内镜经鼻腔入路治疗颅底中线区病变的应用解剖研究

发布时间：2018-06-27 07:33

  本文选题：内镜 + 经鼻腔　； 参考：《南京医科大学》2011年硕士论文

【摘要】：目的研究内镜经鼻腔入路治疗颅底中线区病变的解剖特点,指导手术实践。 方法在10例成人尸头标本上模拟内镜下经鼻腔至颅底中线区域的手术入路。研究该入路下的手术可及范围、路径、各区域的解剖特点。确定术中具有指导意义的解剖标志。 结果采用经双鼻孔-鼻中隔粘膜间入路,可明显提高术中操作的便利性,并能扩大视角。内镜经鼻腔入路可充分显露鞍区解剖结构。前、后组筛窦和双侧上、中鼻甲应根据需要选择性去除。以两侧OCR(opto-carotid recess,颈内动脉-视神经隐窝)的连线定位,在鞍结节、蝶骨平台处磨开骨质,向前可以暴露两侧达眶内侧壁、前达额窦的整个前颅底中线区域,向鞍上可以显露鞍上池、视交叉池、终板池及其内的重要组织结构,并可经终板进入第三脑室。以OCR和颈内动脉隆突定位,可以显露海绵窦下壁和内侧壁,由此进入海绵窦内,可显露其内的血管、神经。去除整个斜坡骨质,可显露中脑、桥脑、延髓及其局部的重要血管、神经。通过尸头模拟手术,总结了以上各个区域手术的路径和重要的解剖标志。测定蝶窦开口长轴的大小为4.4～6.8(5.5±0.9)mm,双侧蝶窦开口内缘间最短处的距离为4.2～6.2(5.2±0.7)mm,鼻小柱至蝶窦开口、鞍底、鞍结节、OCR内缘、斜坡凹陷、筛后动脉、筛前动脉的距离分别为52.6～78.3(63.4±7.6)mm、63.8～90.1(75.7±8.2)mm、71.4～92.5(80.5±6.4)mm、73.5～93.6(82.6±6.3)mm、76.4～96.8(84.8±6.8)mm、64.5～87.5(74.4±7.1)mm、60.3～77.5(67.8±5.6)mm,两侧OCR内缘间的距离为15.0～26.0(22.7±3.7)mm,两侧颈内动脉隆突间的距离为9.8～16.5(13.9±2.1)mm,两侧眶内侧壁间最宽处的距离为25.4～51.5(36.4±8.2)mm。 结论内镜经鼻腔入路可用于治疗整个颅底中线区的病变。该入路视角较显微镜下明显扩大,手术可及范围得到极大扩展,且具有可以直接到达病变区域、避免对脑组织、血管的牵拉等优点。术中通过各个解剖标志的相互对照和组织结构间的毗邻关系可以准确定位,避免术中迷失方向。
[Abstract]:Objective to study the anatomical characteristics of endoscopic transnasal approach in the treatment of skull base midline lesions and to guide the operation practice. Methods 10 adult cadaveric specimens were operated through nasal cavity to the midline of skull base under simulated endoscope. To study the range, path and anatomical characteristics of the operation under this approach. To determine the anatomical markers of guiding significance during the operation. Results the transnasal-nasal septum intermucosal approach can significantly improve the operation convenience and expand the visual angle. Endoscopic transnasal approach can fully reveal the anatomical structure of the Sellar region. Anterior and posterior ethmoid sinus and bilateral superior middle turbinate should be selectively removed as needed. Using bilateral opto-carotid recess (internal carotid artery-optic nerve recess), the bone was sharpened at the Sellar tubercle and the sphenoid plateau, and the bilateral medial orbital wall, the entire anterior midline region of the anterior skull base reached to the frontal sinus, and the suprasellar cistern could be exposed to the anterior skull base. The optic chiasma, the endplate cistern and its internal important tissue structure, and can enter the third ventricle through the endplate. The inferior wall and medial wall of cavernous sinus can be exposed by the localization of OCR and internal carotid artery protuberance, and the vessels and nerves of the cavernous sinus can be exposed. Removing the entire Clivus bone reveals the midbrain, pontine, medulla oblongata and its local important vessels and nerves. Through the simulated operation of cadaveric head, the surgical paths and important anatomical markers in each of the above regions were summarized. The length of long axis of sphenoid sinus orifice was 4. 4 卤6. 8 mm (5.5 卤0. 9) mm, and the shortest distance between bilateral sphenoid sinus orifice was 4. 2 卤6. 2 (5.2 卤0. 7) mm. The length of nasal column to sphenoid sinus orifice, Sellar floor, Sellar nodule OCR inner edge, clival depression, posterior ethmoidal artery were measured. 绛涘墠鍔ㄨ剦鐨勮窛绂诲垎鍒�涓�52.6锝，

本文编号：2073168