筛窦基板层次气化分析及其在鼻内镜鼻窦手术中的应用

Analysis of ethmoidal sinus lamella hierarchical structures and its application in endoscopic sinus surgery

摘要:

目的探讨应用筛窦基板层次性分析方法，指导内镜下筛窦层次性开放的可行性。方法通过鼻窦CT扫描的薄层DICOM数据，层厚层距均为0.65 mm，ImageViewer软件三维重建分析筛窦的基板（IIIV）层次及其气化情况。结果获得100例（200侧）患者鼻窦CT原始薄层数据，通过三维重建分析发现筛骨结构包含5个基板（IV）：①基板V的出现率为60.0%，相邻基板间存在潜在的层次间隙；②Haller气房出现率为28.0%，与中鼻甲、上鼻甲基板结构气化相关者分别占19.5%、8.5%；③上鼻甲及基板气化发生率为91.5%，其中19.1%气化为Onodi气房。最上鼻甲及基板出现率60.0%，气化发生率为76.7%，其中15.8%气化为Onodi气房。Onodi气房出现率为33.0%，来源于上鼻甲基板、最上鼻甲基板的分别占17.5%，9.5%，来源于二者共同气化的占6.0%。各基板及其气化结构组成相对独立的通气引流系统，可单独出现引流障碍。手术中筛窦的开放（IIIV基板）过程，以上鼻甲、最上鼻甲为标志结构，结合CT提示的气化变异，可在其前方分别充分地开放III基板、IV基板气化结构构成的筛窦迷路（包括变异气房，如Haller气房），而根据CT提示V基板的气化状况和方向，可进一步实现V基板及其气化结构（包括Onodi气房）的开放。结论通过分析筛窦基板的层次性结构，对指引内镜下筛窦开放过程实现层次性、标准化有重要指导价值。

关键词:鼻内镜手术|鼻窦|基板|层次性结构|筛窦

Abstract:

ObjectiveTo explore the feasibility of hierarchic ethmoidectomy by analyzing ethmoidal sinus lamella hierarchical structures.MethodsThe original digital imaging and communications in medicine (DICOM) data of sinus computer tomography (CT) were collected. Slice thickness and interval distance were both 0.65mm. Threedimensional (3D) reconstruction of ethmoidal sinus and lamellae (IIIV) hierarchical structures as well as their pneumatization were performed with ImageViewer software.ResultsCT DICOM data from 100 cases (200 sides) were collected and reconstructed for 3D analysis. The ethmoidal sinuses were composed with lamellae IV and lamella V was presented in 60% of the cases. Potential hierarchical spaces existed between the lamellae. The occurrence rate of Haller’s cell was 28.0% , and they were pneumatilazed from the lamella of middle turbinate (19.5%) or the superior turbinate (8.5%), respectively. The pneumatization rate of the superior turbinate and its lamella was 91.5%, and 19.1% of them were pneumatilazed to Onodi cells. The supreme nasal turbinate and its lamella was presented in 60% of the sinuses with a pneumatilization rate of 76.7%, and 15.8% of them were pneumatilized to Onodi cells. The occurrence rate of Onodi cells was 33%, and the cells were originated from the lamellae of superior turbinate (17.5%), supreme nasal turbinate (9.5%), or both (6.0%), respectively. The lamellae and their corresponding pneumatilized structures composed a relatively independent air flow and drainage system and could cause local disorders by themselves. In ethmoidal sinus surgery, the superior and supreme turbinates could be the landmarks for safe endoscopic ethmoidectomy. The III and IV lamellae and their corresponding pneumatilized cells could be completely removed just in the front of the superior and supreme turbinates, respectively. The V lamella and corresponding pneumatilized cells also could be safely and precisely removed according to the landmark of supreme turbinate demonstrated by CT scan.ConclusionAnalysis of the hierarchical lamella structures may have important significance to perform the hierarchical and standard endoscopic ethmoidectomy.

Key words:Endoscopic surgery|Sinus| Basal lamella|Hierachical structure| Ethmoidal sinus