systems have been used in endoscopic sinus surgery (ESS). We were interested determining whether this has repercussions on surgical procedures.
From December 2003 to April 2006, we prospectively evaluated all navigated ESS procedures (Vector vision, Brain lab) by means of a questionnaire. Numerous data were determined including diagnosis, navigation benefit, difficulty of the operation, radiological score and complications.
Navigated ESS was carried out on 106 patients (54 male symbol; 52 female symbol, average age 55 years) with the following diagnoses: 59 chronic sinusitis with nasal polyposis (13 primary surgery, 46 revision surgery), 14 mucocele, 8 benign tumour, 10 malignant sinonasal tumour, and 15 other diseases. There was only a slight correlation between the difficulty of the operation and the use of navigation (r=0.51, P=0.00) and no significant correlation between the radiological score with chronic sinusitis and the use of navigation (r=0.22, P=1.23). On the other hand, we found a significant difference between the benefit of navigation using primary and revision functional ESS in cases of chronic sinusitis with nasal polyps (P=0.005). The degree of benefit of navigation for the different diagnoses was in descending order: recurrent polyposis, mucocele, osteoma, malignant tumors, polyposis (primary surgery) and inverted papilloma. Without navigation, 15 operations (14%) would not have been possible as an endonasal procedure, and 12 operations (11%) would not have been carried out thoroughly enough. In spite of navigation in three operations (3%) the endonasal approach had to be changed to a transfacial approach. Twelve slight and three serious complications (1 dura defect + pneumoencephalos, dura defect, meningitis without CSF leak) occurred.
Navigation exerts a substantial influence on the execution of the ESS by clearly extending its possibilities.
在过去几年中，导航系统已被用于鼻内镜鼻窦手术（ESS）。我们有兴趣确定这是否会对手术操作产生影响。
从2003年12月至2006年4月，我们通过问卷调查对所有采用导航的ESS手术（Vector vision，Brain lab）进行了前瞻性评估。确定了许多数据，包括诊断、导航益处、手术难度、放射学评分和并发症。
对106例患者（男性54例；女性52例，平均年龄55岁）进行了导航ESS手术，诊断如下：59例慢性鼻窦炎伴鼻息肉（13例初次手术，46例翻修手术），14例黏液囊肿，8例良性肿瘤，10例鼻窦恶性肿瘤，以及15例其他疾病。手术难度与导航使用之间仅有轻微相关性（r = 0.51，P = 0.00），慢性鼻窦炎的放射学评分与导航使用之间无显著相关性（r = 0.22，P = 1.23）。另一方面，我们发现在慢性鼻窦炎伴鼻息肉的初次和翻修功能性ESS中，导航益处存在显著差异（P = 0.005）。不同诊断的导航益处程度从高到低依次为：复发性息肉、黏液囊肿、骨瘤、恶性肿瘤、息肉（初次手术）和内翻性乳头状瘤。若无导航，15例手术（14%）无法通过鼻内途径完成，12例手术（11%）无法充分实施。尽管在3例手术（3%）中使用了导航，但仍不得不将鼻内途径改为经面途径。发生了12例轻微并发症和3例严重并发症（1例硬脑膜缺损+气脑、硬脑膜缺损、无脑脊液漏的脑膜炎）。
导航通过显著扩展其可能性，对ESS的实施产生了重大影响。
