硬质内镜下后鼓室的应用解剖学研究

发布时间：2018-03-06 13:58

本文选题：后鼓室　切入点：鼓室窦　出处：《第二军医大学》2005年硕士论文　论文类型：学位论文

【摘要】：目的: 通过对成人头颅标本的后鼓室及周围区域分别进行内镜下和显微镜下解剖观察,结合涉及后鼓室区域的各种手术的要求,进行相关的解剖测量,介绍一种新的研究后鼓室区域的方法,为临床开展相应手术提供解剖学资料。方法: 采用成人头颅标本30侧(左16,右14),分别使用30°和70°内镜经外耳道观察后鼓室的结构,比较不同角度内镜下观察后鼓室的视野,在内镜下制作后鼓室隐窝的模型,用游标卡尺对模型进行测量;在显微镜下使用电钻将外耳道前壁和鼓室前壁的骨质磨除,从前方直接观察后鼓室,使用双脚分规测量隐窝开口的宽度,用游标卡尺测量尖齿间的距离作为隐窝的宽度,使用直角测量钩探查隐窝的深浅,并用标有毫米刻度的金属钩来测量隐窝的深度;在显微镜下使用电钻完成开放式乳突切除术,暴露位于鼓室窦外侧和垂直段面神经前方的骨嵴,使用双脚分规分别测量骨嵴的最宽部分以及上端和下端的宽度。结果: 1.内镜下对后鼓室结构的观察无论使用30°或者70°内镜,都可以对后鼓室骨壁的情况进行完整地观察,70°内镜提供了更大的侧方视野,30°内镜在通过外耳道放入中耳腔时更容易把握方向感和深浅度。4.0mm的内镜比2.7mm的内镜提供更大的视野,但是操作的空间非常小,如果去除外耳道后壁,那么4mm内镜会更加方便。通过对后鼓室观察发现,锥隆起是后鼓室骨壁上最明显的标志,在所有的标本中100%出现,可以作为引导内镜的标志。观察鼓室窦发现有4侧(占13.3%)窦底超过垂直段面神经,面神经骨管部分突入鼓室窦侧壁。本组标本中鼓岬小桥的出现率为60%(共18侧),其中有10侧的鼓岬小桥发现完全穿孔,鼓岬下脚的出现率为16.7%(有5侧)。鼓索隆起也可以作为内镜的引导标志,在标本中100%出现。鼓索嵴在本组出现率为53.3%(共15侧)。 2.鼓室窦的测量结果:测量鼓室窦模型——深度1.06—5.80mm,平均2.65±1.23mm,宽度0.78—3.64mm,平均2.45±0.67mm;直接测量——鼓室窦深度1.10—5.92mm,平均2.70±1.25mm,宽度0.84—3.42mm,平均2.52±0.63m。
[Abstract]:Objective:. The posterior tympanum and the surrounding area of adult head specimens were dissected under endoscope and microscope, and the related anatomical measurements were carried out according to the requirements of all kinds of operations involved in the posterior tympanic region. A new method for studying posterior tympanic area is introduced, which provides anatomic data for clinical operation. Methods:. The structure of posterior tympanic chamber was observed by 30 掳and 70 掳endoscopy respectively in 30 sides of adult skull (left 16, right 14). The visual field of posterior tympanic cavity was observed under different angles of endoscope, and the model of posterior tympanic recess was made under endoscope. The model was measured with Vernier caliper; the bone of the anterior wall of the external auditory canal and the anterior wall of the tympanic chamber was ground with an electric drill under the microscope, the posterior tympanic chamber was observed directly from the front, and the width of the opening of the crypt was measured with the two feet gauge. Using Vernier calipers to measure the distance between cusps as the width of the crypt, using the right angle to detect the depth of the crypt, using a metal hook marked with millimeter scales to measure the depth of the crypt, and using an electric drill under a microscope to complete an open mastectomy. Bone crest was exposed to the lateral and vertical segments of the tympanic sinus. The width of the widest part of the ridge and of the upper and lower ends were measured using the foot gauge. Results:. 1. Endoscopic observation of the structure of the posterior tympanic chamber, whether 30 掳or 70 掳endoscopy, All of them can observe the bone wall of the posterior tympanic chamber completely. The endoscopy of 70 掳provides a larger lateral visual field. The 30 掳endoscope is easier to grasp the sense of direction when the external auditory canal is placed into the middle ear cavity, and the endoscope with a depth of 4.0mm provides a larger visual field than the 2.7mm endoscope. However, the space for operation is very small, and the 4 mm endoscope is more convenient if the posterior wall of the external auditory canal is removed. By observing the posterior tympanic cavity, it was found that the cone eminence was the most obvious sign on the wall of the posterior tympanic bone, and 100% of all the specimens could be used as a guide endoscope. Four sides of the tympanic sinus (13. 3%) were found to be superior to the vertical facial nerve in the bottom of the sinus. The occurrences of promontory bridge in this group were 60 (18 sides), 10 of which were perforated completely. The occurrences of the lower foot of the promontory were 16.7% (5 sides). It could also be used as a guide sign of endoscope and 100% of the specimens. The rate of occurrences of chorda tympani in this group was 53.3% (15 sides in all). 2. Measurement results of tympanic sinus: the depth of tympanic sinus was 1.06-5.80 mm (mean 2.65 卤1.23 mm, width 0.78-3.64 mm, mean 2.45 卤0.67 mm), the depth of tympanic sinus was 1.10-5.92 mm (mean 2.70 卤1.25 mm), the width of tympanic sinus was 0.84-3.42 mm (mean 2.52 卤0.63 mm), the depth of tympanic sinus was 1.10-5.92 mm (mean 2.70 卤1.25 mm), and the width was 0.84-3.42 mm (mean 2.52 卤0.63 mm).
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R764;R322

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