侧方入路对颈静脉孔区结构不同显露程度的解剖学研究

发布时间：2019-05-11 18:38

【摘要】：颈静脉孔位于颞骨茎突的内侧偏前方,前部为颞骨岩部后下缘,后部为枕骨颈静脉,围绕乙状窦岩下窦。左右两侧颈静脉孔大小不等,通常较大。其大小、形态在不同的颅骨有不同差异,同一颅骨两侧不同,同一孔道颅内端、颅外端亦不同。颈静脉孔形态不规则,周围与诸多结构毗邻且相互之间关系密切,众多颅神经和静脉管腔穿行,位置深,解剖结构复杂,手术常难以到达,为重要的颅底通道。颈静脉孔难以暴露因其位置深且周围毗邻迷路、耳蜗,IX-XI对脑神,颈内动、静脉,椎动脉等诸多重要结构,发生肿瘤时不仅累及神经、血管,而且向周围侵袭损害周围结构,使得此区域病变手术切除难度巨大。颈静脉孔区肿瘤特性导致肿瘤临床症状多样,肿瘤可向周围各个方向生长,形态多样,侵及周围组织结构使得病变更加复杂。虽然不同学者对该区解剖结构进行了大量细致的研究为临床工作提供了解剖学依据,但因该区结构的复杂性和研究角度的不同性,使得该区显微解剖学资料任然不足。本课题拟通过6具12侧成年国人头颅湿性标本模拟侧方入路及其改良入路完成对颈静脉孔及其周围结构的显露,对同一区域不同显露结构进行对比研究。旨在通过对颈静脉孔区显微解剖依据肿瘤生长的部位、大小、侵及范围以及综合考虑患者听力状况和后组颅神经功能为前提,为术中在面听神经、后组颅神经功能保护,减少并发症的基础上,尽可能彻底切除肿瘤提供解剖学依据。
[Abstract]:The jugular foramen lies in the anterior part of the styloid process of the temporal bone, the anterior part is the posterior inferior margin of the petrous part of the temporal bone, and the posterior part is the occipital jugular vein surrounding the inferior petrosal sinus of the sigmoid sinus. The size of the jugular foramen varies between the left and right sides, usually larger. Its size and shape are different in different skulls, different on both sides of the same skull, on the intracranial end of the same orifice, and on the extracranial end of the skull. Jugular foramen is irregular in shape, adjacent to many structures and closely related to each other. Many intracranial nerves and venous lumen pass through, the position is deep, the anatomical structure is complex, and the operation is often difficult to reach, so it is an important skull base channel. Jugular foramen is difficult to expose because of its deep position and adjacent labyrinth, cochlea, IX-XI to brain god, internal jugular artery, vein, vertebral artery and many other important structures, the occurrence of tumors not only involves nerves and blood vessels. Moreover, invasion and damage to the surrounding structure make it difficult to resect the lesion in this area. The tumor characteristics of jugular foramen region lead to various clinical symptoms of the tumor. The tumor can grow in various directions and the shape is diverse. The invasion of the surrounding tissue structure makes the lesion more complicated. Although different scholars have done a lot of detailed research on the anatomical structure of this area to provide the basis for clinical work, but because of the complexity of the structure and the different research angles, the microanatomical data in this area are still insufficient. The purpose of this study was to complete the exposure of jugular foramen and its surrounding structures by simulated lateral approach and modified approach in 6 wet specimens of 12 adult Chinese heads, and to compare the different exposure structures in the same area. In order to protect the function of facial auditory nerve and posterior cranial nerve during operation, the microanatomy of jugular foramen area was based on the location, size, invasion range of the tumor and comprehensive consideration of the patient's hearing condition and cranial nerve function in the posterior group. On the basis of reducing complications, complete resection of the tumor as far as possible provides anatomical evidence.
【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】：R322.12

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