经翼点入路颈内动脉上间隙的显微解剖和临床应用研究

发布时间：2018-03-27 10:41

  本文选题：翼点入路　切入点：颈内动脉上间隙　出处：《第一军医大学》2007年博士论文

【摘要】： 目的:通过解剖及观察翼点入路中颈内动脉上间隙穿通动脉的形态、构成与走行,同时观察颈内动脉上间隙中的穿通动脉在前穿质中的分布,为临床中对该间隙的手术使用提供依据。 方法:首先对12具(24侧)已灌注的尸头进行标准的翼点入路开颅,暴露外侧裂后上显微镜,在镜下分离外侧裂,测量颈内动脉上间隙中穿通动脉的直径,观察穿通动脉之间的关系和走行,游离后翻转进一步观察穿通动脉之间的关系和在前穿质的分布情况。并对所取得的结果进行归纳和统计。 结果:所有的穿通动脉均发自主干动脉的背侧。8侧颈内动脉分叉部存在穿通动脉。11侧大脑中动脉存在内侧豆纹动脉,行程短,进入前穿质时与其他穿通动脉存在重叠,4侧内侧豆纹动脉与A1段穿通动脉间存在吻合现象。24侧大脑中动脉均有中间豆纹动脉以及外侧豆纹动脉。豆纹动脉绝大部分从大脑中动脉M1段的分叉前段发出,但是大脑中动脉M1段的分叉越早,分叉后发出的穿通动脉越多。22侧半球存在大脑前动脉A1段的穿通动脉,进入前穿质时分支较多。中间豆纹动脉、外侧豆纹动脉、颈内动脉分叉部穿通动脉、A1段穿通动脉均未见与其他穿通动脉间在前穿质中存在重叠。当一支主干动脉上存在的穿通动脉较少时,穿通动脉直径则较大。 结论:颈内动脉上间隙可作为一个手术间隙,部分病例可以通过主动离断部分内侧豆纹动脉在该间隙取得一个较大的空间。 第二章翼点入路颈内动脉上间隙穿通动脉显微解剖研究 目的:结合在尸头上颈内动脉上间隙穿通动脉的解剖特点,探讨在翼点入路中切除鞍区肿瘤的手术过程中,颈内动脉上间隙在暴露及剥离肿瘤过程中的临床应用价值。 方法:对磁共振显示为大型鞍区肿瘤的31例患者在术中采取颈内动脉上间隙结合第Ⅰ-Ⅳ间隙的方法分离并切除肿瘤,并观察患者术后的症状变化及复查影像学结果。 结果:11例存在颈内动脉分叉部的穿通动脉(35.5%)。15例存在内侧豆纹动脉(占48.4%)。25例存在大脑前动脉A1段的穿通动脉(占80.6%)。由于肿瘤的膨胀性生长,常见鞍区的第Ⅰ、Ⅱ、Ⅲ间隙增大(与尸头及小肿瘤时比较),23例可见视神经受压变薄,与术前患者视力下降症状相符。颈内动脉上间隙均见不同程度增大。7例由于A1及分叉部穿通动脉、M1内侧豆纹动脉缺如形成自然手术间隙进行直接操作。24例颈内动脉上间隙内可见数量不等的穿通动脉,17例需离断1-2支穿通动脉,最多不超过2支,且均为最靠近颈内动脉分又部的分支,直径≤0.3mm。全切除25例,次全切除6例。2例内囊前肢前下部有小片状脑梗塞。所有患者术后均恢复清醒,无肢体活动障碍。30例术前视力下降者中,视力改善者23例,无明显改善者6例,较术前差者1例。一过性尿崩症16例,需长期药物替代治疗者4例。无手术死亡。颈内动脉上间隙可分成以下五型:Ⅰ型:自然间隙大,无穿通支。可进行手术操作。Ⅱ型:自然间隙大,穿通少。可以经过此间隙进行操作。Ⅲ型:自然间隙大,穿通支丰富。可通过主动离断1、2支A1穿通支或内侧豆纹动脉以耿得一定的操作空间。Ⅳ型:自然间隙小,无穿通支。可以通过松解蛛网膜束带对A1、M1的束缚,以取得较大的解剖间隙进行手术操作。V型:自然间隙小,穿通支丰富。此时不宜应用此间隙进行手术操作。 结论:经翼点入路切除大型鞍区肿瘤时,可以采取颈内动脉上间隙作为手术操作径路,增加肿瘤的全切率和减少并发症。
[Abstract]:Objective : To study the distribution of through artery in the internal carotid artery of the internal carotid artery by anatomy and observation of the internal carotid artery , and to observe the distribution of the perforator artery in the internal carotid artery to provide the basis for the surgical use of the gap .


Methods : First , 12 ( 24 sides ) perfused body head was subjected to the standard wing - point approach , and after exposure to the external fissure , the external fissure was separated , the diameter of the puncture artery in the internal carotid artery was measured , the relationship between the penetrating arteries and the distribution of the anteroseptal artery were observed , and the obtained results were summarized and counted .


Results : All the arteries in the middle part of the cerebral artery originate from the dorsal side of the trunk artery . There is an internal carotid artery at the bifurcation of the internal carotid artery . There is an anastomosis between the arteries in the middle part of the cerebral artery .


Conclusion : The clearance of internal carotid artery can be used as a surgical gap .


Study on the Microanatomy of the Gap - through Artery in the Internal Carotid Artery in the second chapter


Objective : To study the clinical application value of the clearance of internal carotid artery during the operation of resection of sellar tumors during the operation of resection of sellar tumors on the internal carotid artery of the corpse .


Methods : Thirty - one patients with large sellar tumors were treated by the method of internal carotid artery clearance and I - 鈪，

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