[1]柯嘉 朱丽 李金红 马芙蓉**.手术模拟系统在中耳手术中的应用[J].中国微创外科杂志,2017,17(3):256-259.
　Ke Jia,Zhu Li,Li Jinhong,et al.Application of Surgery Simulation System in Middle Ear Surgery[J].Chinese Journal of Minimally Invasive Surgery,2017,17(3):256-259.
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手术模拟系统在中耳手术中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年3期
页码:
256-259
栏目:
实验研究
出版日期:
2017-06-20

文章信息/Info

Title:
Application of Surgery Simulation System in Middle Ear Surgery
作者:
柯嘉 朱丽 李金红 马芙蓉**
北京大学第三医院耳鼻咽喉头颈外科，北京100083
Author(s):
Ke Jia;  Zhu Li;  Li Jinhong;  et al.
Department of Otorhinolarygology Head and Neck Surgery, Peking University Third Hospital, Beijing 100083, China
关键词:
计算机模拟; 耳外科手术; 颞骨
Keywords:
Computer simulation; Otologic surgical procedures; Temporal bone
文献标志码:
A
摘要:
目的探讨耳科手术模拟系统Voxel-Man TempoSurg在不同类型中耳手术的模拟操作中的特点与应用。方法选择2012年6月~2015年3月中耳手术40例，包括中耳胆脂瘤21例，胆固醇肉芽肿6例，先天性外中耳畸形4例，颞骨多发骨折9例，留取手术录像。利用耳科手术模拟系统对上述病例进行与手术实际操作相同的模拟操作，对比真实手术，记录外耳道后上嵴、鼓环/鼓沟、听小骨、面神经、外半规管、乙状窦、脑板、圆窗龛等解剖结构以及病变组织在模拟手术中出现的情况。结果按病变类型分为软组织类型27例和骨性类型13例，耳科手术模拟系统中骨性类型中病变的显示率（100%，13/13）明显优于软组织类型（7.4%，2/27）（Fisher检验，P=0.000），其他结构显示率差异无统计学意义（P>0.05）。按乳突气化程度分为气化型16例和非气化型24例，气化型乳突中病变的显示率（68.8%，11/16）显著性高于非气化型（16.7%，4/24）（Fisher检验，P=0.002）。按采用的乳突开放术式分为完壁式25例和开放式15例，完壁式病变显示率（48.0%，12/25）与开放术式（20.0%，3/15）差异无显著性（Fisher检验，P=0.101），其他结构显示率差异亦无统计学意义（P>0.05）。结论利用耳科手术模拟器，在以骨性类型为主的病种及气化较好的乳突中，可以较好地模拟病变的情况。
Abstract:
ObjectiveTo probe into the characteristics and application of the Voxel-Man TempoSurg in middle ear surgical procedures.MethodsA total of 40 middle ear surgical procedures from June 2012 to March 2015 were selected, which included 21 cases of cholesteatoma, 6 cases of cholesterol granuloma, 4 cases of congenital external and middle ear malformation, and 9 cases of temporal fractures. The videos of these routine surgical procedures were reserved. Then simulated procedures same as real procedures in the operations were carriec out. The appearances of the important structures, such as the posterior crest of the external auditory canal, the tympanic sulcus, the ossicles, the facial never, the external semicircular canal, the sigmoid sinus, the cerebral plate and the round window niche were recorded in the simulated procedures while comparing with real procedures. ResultsIn terms of types of lesion, there were 27 cases of soft issue structure lesions and 13 cases of bone structure lesions. In otologic surgery simulation system, the displaying rate of lesions in cases with bone structure lesions (100%, 13/13) was significantly higher than that with soft issue structure lesions (7.4%, 2/27). The difference was statistically significant (Fisher’s Exact Test, P=0.000). However, the displaying rate was not statistically significant in other structures (P>0.05). In terms of mastoid pneumatization, there were 16 cases of pneumatic mastoids and 24 cases of non-pneumatic mastoids. The displaying rate of lesions in cases with pneumatic mastoids (688%, 11/16) was significantly higher than that with non-pneumatic mastoids (16.7%, 4/24). The difference was statistically significant (Fisher’s Exact Test, P=0.002). In terms of surgical types of mastoidectomy, there were 25 cases with canal-wall-up mastoidectomy and 15 cases with canal-wall-down mastoidectomy. The displaying rate of lesions in cases with canal-wall-up mastoidectomy (48.0%, 12/25) was significantly higher than that with canal-wall-down mastoidectomy (20.0%, 3/15), without significant difference (Fisher’s Exact Test, P=0.101). The displaying rate of other structures was not statistically significant (P>005).ConclusionLesions can be simulated satisfactorily in cases with bone structure lesions and good pneumatic mastoid by using otologic simulator.

参考文献/References:

[1]秦笃烈.DH临床应用最新进展:ENT手术模拟器Voxel-Man TempoSurg.中国医疗器械信息,2006,12(6):59-61.
[2]郭庚，王斌全.数字化人体在耳鼻咽喉科手术模拟中的应用.国际耳鼻咽喉头颈外科杂志，2007,31(3):149-152.
[3]Zirkle M,Roberson DW,Leuwer R,et al.Using a virtual reality temporal bone simulator to assess otolaryngology trainees.Laryngoscope,2007,117(2):258-263.
[4]黄选兆，汪吉宝，孔维佳，主编.实用耳鼻咽喉头颈外科学.第2版.北京:人民卫生出版社,2008.683.
[5]谢文,刘胜林,孔维佳,等.虚拟现实技术在微创外科手术学的应用.中国医疗设备，2010,25(7):76-77.
[6]郝欣平,于子龙,李永新.尸头解剖结合Voxel-man手术模拟系统在耳科教学中的应用.中国耳鼻咽喉头颈外科,2015,22(2):107-108.
[7]Khemani S,Arora A,Singh A,et al.Objective skills assessment and construct validation of a virtual reality temporal bone simulator.Otol Neurotol,2012,33(7):1225-1231.
[8]Nash R,Sykes R,Majithia A,et al.Objective assessment of learning curves for the Voxel-Man TempoSurg temporal bone surgery computer simulator.J Laryngol Otol,2012,126(7):663-639.
[9]Reddy-Kolanu G,Alderson D.Evaluating the effectiveness of the Voxel-Man TempoSurg virtual reality simulator in facilitating learning mastoid surgery.Ann R Coll Surg Engl,2011,93(3):205-208.
[10]宋昱，马芙蓉.完壁式乳突根治鼓室成形术的发展及应用.中国微创外科杂志,2015,15(8):755-758.

备注/Memo

备注/Memo:
基金项目：首都卫生发展科研专项（首发-2016-2-4094）**通讯作者，E-mail：furongma@126.com
更新日期/Last Update: 2017-06-20