颈静脉孔区不同手术入路显露结构的对比分析及显微解剖研究

发布时间：2018-01-11 02:12

本文关键词：颈静脉孔区不同手术入路显露结构的对比分析及显微解剖研究　出处：《兰州大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：研究枕下远外侧入路、耳后乙状窦前经颞入路、改良的耳后头颈入路对颈静脉孔区显露范围与结构的区别；熟悉该区域的解剖结构,为临床选择个体化手术入路、尽可能的一期全切除肿瘤、保护重要结构和功能提供可靠的依据。方法：用10%的福尔马林固定的成人头颈湿标本6具(12侧),随机分为A、B、C三组,每组2具标本,在高倍显微镜下模拟颈静脉孔区手术入路。其中A组模拟枕下远外侧入路、B组模拟耳后乙状窦前经颞入路、C组模拟改良的耳后头颈入路进行显微解剖研究,比较三种手术入路所显露的结构及范围；结果：枕下远外侧入路对颈静脉孔区颅内结构显露良好,特别是枕骨大孔区以及脑干下部的前方和侧方；耳后乙状窦前经颞入路对颈静脉孔孔内结构、鼓室、乳突气房及颈动脉鞘周围的结构显露良好,对颅内部分显露较差；改良的耳后头颈入路则通过后、外、上、下等多个角度对颅内外结构均显露良好。结论：不同的手术入路对颈静脉孔区的显露范围及结构各不相同,改良的耳后头颈入路能够更好的从多角度对颅内外结构显露,从而达到一期全切肿瘤。因此,根据颈静脉孔区病变的范围选择不同的手术入路以及选择磨出不同的骨性标志对有效显露和切除病变,减少结构和功能破坏具有非常重要的意义。
[Abstract]:Objective: to study the difference of the exposure range and structure of the jugular foramen area between the far lateral suboccipital approach the posterior sigmoid sinus anterior and temporal approach and the modified retroauricular head and neck approach. Familiarity with the anatomical structure of the region provides a reliable basis for the clinical selection of individualized surgical approaches, as well as for the primary total removal of tumors and the protection of important structures and functions. Methods: six adult head and neck wet specimens with 10% formalin fixation were randomly divided into three groups: group A (n = 2) and group C (n = 2). The surgical approach of jugular foramen area was simulated under high power microscope. The microanatomical study was carried out in group A (simulated far lateral suboccipital approach) and group B (simulated retroauricular sigmoid sinus approach via temporal approach) and modified retroauricular head and neck approach (group C). The structure and scope of the three approaches were compared. Results: the cranial structure of the jugular foramen was well exposed by the far lateral approach of the occipital, especially the anterior and lateral areas of the foramen magnum and the lower part of the brain stem. The posterior sigmoid sinus was well exposed to the structures in the foramen of jugular vein, tympanic chamber, mastoid gas chamber and the sheath of carotid artery via temporal approach. The modified retroauricular head and neck approach was used to reveal the intracranial and external structures at different angles. Conclusion: the exposure range and structure of the jugular foramen area are different in different surgical approaches, and the improved retroauricular approach can better expose the intracranial and external structures from multiple angles. Therefore, according to the range of lesions in the jugular foramen, different surgical approaches and different bone markers can be used to effectively expose and remove the lesions. It is very important to reduce the damage of structure and function.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322;R651.1

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