本文選題：鼻內(nèi)鏡外科技術(shù)　切入點：慢性鼻竇炎　出處：《大連理工大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：上世紀70年代始,鼻內(nèi)鏡鼻竇手術(shù)開始用于慢性鼻竇炎的治療。與傳統(tǒng)Caldwell-lue鼻腔手術(shù)相比,它具有保留鼻竇基本結(jié)構(gòu),維持鼻腔鼻竇通氣、引流等基本生理功能的優(yōu)勢。經(jīng)過多年的發(fā)展,鼻內(nèi)鏡手術(shù)已成為微創(chuàng)外科治療慢性鼻竇炎的標準方法,并延伸至中前顱底和鼻眼相關(guān)領(lǐng)域。“結(jié)構(gòu)-功能-癥狀”辯證理念貫穿其中,推動了鼻內(nèi)鏡外科技術(shù)發(fā)展。其已逐漸從單純治療鼻腔鼻竇炎性感染性疾病、解剖結(jié)構(gòu)異常的角度,提升到治療上呼吸道通氣等生理功能障礙的新層次,應(yīng)用領(lǐng)域也不局限予鼻腔鼻竇病變,己進入睡眠障礙疾病的外科治療干預(yù)中,代表性技術(shù)如鼻腔擴容技術(shù)。維持鼻腔生理功能有賴于鼻腔內(nèi)氣體的合理流動,從氣流動力學(xué)角度深入研究鼻腔氣流改變對局部以及上呼吸結(jié)構(gòu)順應(yīng)性改變的影響,客觀認識鼻腔內(nèi)氣流特征及鼻腔內(nèi)結(jié)構(gòu)與功能之間的相互關(guān)系,具有重要作用,鼻腔氣流動力學(xué)研究在鼻內(nèi)鏡外科臨床實踐發(fā)展過程占有重要地位。運用計算流體動力學(xué)(computational fluid dynamics, CFD)方法,進行數(shù)值模擬方法,開展鼻腔與咽腔的生物力學(xué)特征研究,并檢測臨床主客觀結(jié)果來對比,了解數(shù)值模擬方法的可行性和結(jié)果的有效性,揭示與鼻腔鼻竇疾病相關(guān)的上氣道結(jié)構(gòu)與功能改變之間的關(guān)系,從生物力學(xué)角度,為鼻內(nèi)鏡外科技術(shù)的發(fā)展搭建了數(shù)值量化分析的平臺。研究內(nèi)容如下： 1、選取健康成人高分辨螺旋CT影像學(xué)數(shù)據(jù),建造60例樣本的鼻腔三維模型,進行數(shù)值模擬計算,研究健康成人鼻腔氣流特性,分析流場特征,數(shù)值模擬計算結(jié)果與文獻報道的實驗和數(shù)值模擬數(shù)據(jù)進行比較,驗證本文數(shù)值模擬分析方法的可行性和計算結(jié)果的可信性,總結(jié)正常鼻腔生理狀態(tài)下氣流分布的規(guī)律,建立健康成人鼻腔氣流流場特征值與鼻腔流場分布特征數(shù)據(jù)庫,從生物力學(xué)角度揭示鼻腔結(jié)構(gòu)與功能相適應(yīng)性生理機制,給出鼻腔流場特征值參數(shù),提出鼻腔功能量化的檢測方法與標準,為進行鼻腔數(shù)值模擬研究奠定基礎(chǔ)。 2、通過了解在鼻竇炎發(fā)病及鼻內(nèi)鏡外科手術(shù)中密切相關(guān)的竇口鼻道復(fù)合體(ostiomeatal complex,OMC)I臨床意義,數(shù)值模擬來研究竇口鼻道復(fù)合體與上頜竇氣流異同以及不同大小的上頜竇自然口對上頜竇流場的影響。選取1例成人女性螺旋CT影像學(xué)資料,構(gòu)建鼻腔及上頜竇的三維模型,數(shù)值模擬研究上頜竇中氣流和溫度正常分布,了解上頜竇的生理功能；通過模擬手術(shù)研究上頜竇竇口直徑的變化,上頜竇氣流和溫度的改變,為臨床開展鼻內(nèi)鏡外科手術(shù)量化開放上頜竇竇口大小,提供參考意見。 3、選取一例接受鼻內(nèi)鏡手術(shù)慢性鼻竇炎患者臨床資料,提取術(shù)前術(shù)后CT數(shù)據(jù)資料,建立鼻腔鼻竇數(shù)值模型,研究手術(shù)前后鼻腔鼻竇氣流分布和流場特征值的變化,并采集臨床療效數(shù)據(jù)來驗證分析方法的可行性和結(jié)果的可信性,從生物力學(xué)角度分析慢性鼻竇炎發(fā)病機制,模擬鼻腔鼻竇結(jié)構(gòu)-功能-癥狀之間相關(guān)性,分析鼻內(nèi)鏡手術(shù)的矯正結(jié)構(gòu)與鼻腔鼻竇黏膜炎癥良性轉(zhuǎn)歸之間的關(guān)系,建立鼻內(nèi)鏡外科手術(shù)療效評估數(shù)值平臺。 4、選取3例輕、中、重度OSAHS患者行鼻腔擴容術(shù)前術(shù)后的CT資料,建立上氣道數(shù)值模型,研究手術(shù)前后上呼吸道氣流分布和流場特征值的變化。了解鼻腔擴容術(shù)改善鼻腔通氣量的同時,對于不同嚴重程度的OSAHS疾病患者,整個上氣道阻力的改變情況,上游鼻腔通氣程度的改善能否對下游咽腔產(chǎn)生有益的影響,通過數(shù)值模擬評價術(shù)后OSAHS癥狀的改善情況,并采集臨床觀測數(shù)據(jù)來驗證數(shù)值模擬分析方法的可行性和結(jié)果的可信性。為進一步開展鼻腔擴容手術(shù)適應(yīng)癥研究提供理論依據(jù),為個性化鼻腔擴容術(shù)提供研究方法。
[Abstract]:In the beginning of 70s, endoscopic sinus surgery for treatment of chronic sinusitis. Compared with the traditional Caldwell-lue nasal surgery, it has retained the basic structure of the sinuses, nasal ventilation to maintain, drainage and other basic physiological functions. After years of development, the nasal endoscopic surgery has become the standard method for the treatment of chronic sinusitis and minimally invasive surgery. Extended to the anterior skull base and nose eye related fields. The "structure function" were dialectical philosophy through which to promote the development of endoscopic surgical technique. It has been changed from the simple treatment of nasal cavity and paranasal sinus infections, abnormal anatomy of the angle, to a new level of treatment of upper airway and other physiological function, application the field is not limited to the nasal and sinus lesions, surgical intervention has entered sleep disorders in representative techniques such as nasal cavity expansion technology. To maintain the nasal cavity Reasonable flow depends on the physiological function of the nasal cavity gas, gas flow from the perspective of dynamic change of nasal airflow and respiratory effects of local adaptation structure change, objective understanding of relationship between nasal airflow characteristics and nasal cavity structure and function, and plays an important role on nasal airflow dynamics plays an important role in the development process of the nose endoscopic surgery clinical practice. Using computational fluid dynamics (computational fluid, dynamics, CFD) method, numerical simulation method, carry out the biomechanical features of the nasal and pharyngeal cavity, and to detect the clinical results of subjective and objective to compare the effectiveness and feasibility of understanding the results of numerical simulation method, reveal the relationship between upper airway structure and function change with the nasal cavity and paranasal sinus diseases, from the view of biomechanics, built for the development of numerical quantification of nasal endoscopy Analysis platform. The contents of the research are as follows:
1 healthy adults were selected for high resolution spiral CT imaging data of 60 cases of nasal three-dimensional model construction samples, numerical simulation, healthy adult nasal airflow characteristics, analysis of flow field characteristics, comparing experimental and numerical simulation data results with the reported numerical simulation, simulation credibility analysis method and the results of feasibility to validate the numerical summary of air distribution regularity of normal nasal physiological condition, establish the flow field characteristics of healthy adult nasal airflow distribution characteristics of flow field value and the database to reveal the structure and function of nasal cavity, nasal phase adaptive physiological mechanism from the view of biomechanics, given the nasal cavity flow field characteristic parameters, the test method and standard of nasal function quantification, for numerical nasal cavity simulation study of the foundation.
2, through the understanding of the pathogenesis and sinusitis in nasal endoscopic surgery is closely related to the ostiomeatal complex (ostiomeatal complex, OMC I) clinical significance, numerical simulation to study the ostiomeatal complex and maxillary sinus flow similarities and differences and different sized natural ostium of maxillary sinus of maxillary sinus. The influence of the flow field from 1 cases of adult image female spiral CT data, construction of three-dimensional model of nasal cavity and maxillary sinus, maxillary sinus in the numerical simulation of the flow and temperature of normal distribution, understand the physiological function of the maxillary sinus; surgical simulation research by changing the diameter of the maxillary sinus, maxillary sinus airflow and temperature change, carry out clinical endoscopic surgery to quantify open maxillary sinus size, provide a reference.
3, select patients received clinical data of nasal endoscopic surgery for chronic sinusitis patients before and after surgery, extraction of CT data, the establishment of sinonasal numerical model, changes of before and after the operation of nasal airflow distribution and flow characteristic value, credibility and collection of clinical efficacy data to verify the feasibility and results analysis methods, analysis of the pathogenesis of chronic sinusitis from the view of biomechanics, the correlation between simulation structure of nasal function and symptoms, to analyze the relationship between the endoscopic surgical correction of nasal mucosa inflammation structure and benign outcome, establish the curative effect of nasal endoscopic surgery to evaluate the numerical platform.
4, a total of 3 cases of mild, severe CT, OSAHS data for patients with nasal cavity expansion before and after surgery, the upper airway establishment of numerical model, flow distribution and flow field characteristics of respiratory changes before and after the operation. The value of knowledge expansion nasal surgery to improve nasal ventilation volume at the same time, for the different severity of OSAHS disease. The upper airway resistance changes, the upper nasal ventilation improvement can have beneficial effects on the downstream of the pharyngeal cavity, through the numerical simulation to improve the situation evaluation of postoperative OSAHS symptoms, clinical observation and collection of data to verify the numerical simulation results of the credibility and feasibility analysis method. For the further development of nasal cavity expansion surgery to provide the theory of on the basis of disease research, provide research methods for personalized expansion nasal surgery.

【學(xué)位授予單位】：大連理工大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R765.9

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