摘要目的 探讨CT仿真内镜(CTVE)技术在神经内镜下经鼻蝶入路垂体瘤切除术中的作用及应用价值.方法 选取2015年1月至2017年12月神经内镜下经鼻蝶入路行垂体瘤手术患者21例,患者术前均行GE64排螺旋CT鞍区薄层扫描,然后通过CTVE重建模拟图像,比较CTVE模拟图像和神经内镜术中图像的一致性.结果 CTVE模拟图像和神经内镜术中情况对蝶窦开口、视神经管隆起、颈内动脉隆起和视神经管-颈内动脉隐窝(O-C隐窝)的评级一致性较好(Kappa＝0.774、0.912、0.959和0.958);对蝶窦中隔、鞍底和斜坡隐窝的评级一致性一般(Kappa＝0.479、0.691和0.721).结论 CTVE技术能够在术前准确模拟重建鞍区的重要解剖结构,有助于手术方案的设计及手术疗效和安全性的提高;该项技术也对神经内镜技术的学习和掌握有所帮助.

abstractsObjective To explore the clinical efficacy and application value of CT virtual endoscopy (CTVE) in endoscopic resection of pituitary via transsphenoidal approach. Methods From January 2015 to December 2017, 21 patients with pituitary adenomas undergoing endoscopic transsphenoidal approach surgery were selected. All the patients were performed CT scan with GE64 spiral CT before operation, then reconstructed by CTVE. The preoperative CTVE simulated images and the observed images in the operation were compared, and the consistency of the 2 images was analyzed. Results CTVE simulated images and the observed images in the operation showed good consistency in the ratings of sphenoid sinus opening, optic canal protuberance, internal carotid artery protuberance and optic canal internal carotid recess (O-C recess) ( Kappa ＝ 0.774, 0.912, 0.959 and 0.958); and general consistency in the ratings of septum of sphenoid sinus, sellar floor and ramp recess ( Kappa＝0.479, 0.691 and 0.721). Conclusions CTVE technology can accurately simulate the reconstruction of the important anatomical structure of the saddle area before operation, which helps to design the operation plan and improve the curative effect and safety of the operation; this technique also helps to learn and master the endoscope technology.