内窥镜辅助乙状窦前—迷路后手术入路的解剖学研究

发布时间：2018-06-25 12:01

本文选题：内窥镜 + 乙状窦前-迷路后入路　；参考：《福建医科大学》2006年硕士论文

【摘要】：目的：经乙状窦前-迷路后入路在内窥镜辅助下对桥小脑角区、岩斜区进行解剖学研究，并与乙状窦后入路比较，探讨乙状窦前入路中影响内窥镜的解剖学因素、两种入路各自优缺点，为临床应用提供参考。方法：在15具30侧成年国人尸头(福尔马林固定，动脉已灌注红色乳胶染料)上模拟乙状窦前-迷路后手术入路操作，逐层解剖，明确相关解剖结构毗邻关系、测量相关数据。内窥镜下观察桥小脑角、岩斜区颅内结构，探讨影响内窥镜操作因素。完成内窥镜观察后，开颅，去除脑组织。观察、测量手术入路相关数据以及岩静脉、Meckel囊等解剖结构。在一例新鲜头颅标本上模拟两种手术入路操作，结合解剖学数据比较其各自的优缺点。结果：宽大、前移的乙状窦以及颅内复杂的血管神经关系可能影响内窥镜的操作。内窥镜利用解剖间隙可到达桥小脑角区、岩斜区，无需过度的牵拉小脑、脑干，可以清晰观察到普通显微镜无法观察到的隐蔽结构、死角。在乙状窦前入路，，内窥镜甚至可以观察到脑干腹侧结构。到达靶区的距离比窦后入路短。结论：乙状窦前入路具有据岩斜区距离短、方便脑干腹侧的操作、对脑组织牵拉轻微等优点。熟悉该区域的解剖学特点及影响内窥镜应用的因素，有助于该入路的临床应用。乙状窦后入路操作简单，距颅内深部结构远，需要一定的小脑的牵拉，而且不易处理脑干腹侧的病变。内窥镜的辅助应用有助于减少脑组织的牵拉、观察到显微镜下不易发现的细节与隐蔽结构；避免重要结构的损伤与减少肿瘤的残余。
[Abstract]:Objective: to study the anatomy of cerebellopontine angle area and petroclival region by transsigmoid antral approach and retrosigmoid approach under endoscope, and compare with retrosigmoid sinus approach. To explore the anatomical factors affecting endoscope in the anterior sigmoid approach, the advantages and disadvantages of the two approaches were discussed, which provided reference for clinical application. Methods: the heads of 30 adult Chinese cadavers were fixed with formalin. The antesigmoid sinus and labyrinthine approach were simulated on the artery. The anatomic structures were dissected layer by layer, and the adjacent relationship of the related anatomical structures was determined, and the relevant data were measured. The cranial structures of cerebellopontine angle and petroclival region were observed under endoscope to investigate the factors affecting the operation of endoscopy. After endoscope observation, craniotomy, brain tissue removal. The data related to the surgical approach and the anatomic structure of Meckel's sac of the petrosal vein were observed and measured. Two surgical approaches were simulated on a fresh head specimen and their advantages and disadvantages were compared with anatomical data. Results: the large, anterior sigmoid sinus and complex intracranial vascular-nerve relationship may affect the operation of endoscope. By using anatomic space, endoscope can reach the cerebellopontine angle area, petroclival area, without excessive pulling cerebellum and brain stem, and can clearly observe the concealed structure and dead angle which can not be observed by ordinary microscope. The ventral structure of the brain stem could even be observed by endoscope through the anterior sigmoid approach. The distance to the target area was shorter than that of the posterior sinus approach. Conclusion: the anterior sigmoid sinus approach has the advantages of short distance of diagonal region, convenient operation of ventral brainstem and slight traction of brain tissue. Familiarity with the anatomical features of the region and the factors affecting the application of endoscope are helpful to the clinical application of the approach. The retrosigmoid approach is simple, far from the deep structure of the brain, and requires a certain traction of the cerebellum, and it is not easy to deal with the ventral lesions of the brain stem. The auxiliary application of endoscope can help to reduce the pulling of brain tissue, observe the details and hidden structures that are difficult to find under microscope, avoid the damage of important structures and reduce the residual of tumor.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R322

【引证文献】