经单鼻孔—蝶窦入路垂体瘤显微切除术的临床应用解剖

发布时间：2018-04-17 22:06

本文选题：显微解剖 + 单鼻孔-蝶窦入路　；参考：《浙江大学》2006年硕士论文

【摘要】：目的:以经单鼻孔—蝶窦入路垂体腺瘤显微切除术为目标,研究该术式的临床应用。材料及方法:取经10%甲醛溶液固定的成人尸头标本10个,去颅顶及大脑,保留视交叉、视束及、垂体柄、垂体、鞍隔、双侧海绵窦及颅底结构。显微镜下测量:1.解剖观察双侧海绵窦鞍膈、鞍膈孔、垂体柄、垂体、海绵间窦,并在经前床突冠状切面,经垂体窝中点的冠状切面,经后床突冠状切面三处,分别测量双侧颈内动脉、颅神经距中线的距离,以及双侧海绵窦内侧壁在鞍底处距中线的距离。视神经颅内段平均长度,视交叉构成的夹角。滑车神经进入海绵窦处与硬膜边缘的距离,滑车神经走行与天幕裂孔缘的夹角。2.沸煮标本2~4小时(加入5%NaOH,脱脂)后,去除鼻腔及鞍区软组织,在尸头颅骨上模拟经单鼻孔直接蝶窦入路手术,先后于蝶窦前壁、鞍底按设计要求开骨窗,显微镜下测量并进行拍照。数据处理采用SPSS11.0软件包。结果:1.鼻孔径:平均16.2±2.4mm 13.9~21.3mm:2.犁状骨游离面下缘(后鼻腔与咽部交界处)距蝶窦开口的距离:平均21±1.4mm 17.6～25.3mm 3.蝶窦前壁最佳骨窗上缘距蝶窦开口:平均2.1±0.35mm 1.6～2.8mm;蝶窦开口至前颅底蝶平面的距离为:平均7.2±0.82mm 5.3～8.0mm:4.双侧颈内动脉距中线的距离经前床突冠状切面内颈内动脉距中线的距离:5.8～7.4mm 6.5±1.4mm;经垂体窝中点的冠状切面双侧颈内动脉距中线的距离:7.7～9.0mm 8.4±1.34mm;经后床突冠状切面双侧颈
[Abstract]:Objective: to study the clinical application of microresection of pituitary adenoma via single nostril-sphenoid sinus approach.Materials and methods: ten adult cadaveric head specimens fixed with 10% formaldehyde solution were removed from the skull and brain, and the optic chiasma, optic bundle and pituitary stalk, pituitary gland, saddle septum, bilateral cavernous sinus and skull base structure were preserved.Measure 1: 1 under the microscope.The bilateral internal carotid arteries were measured on the bilateral Sellar diaphragm, Sella diaphragm foramen, pituitary stalk, pituitary gland, intercavernous sinus. The bilateral internal carotid arteries were measured on the coronal section through the anterior clinoid process, the coronal section at the midpoint of the pituitary fossa, and the coronal section through the posterior clinoid process.The distance from the cranial nerve to the midline and the distance from the bilateral lateral wall of the cavernous sinus to the midline at the base of the saddle.The average length of intracranial segment of optic nerve and the angle of optic chiasma.The distance between the trochlear nerve entering the cavernous sinus and the edge of the dura dura and the angle between the trochlear nerve and the margin of the tentorial fissure.After boiling the specimen for 2 hours (adding 5 NaOH, degreasing), the nasal cavity and the soft tissue of the Sellar region were removed, and the direct sphenoid sinus approach was simulated on the cadaveric skull bone. The bone window was opened at the anterior wall of the sphenoid sinus and at the base of the Sellar according to the design requirements.Measure and photograph under microscope.SPSS11.0 software package is used for data processing.The result is 1: 1.Nostril diameter: 16.2 卤2.4mm 13.9mm: 21.3 mm: 2.The distance between the lower margin of the plow free surface (the junction between the posterior nasal cavity and the pharynx) and the sphenoid sinus orifice was 21 卤1.4mm 17.6~25.3mm 3 on average.The distance from the superior edge of the anterior wall of sphenoid sinus to the sphenoid sinus orifice was 2.1 卤0.35mm 1.6 卤2.8 mm on average, and the distance from the sphenoid sinus orifice to the sphenoid plane of the anterior skull base was 7.2 卤0.82mm 5.3 卤8.0 mm: 4 on average.The distance from bilateral internal carotid artery to the midline is from the anterior clinoid process coronal section to the midline: 5.8mm 7.4mm 6.5 卤1.4mm; through the midpoint of pituitary fossa, the distance between bilateral internal carotid artery and the midline is: 7.7mm 9.0mm 8.4 卤1.34mm; and the distance between bilateral internal carotid artery and the midline of posterior clinoid process coronal section is: 7.7mm 9.0mm 卤1.34mm; the distance between bilateral internal carotid artery and midline is 7.7mm 9.0mm 卤1.34mm.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R736.4;R322

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