蝶腭动脉和筛动脉的应用解剖学研究

发布时间：2018-06-06 02:44

  本文选题：蝶腭动脉 + 筛前动脉　； 参考：《南华大学》2012年硕士论文

【摘要】：目的： 通过对蝶腭孔的位置和蝶腭动脉分支在鼻腔外侧壁的穿出点进行观测，探讨传统中鼻道入路蝶腭动脉结扎术的不足；通过观测鼻后外侧动脉分支在鼻腔外侧壁的分布，探讨下鼻甲动脉电凝的可行性；通过对筛动脉的解剖和临床资料的研究与分析，探寻一种可供选择的结扎术式。 材料和方法： 1.干性半侧颅骨50例。16具头颈部标本，其中12具防腐标本，4具为新鲜标本。临床资料（影像，内镜）。 2.干性半侧颅骨标本50例，观察蝶腭孔的位置，测量蝶腭孔的相关数据，测量筛前孔至鼻前棘的距离及其连线与鼻底的夹角。 3．16具防腐和新鲜头部标本灌注后，其中10具行正矢中状切，5具沿中鼻甲后端平面行冠状切，1具新鲜标本用于制作铸型。 4.在20侧头部正中矢状切标本上，对鼻腔外侧壁结构进行解剖，测量鼻后外侧动脉穿出点至上颌窦自然口、至鼻后孔、至中鼻甲后端的距离；测量鼻后中隔动脉穿出点至中鼻甲后端水平距离和垂直距离、及至中鼻甲附着部的距离。观察鼻后外侧动脉在中鼻道的分支分布，测量下鼻甲动脉起点至中鼻甲附着部、下鼻甲附着部的垂直距离，至中鼻甲后端附着部、下鼻甲后端附着部的水平距离（在下鼻甲附着部的水平测量），至上颌窦自然口的距离。在5具冠状切的标本，充分显露蝶窦前壁，测量鼻后中隔动脉上、下支至蝶窦口的垂直距离及其外径；去除眶顶和筛顶，充分显示筛前动脉主干走行。 5.观察铸型标本中蝶腭动脉分支和筛动脉的主干走行。 6.分析临床典型内镜和影像资料。 结果： 1.蝶腭孔的位置：第一类：蝶腭孔位于中鼻道和后鼻道后部的移行区域，38例占76%，，其前缘的中部与筛嵴后端接触；第二类：蝶腭孔紧邻筛嵴且位于其后上，12例占24%。蝶腭孔相关数据测量：筛嵴至鼻前棘的距离：54.15±7.82mm；筛嵴至前鼻棘的连线与鼻底的夹角：(21.4±3.6)°；筛嵴至下鼻甲水平部的距离：13.11±2.12mm；筛嵴至腭骨水平板的距离：18.27±1.13mm。 2.蝶腭动脉分支穿出点的相关数据测量：鼻后外侧动脉穿出点至上颌窦自然口的距离：21.60±3.03mm；至鼻后孔的距离：9.41±2.05mm；至中鼻甲后端的距离：8.21±1.74mm。鼻后中隔动脉穿出点至中鼻甲后端水平距离：7.72±2.04mm；至中鼻甲后端的垂直距离：8.11±2.45mm；至中鼻甲附着部的距离：4.31±1.69mm。相对于中鼻甲在鼻腔外侧壁的附着部而言，鼻后中隔动脉穿出点均较恒定的位于其后上方。鼻后中隔动脉上、下支至蝶窦口的垂直距离及其外径：上支距蝶窦口的距离：8.50±0.20mm；下支距蝶窦口的距离：13.22±0.30mm；上支外径：0.93±0.06mm；下支外径：1.01±0.21mm。 3.在20侧标本中，有19例（95%），其鼻后外侧动脉分为中鼻甲动脉和下鼻甲动脉两个分支，分别供应中鼻甲、下鼻甲，仅有1例标本（5%）的鼻后外侧动脉发出三个分支，即两支下鼻甲动脉，一支为中鼻甲动脉；鼻后外侧动脉在鼻腔外侧壁发出分支的高度也不尽相同，近端分叉和远端分叉分别占95%(19例)和5%（1例）；在12例（60%）标本中观测到上颌窦后囟支，其中起源于中鼻甲动脉的为10例，起源于下鼻甲动脉的为2例。在3例（15%）标本中，可见腭降动脉的分支从后面加入到下鼻甲动脉；下鼻甲动脉起点的相关数据测量：下鼻甲动脉起点到中鼻甲附着部的垂直距离：2.50±1.22mm;下鼻甲动脉起点到下鼻甲附着部的垂直距离:9.50±2.10mm;下鼻甲动脉起点到中鼻甲后端附着部的距离:8.21±2.80mm;下鼻甲动脉起点到下鼻甲后端附着部的水平距离:9.20±1.82mm;下鼻甲动脉起点到上颌窦自然口的距离:20.22±3.01mm。 4.筛前动脉主干穿过三个腔：眼眶、筛窦、颅前窝，该血管在筛窦内呈水平位向前内走行，于嗅窝前部穿入鼻腔。筛动脉窦内段部分紧贴筛顶走行，部分离筛顶有一段距离。筛前孔到鼻前棘的距离为58.13±4.01mm,筛前孔至鼻前棘连线与鼻底的夹角为(65.5±4.5)°。 结论： 1．通过两步法分别结扎蝶腭动脉两主干是一种可供选择的方法。 2．下鼻甲手术前为减少术中出血，可在下鼻甲后端前上1cm左右，靠经下鼻甲附着部电凝下鼻甲动脉。 3．沿眶纸板鼻腔侧和筛顶的夹角区域寻找结扎筛动脉是一种可以尝试的方法。
[Abstract]:Objective:
Through the observation of the location of the sphenopalatine hole and the perforating point of the sphenopalatine artery in the lateral wall of the nasal cavity, the shortcomings of the traditional transsphenoidal ligation of the sphenopalatine artery were discussed. The feasibility of the electrocoagulation of the inferior turbinate artery was explored by observing the distribution of the lateral nasal lateral artery in the lateral wall of the nasal cavity, and the anatomical and clinical data of the sifted artery were analyzed. Research and analysis to explore an alternative way of ligation.
Materials and methods:
1. 50 cases of dry half side skull were.16 with head and neck specimens, 12 of them were anticorrosive specimens, 4 were fresh specimens. Clinical data (imaging, endoscopy).
2. the 50 cases of dry semi cranial bone specimens were used to observe the location of the sphenopalatine foramen and the related data of the sphenopalatine holes. The distance between the anterior sieves and the anterior nasal spines and the angle between the line and the bottom of the nose were measured.
After perfusion of 3.16 anticorrosive and fresh head specimens, 10 of them were cut in the middle of the normal vector, and 5 were cut along the posterior end of the middle turbinate, and 1 fresh specimens were used to make the cast.
4. on 20 sides of the median sagittal section of the head, the structure of the lateral nasal wall was dissected, and the distance from the posterior nasal cavity to the natural mouth of the maxillary sinus, to the posterior nasal hole and to the posterior end of the middle turbinate was measured; the distance from the posterior nasal septum to the posterior nasal turbinate and the distance to the attachment of the middle turbinate was measured. The branches of the posterolateral artery were distributed in the middle nasal canal, measuring the distance between the starting point of the inferior turbinate artery to the attachment of the middle turbinate, the vertical distance of the inferior turbinate attachment, the attachment of the posterior turbinate, the horizontal distance of the posterior inferior turbinate attachment part (level at the inferior turbinate attachment part), the distance from the maxillary sinus natural mouth. The 5 coronoid specimens were fully demonstrated. The anterior wall of the sphenoid sinus is used to measure the vertical distance and the outer diameter of the superior septal artery, the lower branch of the nasal septum to the mouth of the sphenoid sinus, and the removal of the orbital top and the ethmoid top, which fully displays the main artery of the anterior ethmoid artery.
5. to observe the branches of the sphenopalatine artery and the ethmoidal artery in cast specimens.
6. analysis of typical clinical endoscopy and imaging data.
Result锛

本文编号：1984696