扩大中颅底入路颈内动脉岩骨段血管搭桥术的显微解剖及动物实验研究
发布时间：2019-01-04 07:23
【摘要】：第一部分：扩大中颅底入路颈内动脉岩骨段的显微解剖 目的研究经扩大中颅底手术入路颈内动脉岩骨段及其周围毗邻结构的解剖学特点,为临床手术提供解剖学基础。 方法在6具动脉灌注乳胶的成人尸头上模拟扩大中颅底手术入路,在显微镜下观察颈内动脉岩骨段及其分段、分支,岩浅大神经,膝状神经节,耳蜗,内听道的解剖关系并进行测量。 结果颈内动脉岩骨段共分为水平段、膝部、垂直段三段,经扩大中颅底入路可暴露三段平均距离分别为9.1±1.1mm、3.8±0.3mm、10.2±1.5mm,血管直径分别为5.5±0.4mm、5.4±1.Omm、5.2±0.7mm.本实验未发现其具有分支。向前牵拉V3可增加岩骨段ICA的暴露长度4.0±0.5mm(P0.05)。棘孔,弓状隆起,岩浅大神经,膝状神经节是扩大中颅底手术入路的重要解剖标志。颈内动脉岩骨段,耳蜗,内听道等是扩大中颅底入路手术入路中的重要解剖结构。 结论颈内动脉岩骨段具有分支少,管径粗的优点,是进行颅内外血管搭桥的适宜部位。向前牵拉V3可显著增加岩骨段ICA的暴露长度(P0.05),为此处行血管搭桥手术提供了更长的操作距离。扩大中颅底入路行岩骨段ICA搭桥是一种处理该部位病变的良好辅助术式。 第二部分：颅内外颈内动脉系统高流量搭桥动物模型的建立 目的通过模拟扩大中颅底入路,建立大型动物颈外动脉-颅内颈内动脉系统高流量搭桥和围手术期观察模型,为颅内外高流量血管搭桥手术应用于临床,摸索出一整套完成该项手术所需的临床实践培训模式,为相关神经外科,血管外科,颅底外科医师提供一个模拟训练的平台。 方法比格犬2只,体重在9Kg-10Kg之间。术前肌注盐酸氯胺酮10mg/Kg,实施基础麻醉。建立静脉通道,以盐酸氯胺酮2mg/Kg进行麻醉诱导,气管插管后,衔接麻醉机辅助呼吸。氯胺酮维持麻醉。选择颈外动脉的直接终末支颌内动脉未进骨的一段作为搭桥起点,大脑中动脉在侧裂中的分支作为止点,取犬的股动脉为桥血管进行颅内外搭桥手术。术后立即行全脑动脉数字剪影血管造影(DSA)观察血管搭桥畅通情况 结果2只比格犬(2侧)均在显微镜下行颌内动脉-大脑中动脉M2段高流量血管搭桥手术,制成模型,手术顺利,无麻醉意外发生,移植血管通畅,手术时间为7-9小时。术后DSA显示大脑中动脉M2段经移植血管供血,两端吻合口及移植血管通畅。 结论犬颅内外颈内动脉系统高流量血管搭桥模型,具有材料相似,流量高,血压相似,手术平稳,通畅率高的优点,更加接近颅内外颈内动脉高流量搭桥的真实手术过程,可以为希望掌握高流量血管搭桥技术的外科医师提供一个更接近于真实手术过程的模拟训练平台。
[Abstract]:Part I: microanatomy of the petrosal segment of the internal carotid artery via the extended middle skull base approach objective to study the anatomical characteristics of the petrosal bone segment of the internal carotid artery and its adjacent structures through the extended middle skull base approach, and to provide anatomic basis for clinical operation. Methods six adult cadaveric cadavers with arterial infusion of latex were used to simulate the enlarged middle skull base approach. The petrosal bone segment and its segments, branches, superficial petrosal nerve, geniculate ganglion and cochlea of the internal carotid artery were observed under microscope. The anatomical relationship of the internal auditory canal was measured. Results the petrous bone segment of the internal carotid artery was divided into three segments: horizontal segment, knee segment and vertical segment. The mean distance of the three segments exposed through the extended middle skull base approach was 9.1 卤1.1 mm, 3.8 卤0.3 mm and 10.2 卤1.5 mm, and the diameter of the vessels was 5.5 卤0.4 mm, respectively. 5.4 卤1.Omm.5.2 卤0.7mm. No branch was found in this experiment. Drawing V3 forward increased the exposure length of ICA in petrosal bone segment by 4.0 卤0.5mm (P0.05). Foramen spinosus, arcuate eminence, superficial greater petrosal nerve and geniculate ganglion are important anatomic markers for expanding the approach of middle skull base operation. The petrosal segment, cochlea and internal auditory canal of the internal carotid artery are important anatomical structures in the extended middle skull base approach. Conclusion the petrous bone segment of the internal carotid artery has the advantages of less branches and thicker diameter, which is the suitable site for external intracranial artery bypass grafting. Pulling V3 forward can significantly increase the exposure length of ICA in petrosal bone segment (P0.05), which provides a longer operating distance for vascular bypass surgery. Extending the middle skull base approach to the petrosal bone segment ICA bypass is a good auxiliary procedure for the treatment of this site. Part two: establishment of animal model of high flow bypass graft of internal and external carotid artery system objective to establish a large animal model of large external carotid artery internal carotid artery system high flow bypass graft and perioperative period by simulating the expansion of the middle skull base approach. In order to apply high flow blood vessel bypass surgery to clinical practice, a set of clinical training models needed to complete the operation were found out, and a simulated training platform for neurosurgery, vascular surgery and skull base surgeons was provided. Methods two Beagle dogs were weight between 9Kg-10Kg. Ketamine hydrochloride 10 mg / kg was injected intramuscularly before operation to perform basic anesthesia. To establish an intravenous channel and induce anesthesia with ketamine hydrochloride 2mg/Kg. After tracheal intubation, the anesthesia machine was connected to assist breathing. Ketamine maintains anesthesia. The internal maxillary artery of the external carotid artery was chosen as the starting point, the branch of the middle cerebral artery in the lateral fissure as the stop point, and the femoral artery of the dog as the graft vessel. The smooth flow of artery bypass grafts was observed by digital silhouette angiography of global cerebral artery (DSA) immediately after operation. Results two Beagle dogs (2 sides) underwent high flow artery bypass grafting of internal maxillary artery to middle cerebral artery (M2 segment) under microscope. The model was made, the operation was smooth, no anaesthesia accident occurred, the vascular graft was patency, the operation time was 7-9 hours. DSA showed that the M 2 segment of the middle cerebral artery was supplied by the grafts and the anastomotic stoma and graft vessels were patency. Conclusion the canine model of high flow artery bypass with internal and external carotid artery system has the advantages of similar material, high flow rate, similar blood pressure, stable operation and high patency rate, which is closer to the true operation process of high flow bypass graft of internal and external carotid artery. It can provide a simulation training platform for surgeons who want to master high flow vascular bypass technique.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R651.1;R322.8
[Abstract]:Part I: microanatomy of the petrosal segment of the internal carotid artery via the extended middle skull base approach objective to study the anatomical characteristics of the petrosal bone segment of the internal carotid artery and its adjacent structures through the extended middle skull base approach, and to provide anatomic basis for clinical operation. Methods six adult cadaveric cadavers with arterial infusion of latex were used to simulate the enlarged middle skull base approach. The petrosal bone segment and its segments, branches, superficial petrosal nerve, geniculate ganglion and cochlea of the internal carotid artery were observed under microscope. The anatomical relationship of the internal auditory canal was measured. Results the petrous bone segment of the internal carotid artery was divided into three segments: horizontal segment, knee segment and vertical segment. The mean distance of the three segments exposed through the extended middle skull base approach was 9.1 卤1.1 mm, 3.8 卤0.3 mm and 10.2 卤1.5 mm, and the diameter of the vessels was 5.5 卤0.4 mm, respectively. 5.4 卤1.Omm.5.2 卤0.7mm. No branch was found in this experiment. Drawing V3 forward increased the exposure length of ICA in petrosal bone segment by 4.0 卤0.5mm (P0.05). Foramen spinosus, arcuate eminence, superficial greater petrosal nerve and geniculate ganglion are important anatomic markers for expanding the approach of middle skull base operation. The petrosal segment, cochlea and internal auditory canal of the internal carotid artery are important anatomical structures in the extended middle skull base approach. Conclusion the petrous bone segment of the internal carotid artery has the advantages of less branches and thicker diameter, which is the suitable site for external intracranial artery bypass grafting. Pulling V3 forward can significantly increase the exposure length of ICA in petrosal bone segment (P0.05), which provides a longer operating distance for vascular bypass surgery. Extending the middle skull base approach to the petrosal bone segment ICA bypass is a good auxiliary procedure for the treatment of this site. Part two: establishment of animal model of high flow bypass graft of internal and external carotid artery system objective to establish a large animal model of large external carotid artery internal carotid artery system high flow bypass graft and perioperative period by simulating the expansion of the middle skull base approach. In order to apply high flow blood vessel bypass surgery to clinical practice, a set of clinical training models needed to complete the operation were found out, and a simulated training platform for neurosurgery, vascular surgery and skull base surgeons was provided. Methods two Beagle dogs were weight between 9Kg-10Kg. Ketamine hydrochloride 10 mg / kg was injected intramuscularly before operation to perform basic anesthesia. To establish an intravenous channel and induce anesthesia with ketamine hydrochloride 2mg/Kg. After tracheal intubation, the anesthesia machine was connected to assist breathing. Ketamine maintains anesthesia. The internal maxillary artery of the external carotid artery was chosen as the starting point, the branch of the middle cerebral artery in the lateral fissure as the stop point, and the femoral artery of the dog as the graft vessel. The smooth flow of artery bypass grafts was observed by digital silhouette angiography of global cerebral artery (DSA) immediately after operation. Results two Beagle dogs (2 sides) underwent high flow artery bypass grafting of internal maxillary artery to middle cerebral artery (M2 segment) under microscope. The model was made, the operation was smooth, no anaesthesia accident occurred, the vascular graft was patency, the operation time was 7-9 hours. DSA showed that the M 2 segment of the middle cerebral artery was supplied by the grafts and the anastomotic stoma and graft vessels were patency. Conclusion the canine model of high flow artery bypass with internal and external carotid artery system has the advantages of similar material, high flow rate, similar blood pressure, stable operation and high patency rate, which is closer to the true operation process of high flow bypass graft of internal and external carotid artery. It can provide a simulation training platform for surgeons who want to master high flow vascular bypass technique.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R651.1;R322.8
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