郭宇宏+刘跃亭+郭庚+蒯东+薛乃照+王艳丽+李超

[摘要] 目的 探讨CT仿真内镜（CTVE）技术在垂体腺瘤经鼻-蝶手术中的临床应用效果。 方法 收集垂体腺瘤患者27例，均行内镜下经鼻-蝶垂体腺瘤切除术，术前行CTVE图像重建，并与术中内镜下图像进行对比，分析两者在该手术入路过程中的相关性及吻合度。 结果 CTVE比术中内镜能更形象、更具体地显示鞍底解剖结构，对蝶窦中隔、鞍底、斜坡隐窝等结构的显示范围较术中内镜大。 结论 CTVE能显示蝶窦及鞍底的解剖标志同内部结构的三维解剖关系，有助于术中定位，提高手术操作的安全性。

[关键词] 垂体腺瘤；CT仿真内镜；经鼻-蝶手术

[中图分类号] R584[文献标识码] A[文章编号] 1674-4721（2014）05（c）-0110-03

Clinical application of CT virtual endoscopy on nasal-sphenoid sinus surgery in the treatment of pituitary adenoma

GUO Yu-hong1 LIU Yue-ting2▲ GUO Geng2 KUAI Dong2 XUE Nai-zhao2 WANG Yan-li1 LI Chao2

1.The First Clinical Medical College of Shanxi Medical University,Taiyuan 030001,China;2.Department of Neurosurgery,the First Hospital of Shanxi Medical University,Taiyuan 030001,China

[Abstract] Objective To investigate clinical application effect of CT virtual endoscopy(CTVE)on nasal-sphenoid sinus surgery in the treatment of pituitary adenoma. Methods 27 patients with pituitary adenoma were selected and treated by nasal-sphenoid sinus surgery.The CTVE image of sellar region were reconstructed with the presurgical CT data at workstation and compared with intraoperative endoscopy view.The correlation was analysed between CTVE and intraoperative endoscopy view in the operative approach. Results The CTVE image could indicate the anatomy of sphenoid sinus and sellar floor more visually than intraoperative endoscopy view.The CTVE visual fields of sphenoid septa,sellar floor and clivus notch was larger than that from the intraoperative endoscopy respectively. Conclusion CTVE can display the anatomic symbols of sphenoid sinus and interior structure in a three-dimensional mode.CTVE can help preoperative planning and increase the safety of nasal-sphenoid sinus surgery.

[Key words] Pituitary adenoma;CT virtual endoscopy;Nasal-sphenoid sinus surgery

垂体腺瘤是颅内较为常见的良性肿瘤，发病率在颅内肿瘤中仅低于胶质细胞瘤和脑膜瘤，约占颅内肿瘤的10%[1]。随着神经影像学技术与内分泌诊断技术的不断进步，越来越多的垂体腺瘤被发现。目前经鼻-蝶手术是垂体瘤手术的首选术式[2-4]。蝶窦中隔及鞍底的血管、神经等是经鼻-蝶手术的重要解剖标志，然而术前常规的CT及MRI影像资料提供的只是断层解剖二维图像，与术中所见的三维图像有一定区别，术者只能通过“主观”想象来重构蝶窦中隔及其相关结构的三维图像，有一定的主观性及不准确性。对于蝶窦结构复杂的病例，或经鼻-蝶手术的初学者，术中常需借助额外设备对鞍底等进行定位，这增加了额外设备、手术时间、费用及感染机会等[5]。本研究通过对内镜下经鼻-蝶手术中解剖结构与CT仿真内镜（CT virtual endoscopy，CTVE）模拟经鼻-蝶手术入路的比较，探讨CTVE在经鼻-蝶手术中的临床应用效果。……