中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2010年
6期
602-605
,共4页
内镜%经鼻入路%斜坡%应用解剖学
內鏡%經鼻入路%斜坡%應用解剖學
내경%경비입로%사파%응용해부학
Endoscope%Endonasal approach%Clivus%Clinical anatomy
目的 研究扩大的内镜下经鼻至斜坡腹侧区入路手术的显露范围、解剖标志点及相关结构的距离.方法 取甲醛固定后成人头颅湿标本20例,显微镜下解剖观察经鼻至斜坡腹侧区手术入路的解剖标志点,测量相关解剖结构的距离;取新鲜成人头颅标本5例,完全模拟内镜下经鼻至斜坡腹侧区入路手术.在内镜下扩展显露斜坡区的主要解剖标志点,并研究其相互位置关系.结果扩大的内镜下经鼻至斜坡腹侧区入路手术的标志点包括中鼻甲、后鼻孔、咽鼓管咽口、鼻咽部黏膜、双侧蝶窦口、头长肌和颈长肌、咽结节、枕骨大孔前缘中点、颈内动脉、蝶腭动脉等.自鼻前棘至中下斜坡腹侧中线相关结构(咽结节、枕骨大孔前缘中点)的距离分别为(78.23±2.58)mm、(89.60±2.52)mm;经鼻人路完全暴露中下斜坡区,最短距离为(89.60±2.52)mm.颅底骨质磨除范围分别以两侧翼管和破裂孔为界,翼管左、右侧距中线距离为(9.25±0.55)mm、(9.19±0.50)nml,破裂孔左、右侧距中线距离为(10.64±0.83)toni、(10.75±0.84)mm,比较差异无统计学意义(P>0.05).结论 相关解剖结构及对脑组织的牵拉、颅底骨质磨除位置和范围是扩大的内镜下经鼻至斜坡腹侧区入路手术需要解决的主要解剖学问题.
目的 研究擴大的內鏡下經鼻至斜坡腹側區入路手術的顯露範圍、解剖標誌點及相關結構的距離.方法 取甲醛固定後成人頭顱濕標本20例,顯微鏡下解剖觀察經鼻至斜坡腹側區手術入路的解剖標誌點,測量相關解剖結構的距離;取新鮮成人頭顱標本5例,完全模擬內鏡下經鼻至斜坡腹側區入路手術.在內鏡下擴展顯露斜坡區的主要解剖標誌點,併研究其相互位置關繫.結果擴大的內鏡下經鼻至斜坡腹側區入路手術的標誌點包括中鼻甲、後鼻孔、嚥鼓管嚥口、鼻嚥部黏膜、雙側蝶竇口、頭長肌和頸長肌、嚥結節、枕骨大孔前緣中點、頸內動脈、蝶腭動脈等.自鼻前棘至中下斜坡腹側中線相關結構(嚥結節、枕骨大孔前緣中點)的距離分彆為(78.23±2.58)mm、(89.60±2.52)mm;經鼻人路完全暴露中下斜坡區,最短距離為(89.60±2.52)mm.顱底骨質磨除範圍分彆以兩側翼管和破裂孔為界,翼管左、右側距中線距離為(9.25±0.55)mm、(9.19±0.50)nml,破裂孔左、右側距中線距離為(10.64±0.83)toni、(10.75±0.84)mm,比較差異無統計學意義(P>0.05).結論 相關解剖結構及對腦組織的牽拉、顱底骨質磨除位置和範圍是擴大的內鏡下經鼻至斜坡腹側區入路手術需要解決的主要解剖學問題.
목적 연구확대적내경하경비지사파복측구입로수술적현로범위、해부표지점급상관결구적거리.방법 취갑철고정후성인두로습표본20례,현미경하해부관찰경비지사파복측구수술입로적해부표지점,측량상관해부결구적거리;취신선성인두로표본5례,완전모의내경하경비지사파복측구입로수술.재내경하확전현로사파구적주요해부표지점,병연구기상호위치관계.결과확대적내경하경비지사파복측구입로수술적표지점포괄중비갑、후비공、인고관인구、비인부점막、쌍측접두구、두장기화경장기、인결절、침골대공전연중점、경내동맥、접악동맥등.자비전극지중하사파복측중선상관결구(인결절、침골대공전연중점)적거리분별위(78.23±2.58)mm、(89.60±2.52)mm;경비인로완전폭로중하사파구,최단거리위(89.60±2.52)mm.로저골질마제범위분별이량측익관화파렬공위계,익관좌、우측거중선거리위(9.25±0.55)mm、(9.19±0.50)nml,파렬공좌、우측거중선거리위(10.64±0.83)toni、(10.75±0.84)mm,비교차이무통계학의의(P>0.05).결론 상관해부결구급대뇌조직적견랍、로저골질마제위치화범위시확대적내경하경비지사파복측구입로수술수요해결적주요해부학문제.
Objective To define the exposure extent of the ventral part of the clivus under the extended endoscopic endonasal approach,important anatomical landmarks and the distance between each other via this approach.Methods Twenty formalin-fixed intact adult human head-neck specimens,in which only the arteries was injected with red latex,were longitudinally and coronally dissected to evaluate the surgical key steps and the advantages and limitations via extended endoscopic endonasal approach and selected measurements were obtained.Five fresh and intact head-neck specimens were used to perform analogical operation via the extended endoscopic endonasai approach to the ventral part of the clivus.The surgical exposure of main landmarks in the clivus was extended under endoscope and microscope,and the interactions and distances between the landmarks were studied.ResultsAnatomic landmarks of the approach included the middle turbinate,the choana narium,the Eustachian tube ostium,and the nasopharynx mucosa,the aperture of sphenoidal sinus,the longus capitis,the longus colli,the basion,the internal carotid artery and the sphenopalatine artery.The distances between the anterior nasal spine and both the pharyngeal tubercle and the basion were (78.23±2.58) mm and (89.60±2.52) mm,respectively.The shortest distance exposuring ventral region of clivus completely should be (89.60+2.52) mm.The exposure in the inferior wall of sphenoid sinus and the lower clivus was limited by pterygoid canal and foramen lacerum,and the average distances from the median line to them were (9.22±0.52) mm and (9.70±0.70) mm,respectively; no significant difference between the left and right was found (P>0.05).Conclusion knowing the anatomical structure,understanding its connection with the brain tissue and its exposure extent of the ventral part of the clivus are the major problems that need to be solved in the extended endoscopic endonasal approach.
