额鼻区手术入路断层解剖学研究及意义

发布时间：2018-01-03 02:16

本文关键词：额鼻区手术入路断层解剖学研究及意义　出处：《天津医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的额鼻区位于鼻的上方、视器的内侧、脑和脑血管的下方。主要结构包括额窦、鼻额管(峡)及额隐窝。其交通广泛,发生于此的肿瘤、类肿瘤易转移,且难以彻底清除。随着医学的发展和进步,国内外学者对此从大体到影像学进行大量报道,但未见用连续薄切片技术的研究。鉴此,我们用改进火棉胶包埋薄切片(0.25mmm)的技术及应用解剖学方法,对额鼻区进行断层与应用解剖学研究,为额鼻区手术入路提供形态学与临床应用解剖学依据。方法取固定成尸头标本30例,取前颅底。标本经20%HCl脱钙,梯度脱水(将组织块按照顺序浸泡在浓度依次为70%、80%、95%、无水乙醇和乙醚乙醇的液体中),梯度浸胶(将组织块按顺序依次放入浓度为5%、8%和15%的火棉胶中浸泡),包埋,焊块,用德国制造JUNGAG型大脑切片机,在水平面、矢状面和冠状面切成0.25mm薄切片(三维),对额鼻区的形态、毗邻特点进行观测。并用80侧干燥颅骨及20侧脱钙尸头标本对额鼻区进行测量,并获取一些数据。结果对水平面、矢状面及冠状面的不同层面进行描述,额鼻区结构形态多样,左右形态和位置均不对称。额鼻区的结构整体形似沙漏,额窦是沙漏的上半部,鼻额管(峡)是沙漏的狭细部,额隐窝是沙漏的下半部。在水平面上,额窦可呈现三角形、手枪形、牛角管形、弧形、镰刀形、短棒状形甚至驼峰形；鼻额管上口形状呈圆形、卵圆形、长梭形,窄缝形；额隐窝呈梨形、矩形及扁窄的裂隙形。冠状面上,额窦呈三角形、蝶翼形或四边形；鼻额管呈弧形；额隐窝呈三角形或近似矩形。矢状面上,额窦呈锥形、横置的喇叭形或椭圆形,鼻额管呈“S”形,直线型及斜行狭长的形态。结论将水平断层、冠状断层及矢状断层有效地结合,对诊断额鼻区疾病和指导手术更加有效。本研究结合断层解剖学与应用解剖学,为FESS技术设计出一条新型手术入路,即经鼻腔自然通道行额鼻区手术入路。从中鼻道进入,找到筛泡和半月裂孔并以其为标志,将手术器械向前上方延伸,找到鼻额管下口。用长弯头吸引切割器经鼻额管从下向上进行操作,进行引流或窦腔内肿物切除。由此处入路手术创伤小、出血少,安全系数高、术后并发症少。在术前对额鼻区进行影像学检测,以提高手术的成功率。
[Abstract]:Above the objective frontal nasal area is located in the medial nasal, the lower brain and cerebral blood vessels. The main structure includes frontal sinus, intranasal (GAP) and frontal recess. The traffic is widespread, happened in this tumor, tumor metastasis, and it is difficult to completely remove. Along with the development and progress of medicine in China foreign scholars from the general to imaging a lot of reports, but the study of continuous thin slice with no. In view of this, we use the improved celloidin slices (0.25mmm) technique and applied anatomy method, research and application of the frontonasal anatomy fault zone, to provide morphological and anatomical basis for clinical application value the nasal surgical approach.
Methods fixed cadaveric head specimens in 30 cases, the anterior skull base. Specimens were decalcified with 20%HCl, gradient dehydration (tissue soaked in the concentration in accordance with the order of the order of 70%, 80%, 95%, ethanol and ether ethanol liquid), gradient (dipping tissue successively into the concentration of 5%, 8% and 15% of the collodion embedding, immersion), welding block, manufacturing JUNGAG brain slicing machine in Germany, in the horizontal plane, sagittal and coronal thin slices cut into 0.25mm (San Wei), the amount of nasal shape, adjacent to the characteristics were observed. And to measure the amount of nasal side 80 dry skull and 20 lateral decalcified cadaveric head specimens, and get some data.
The results of the horizontal plane, to describe the different levels of sagittal and coronal structure, frontonasal region diversity, about shape and position are asymmetric. The overall structure of frontonasal region resembling an hourglass, the frontal sinus is part of the hourglass, intranasal (GAP) is the amount of detail narrow, hidden nest is lower the hourglass. In the horizontal plane, the frontal sinus can be triangular, shaped like a horn, tube shaped, curved, sickle shaped, short rod shaped and hump shaped; intranasal mouth is circular, oval, fusiform, narrow; frontal recess is pear shaped, rectangular shape and narrow slit. The coronal plane, frontal triangle, butterfly wing or quadrilateral; intranasal arc; frontal recess is triangular or rectangular. The sagittal, frontal conical, transverse horn shaped or oval, nasofrontal duct was "S" shape, straight and oblique strip shape.
Conclusion the level of fault, fault and coronal sagittal effectively combined, more effective in the diagnosis of frontonasal region disease and guiding surgery. On the basis of anatomy and applied anatomy, FESS technology to design a new surgical approach, namely nasal surgery, nasal region natural channel. The approach from entering find the bulla meatus, semilunar hiatus and its signs, surgical instruments will be forward extending above, find the nasofrontal duct mouth. With long nasal tube, elbow cutterbar from down to up, drainage or sinus tumor resection. The approach to surgical trauma, less bleeding, high safety, less postoperative complications. The preoperative imaging of frontonasal region detection, in order to improve the success rate of the operation.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322-3

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