基于图像融合的手术导航系统在头颈部低流量脉管畸形硬化治疗中的应用

doi:10.3969/j.issn.1674-8115.2021.05.023

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (5): 695-700.doi: 10.3969/j.issn.1674-8115.2021.05.023

• 技术与方法 • 上一篇

基于图像融合的手术导航系统在头颈部低流量脉管畸形硬化治疗中的应用

顾豪¹(), 杨希¹(), 张紫旻², 金云波¹, 胡丽¹, 陈辉¹(), 林晓曦¹()

^1.上海交通大学医学院附属第九人民医院整复外科，上海 200011
^2.上海交通大学医学院附属第九人民医院放射科，上海 200011

出版日期:2021-05-28 发布日期:2021-05-27
通讯作者: 陈辉,林晓曦 E-mail:drguhao9prs@gmail.com;chenhui9801640@163.com;linxiaoxi@126.com
作者简介:顾豪（1994—），男，博士生；电子信箱：drguhao9prs@gmail.com|顾豪（1994—），男，博士生；电子信箱：drguhao9prs@gmail.com
基金资助:
上海市申康医院发展中心临床技能与临床创新三年行动计划(16CR1007A);上海交通大学医学院附属第九人民医院临床研究助推计划(JYLJ001);上海交通大学医学院附属第九人民医院生物样本库专项基金(YBKA201902)

Image-fusion-based surgical navigation in sclerotherapy for low-flow vascular malformations in the risky regions of head and neck

Hao GU¹(), Xi YANG¹(), Zi-min ZHANG², Yun-bo JIN¹, Li HU¹, Hui CHEN¹(), Xiao-xi LIN¹()

^1.Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
^2.Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Online:2021-05-28 Published:2021-05-27
Contact: Hui CHEN,Xiao-xi LIN E-mail:drguhao9prs@gmail.com;chenhui9801640@163.com;linxiaoxi@126.com
Supported by:
Three-Year Plan of Clinical Skills and Innovation Program of Shanghai Shenkang Hospital Development Center(16CR1007A);Clinical Research Program of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(JYLJ001);Special Fund for Biobank of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(YBKA201902)

摘要/Abstract

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

中图分类号:

R543

顾豪, 杨希, 张紫旻, 金云波, 胡丽, 陈辉, 林晓曦. 基于图像融合的手术导航系统在头颈部低流量脉管畸形硬化治疗中的应用[J]. 上海交通大学学报(医学版), 2021, 41(5): 695-700.

Hao GU, Xi YANG, Zi-min ZHANG, Yun-bo JIN, Li HU, Hui CHEN, Xiao-xi LIN. Image-fusion-based surgical navigation in sclerotherapy for low-flow vascular malformations in the risky regions of head and neck[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(5): 695-700.

图/表 5

参考文献 17

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Patient No.	Sex	Age/year	Site	Diagnosis	Previous treatment	Local symptom
1	Female	47	Left orbit	VM	Percutaneous sclerotherapy	Argamblyopia caused by blepharoptosis and swelling
2	Female	3	Left orbit	LM	Percutaneous sclerotherapy
3	Female	19	Left orbit	VM	Percutaneous sclerotherapy and laser
4	Male	6	Right orbit	LM	Percutaneous sclerotherapy
5	Female	8	Left orbit	LM	Percutaneous sclerotherapy
6	Male	16	Bilateral orbit	VM	Percutaneous sclerotherapy	Swelling
7	Male	27	Left face and neck	VM	Percutaneous sclerotherapy and laser	Dyspnoea (before tracheotomy)
8	Male	29	Right face and neck	VM	Percutaneous sclerotherapy, laser, and orthodontic orthognathic treatment
9	Male	33	Bilateral face and neck	VM	Laryngoscope-guided sclerotherapy, resection of phlebolith, and percutaneous sclerotherapy
10	Male	21	Bilateral face and neck	VM	Percutaneous sclerotherapy

Patient No.	Sex	Age/year	Site	Diagnosis	Previous treatment	Local symptom
1	Female	47	Left orbit	VM	Percutaneous sclerotherapy	Argamblyopia caused by blepharoptosis and swelling
2	Female	3	Left orbit	LM	Percutaneous sclerotherapy
3	Female	19	Left orbit	VM	Percutaneous sclerotherapy and laser
4	Male	6	Right orbit	LM	Percutaneous sclerotherapy
5	Female	8	Left orbit	LM	Percutaneous sclerotherapy
6	Male	16	Bilateral orbit	VM	Percutaneous sclerotherapy	Swelling
7	Male	27	Left face and neck	VM	Percutaneous sclerotherapy and laser	Dyspnoea (before tracheotomy)
8	Male	29	Right face and neck	VM	Percutaneous sclerotherapy, laser, and orthodontic orthognathic treatment
9	Male	33	Bilateral face and neck	VM	Laryngoscope-guided sclerotherapy, resection of phlebolith, and percutaneous sclerotherapy
10	Male	21	Bilateral face and neck	VM	Percutaneous sclerotherapy

Patient No.	Region	Approach	Result of puncture	Sclerosant	Complication	Follow-up/month
1	Left retrobulbar	Percutaneously	Success	B	None	16
2	Left retrobulbar	Percutaneously	Success	B	None	9
3	Left nasal intraorbital	Percutaneously	Success	BPF	None	3
	Left inferior intraorbital	Percutaneously	Success	BPF	None
4	Right superior nasal intraorbital	Percutaneously	Success	B	None	4
	Right inferior temporal intraorbital	Percutaneously	Success	B	None
5	Left superior nasal intraorbital	Percutaneously	Failure	No delivery	None	6
6	Right nasal intraorbital	Percutaneously	Success	BPF	None	4
	Left retrobulbar	Percutaneously	Success	BPF	None
7
1st procedure	Left nasopharynx	Transorally	Success	No delivery^①	None	2.5
	Lingual radix	Transorally	Success	BPF	None
2nd procedure	Left lingual radix	Transorally	Success	BPF	None	7.5
	Left nasopharynx	Transorally	Failure	No delivery	None
3rd procedure	Left nasopharynx	Transorally	Failure	No delivery	None	3
	Posterior wall of left oropharynx	Percutaneously through mouth floor	Success	BPF	None
4th procedure	Left nasopharynx	Transorally	Success	BPF	None	5
	Posterior wall of left oropharynx	Percutaneously through mouth floor	Failure	No delivery	None
8
1st procedure	Posterior wall of right nasopharynx and oropharynx	Transorally	Success	BPF	None	3.5
2nd procedure	Right lingual radix	Transorally	Success	BPF	None	8.5
	Posterior wall of right nasopharynx and oropharynx	Transorally	Success	A & BPF	None
3rd procedure	Right lingual radix	Percutaneously through mouth floor	Success	BPF	None	8
9
1st procedure	Left supraglottic	Transorally	Success	BPF	None	4
	Right nasopharynx	Transorally	Failure	No delivery	None
	Glottis	Percutaneously	Success	A	Pneumonia caused by glottic ulcer
2nd procedure	Left laryngopharynx	Percutaneously through mouth floor	Success	BPF	None	1.5
	Right nasopharynx	Transorally	Failure	No delivery	None
3rd procedure	Left supraglottic	Percutaneously through mouth floor	Success	BPF	None	11
10
1st procedure	Right nasopharynx	Transorally	Success	BPF	None	6
2nd procedure	Right oropharynx	Transorally	Success	A & BPF	None	5
3rd procedure	Pre-epiglottic space	Percutaneously through mouth floor	Success	BPF	None	3

Patient No.	Region	Approach	Result of puncture	Sclerosant	Complication	Follow-up/month
1	Left retrobulbar	Percutaneously	Success	B	None	16
2	Left retrobulbar	Percutaneously	Success	B	None	9
3	Left nasal intraorbital	Percutaneously	Success	BPF	None	3
	Left inferior intraorbital	Percutaneously	Success	BPF	None
4	Right superior nasal intraorbital	Percutaneously	Success	B	None	4
	Right inferior temporal intraorbital	Percutaneously	Success	B	None
5	Left superior nasal intraorbital	Percutaneously	Failure	No delivery	None	6
6	Right nasal intraorbital	Percutaneously	Success	BPF	None	4
	Left retrobulbar	Percutaneously	Success	BPF	None
7
1st procedure	Left nasopharynx	Transorally	Success	No delivery^①	None	2.5
	Lingual radix	Transorally	Success	BPF	None
2nd procedure	Left lingual radix	Transorally	Success	BPF	None	7.5
	Left nasopharynx	Transorally	Failure	No delivery	None
3rd procedure	Left nasopharynx	Transorally	Failure	No delivery	None	3
	Posterior wall of left oropharynx	Percutaneously through mouth floor	Success	BPF	None
4th procedure	Left nasopharynx	Transorally	Success	BPF	None	5
	Posterior wall of left oropharynx	Percutaneously through mouth floor	Failure	No delivery	None
8
1st procedure	Posterior wall of right nasopharynx and oropharynx	Transorally	Success	BPF	None	3.5
2nd procedure	Right lingual radix	Transorally	Success	BPF	None	8.5
	Posterior wall of right nasopharynx and oropharynx	Transorally	Success	A & BPF	None
3rd procedure	Right lingual radix	Percutaneously through mouth floor	Success	BPF	None	8
9
1st procedure	Left supraglottic	Transorally	Success	BPF	None	4
	Right nasopharynx	Transorally	Failure	No delivery	None
	Glottis	Percutaneously	Success	A	Pneumonia caused by glottic ulcer
2nd procedure	Left laryngopharynx	Percutaneously through mouth floor	Success	BPF	None	1.5
	Right nasopharynx	Transorally	Failure	No delivery	None
3rd procedure	Left supraglottic	Percutaneously through mouth floor	Success	BPF	None	11
10
1st procedure	Right nasopharynx	Transorally	Success	BPF	None	6
2nd procedure	Right oropharynx	Transorally	Success	A & BPF	None	5
3rd procedure	Pre-epiglottic space	Percutaneously through mouth floor	Success	BPF	None	3

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基于图像融合的手术导航系统在头颈部低流量脉管畸形硬化治疗中的应用

Image-fusion-based surgical navigation in sclerotherapy for low-flow vascular malformations in the risky regions of head and neck

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