海绵间窦及相关结构的临床应用解剖

发布时间：2018-01-18 08:16

  本文关键词：海绵间窦及相关结构的临床应用解剖　出处：《第二军医大学》2006年硕士论文　论文类型：学位论文

  更多相关文章： 海绵间窦 海绵窦 海绵窦内颈内动脉 垂体 视神经 经蝶手术 鼻内镜 应用解剖

【摘要】：[目的] 本课题结合临床手术需要，在手术显微镜和鼻内镜下，通过应用解剖学研究海绵间窦及相关结构，为经鼻蝶垂体瘤手术和扩大经蝶手术避免损伤海绵间窦、减少手术并发症及改进手术进路提供解剖学参考依据；通过模拟在鼻内镜下经蝶和扩大经蝶入路，对海绵间窦及其相关结构进行解剖定位标志和解剖学观测。 [方法] 在手术显微镜下对20(男12、女8)具，在鼻内镜下对5(男4、女1)具成年尸头的海绵间窦及其相关结构进行临床应用解剖学研究。对前海绵间窦、下海绵间窦、后海绵间窦、鞍背窦和基底窦的出现率、位置、形态、大小等进行解剖学观察。同时，对海绵间窦相关结构，如：蝶窦，垂体，，海绵窦内颈内动脉，视神经，视交叉，筛动脉的位置、结构、形态等进行观察测量。所得数据经SAS软件包进行统计学处理。 [结果] ①前、下、后海绵间窦，基底窦，鞍背窦的出现率分别为95％，75％，10％，100％和30％。在正中矢状面上，各窦的前后径分别为(2.15±0.90)mm，(5.14±2.54)mm，(1.30±0.40)mm，(2.26±0.91)mm，(2.01±0.80)mm；上下径为(2.74±0.96)mm，(1.24±0.81)mm，(1.48±0.29)mm，(15.67±4.54)mm，(3.35±1.93)mm。②海绵窦内颈内动脉呈“S”形双弯曲的出现率为37.5％(15侧)，呈中间型弯曲的52.5％(21侧)，呈直线型的10％(4侧)。③蝶窦的5种分型，本组标本Ⅰ型(甲介型)未见；Ⅱ型(鞍前型)出现率为25％(10侧)；Ⅲ型(半鞍型)为27.5％(11例)；Ⅳ型(全鞍型)为27.5％(11侧)；Ⅴ型(鞍枕型)为20％(8侧)。④鼻小柱根部至蝶窦口下极及蝶腭孔的距离分别为(60.40±3.21)mm和(62.14±1.93)mm；蝶腭动脉至蝶窦口下极的距离为(12.20±1.10)mm，在蝶腭孔处蝶腭动脉的外径为(1.99±0.13)mm；蝶窦口下极至鼻中隔后上动脉及鼻中隔后下动脉的距离分别为(3.49±0.24)mm和(6.42±1.08)mm。⑤蝶窦后壁沿颈内动脉隆凸两侧缘分别画2条直线，4条垂线将蝶窦腔分为一个中间腔及两个旁中间腔和两个外侧腔。⑥垂体、垂体上动脉、视神经颅内段、视交叉、视神经管内段及筛动脉观察及测量。 [结论]海绵间窦的出现率及发育与蝶窦气化类型有负相关的趋势，下、前海绵间窦为经蝶或扩大经蝶蝶鞍区手术径路必经结构，术中伤及发育良好的海绵
[Abstract]:[Objective] to study the intercavernous sinus and its related structures through applied anatomy under surgical microscope and nasal endoscope in order to meet the needs of clinical operation. To provide anatomic reference for transsphenoidal pituitary adenoma operation and expanded transsphenoidal surgery to avoid injury of intercavernous sinus, reduce operative complications and improve operative approach. The anatomic localization and anatomical observation of the intercavernous sinus and its related structures were carried out by simulating transsphenoidal approach and expanding transsphenoidal approach under nasal endoscope. [Methods] 20 (male 12, female 8) and 5 (male 4) under the operation microscope and nasal endoscope respectively. The incidence, location and morphology of anterior intercavernous sinus, inferior intercavernous sinus, posterior intercavernous sinus, dorsal Sellar sinus and basal sinus were studied. At the same time, the position and structure of the sphenoid sinus, pituitary, internal carotid artery, optic nerve, optic chiasma and ethmoidal artery were observed. The data were analyzed by SAS software package. [Results (1) the occurrence rates of anterior, inferior, posterior intercavernous sinus, basal sinus and dorsal Sellar sinus were 95% and 30%, respectively. The anteroposterior and posterior diameters of each sinus were 2.15 卤0.90 mm and 5.14 卤2.54 mm respectively. The diameter of each sinus was 1.30 卤0.40 mm and 2.26 卤0.91mm. 2.01 卤0.80 mm; The upper and lower diameters were 2.74 卤0.96 mm / L 1.24 卤0.81 mil / 1.48 卤0.29 m / m / l 15.67 卤4.54 mm / mm. The incidence of "S" shape double curvature of the internal carotid artery in the cavernous sinus was 3.35 卤1.93 卤1.93 mm / .2. The occurrence rate of "S" double curvature in the cavernous sinus was 37.5%, and that in 15 sides of the cavernous sinus was 52.5% (21 sides). There were 5 types of 10 and 4 sides of sphenoid sinus with linear type, but no type I (type A) was found in this group. The occurrence rate of type 鈪

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