内窥镜辅助前、外侧锁孔入路的显微解剖学研究及临床应用

发布时间：2018-08-21 12:50

【摘要】：目的:分别行经胼胝体前纵裂(anterior interhemispheric keyhole approach AIKA)、眶上(supraorbital keyhole approach SKA)、翼点(pterional keyhole approach PKA)内窥镜辅助锁孔入路的显微解剖学研究:(1)明确此三种入路的最佳皮肤切口及骨窗的部位;(2)观察三种入路对鞍区显微解剖结构的显露情况;(3)测量此三种入路到达鞍区各解剖标志的手术距离,整理并分析;(4)通过临床应用探讨此三种锁孔入路的手术适应证;(5)通过内窥镜的使用剖析内窥镜在锁孔手术中的应用价值;(6)与常规“大骨瓣”开颅的纵裂入路、额下入路和翼点入路比较,总结锁孔入路的优缺点及临床中应注意的问题。方法:(1) 在15具福尔马林固定的成人尸头上,分别经AIKA、SKA、PKA全程模拟锁孔手术入路操作。①AIKA:选择距眉间上约4.5cm与额纹一致的横行皮肤切口,长约5cm,于正中眉间上3cm处钻孔,做长3.0cm、宽2.5cm大小骨窗,其前缘距眉间约3cm,剪开的硬膜翻向矢状窦(superior sagittal sinus SSS),沿胼胝体前缘到达鞍区。②SKA:皮肤切口内侧位于眶上缘内、中1/3交界处(眶上切迹),外侧延伸至眉外少许。额骨颧突后钻孔,骨窗平前颅窝底,向内上开一大小约3.0×2.5cm的骨窗,经额叶底面进入鞍区。③PKA:切口内侧在眉毛与瞳孔垂直线交点的稍外侧,向外延长至眉外侧2cm左右。于额骨颧突后钻孔,骨窗要求前面紧贴前颅窝底,上缘为颞上线,外缘达蝶骨嵴外侧,长约3cm、宽约2.5cm。经侧裂池进入鞍区。(2)在显微镜下观察各入路对鞍区解剖结构的显露情况,测量相关数据。(3)使用内窥镜窥视各入路中显微镜不能直视的显微解剖结构,(4)经AIKA切除肿瘤6例,经SKA切除34例,经PKA切除31例。结果:经胼胝体前纵裂间隙可清楚地暴露中线处前交通动脉复合体、视交叉(optic
[Abstract]:Objective: to study the microanatomy of (anterior interhemispheric keyhole approach AIKA), supraorbital (supraorbital keyhole approach SKA), pterional (supraorbital keyhole approach SKA), endoscope assisted keyhole approach through anterior longitudinal fissure of corpus callosum: (1) to determine the best skin incision and the location of bone window of the three approaches; (2) to observe the location of the bony window; Observe the exposure of the three approaches to the microanatomical structure of the Sellar region; (3) measure the operative distance between the three approaches to the Sella region anatomic markers, (4) to discuss the indications of these three keyhole approaches through clinical application; (5) to analyze the application value of endoscope in keyhole operation; (6) to explore the longitudinal fissure approach with conventional "large bone flap" craniotomy. To compare subfrontal approach with pterional approach, the advantages and disadvantages of keyhole approach and clinical problems were summarized. Methods: (1) in 15 adult cadaveric heads fixed with formalin, we simulated the operation of keyhole operation by AIKAK SKAPKA. 1 AIKA: select the transverse skin incision about 4.5cm and frontostripe, which is about 5 cm long, and drill holes in 3cm in the middle of the brow. Long 3.0 cm, wide 2.5cm size bone window, its front edge is about 3 cm from the brow, cut dural inverted sagittal sinus (superior sagittal sinus SSS), along the anterior edge of corpus callosum to the Sellar region .2SKA: the medial incision is located in the superior orbital margin. The middle 1 / 3 junction (supraorbital notch) extends slightly outside the eyebrow. The posterior zygomaticoid process of the frontal bone was drilled, the bone window flattened the base of the anterior cranial fossa, and a 脳 2.5cm bone window was opened up to the bottom of the frontal lobe into the saddle area .3PKA: the medial side of the incision was slightly lateral to the vertical line between the eyebrow and the pupil and extended outwards to the lateral 2cm of the eyebrow. The posterior zygomaticoid process of the frontal bone was drilled, and the bone window was required to close to the base of the anterior cranial fossa. The upper margin was superior temporal line, and the outer margin reached to the lateral side of the sphenoid crest, about 3 cm long and 2.5 cm wide. The lateral fissure cistern entered the Sellar region. (2) the exposure of the anatomical structure of the Sellar region was observed under microscope, and the relevant data were measured. (3) the microanatomical structure of the Sellar region which could not be seen directly by microscope was observed by endoscope. (4) 6 cases of tumors were resected by AIKA. 34 cases were resected by SKA and 31 cases by PKA. Results: the anterior communicating artery complex at the midline could be exposed clearly through the space of the anterior longitudinal fissure of corpus callosum and the optic chiasma (optic).
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R651;R322

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