迷路下入路内听道及岩尖区手术的显微解剖学研究

发布时间：2018-01-15 09:03

本文关键词：迷路下入路内听道及岩尖区手术的显微解剖学研究　出处：《昆明医学院》2009年硕士论文　论文类型：学位论文

【摘要】： 【目的】本研究通过在尸头上模拟耳后经迷路下径路暴露内听道、岩尖区各结构,提供解剖学依据,并结合影像学检查结果,通过二者的对比定量研究此区各重要结构的形态特征,总结此区重要血管神经的走行规律及变异,并探讨该术式及改良术式的优越性和安全性,为临床手术提供参考依据。【方法】对20例成人头颅标本行高分辨率CT双侧颞骨薄层扫描并测量相关数据,观察乳突气房的气化程度、范围以及颈静脉球窝、乙状窦的情况等。全部数据均摄片留存。然后在显微镜下模拟迷路下径路及改良径路暴露内听道、岩尖区、颈静脉球及颈静脉孔区,完成该区内各重要解剖结构的测量和拍摄。【结果】1.影像测量与实际解剖测量结果差异无统计学意义(P0.05)。 2.①迷路下入路骨质磨除范围的形态和面积个体差异较大,6侧由于颈静脉球顶紧贴甚至高于后半规管下弓峰,不能完成迷路下入路手术。②迷路下手术入路与水平半规管呈28.42°±2.64°(25.78°～31.06°),经迷路下径路开放内听道的可能性为85%(34/40)。③能经迷路下入路暴露内听道的标本乳突气化都较良好,且大多存在迷路下气房。④迷路下入路骨质磨除范围以面神经垂直段至乙状窦中段距离为横径,距离平均为6.84 mm;以后半规管至颈静脉球顶距离为纵径,距离平均为4.56mm,它是迷路下手术入路的决定性参数。⑤改良后的迷路下径路使开放内听道的可能性变为90%(36/40),而且术野更加宽敞。【结论】1.CT扫描测量与实际解剖测量结果差异无统计学意义(P0.05),所以术前颞骨CT薄层扫描可以指导术中安全有效地磨除岩骨。 2.经迷路下入路手术及改良术式切除内听道、岩尖病变能够保护半规管、迷路不受损伤,保存听力和前庭功能,是一个具有临床应用意义的手术途径。采用切除后半规管弓的改良术式,使术野上方的操作空间相对扩大,从而尽量避开对颈静脉球的损伤,使迷路下进路的适应证进一步扩大。 3.经迷路下入路手术易受乙状窦前置、高位颈静脉球、迷路下气化不良等的影响,常会导致手术视野狭小、操作困难。因此,我们应全面掌握各结构间的各种关系,结合手术前详尽的影像学检查,以制定合理的手术入路。
[Abstract]:[objective] to provide anatomical basis by simulating the structure of internal auditory canal and petrous apical region through the sublabyrinthine approach on the cadaveric head, and combined with the results of imaging examination. The morphological characteristics of each important structure in this area were studied quantitatively by comparing the two methods, and the rule and variation of the important vessels and nerves in this area were summarized, and the superiority and safety of the operation and the modified operation were discussed. To provide reference for clinical operation. [methods] Twenty adult head specimens were scanned with high resolution CT on bilateral temporal bone and relevant data were measured to observe the degree of vaporization of mastoid gas chamber and its scope and jugular fossa. The sigmoid sinus and so on. All the data were taken. Then the inferior labyrinthine pathway and the modified pathway were simulated under the microscope to expose the internal auditory canal, petrous apical region, jugular bulb and jugular foramen area. The important anatomical structures in the area were measured and photographed. [results] 1. There was no significant difference between image measurement and actual anatomical measurement (P 0.05). 2.1 individual differences in the shape and area of bone removal area in the sublabyrinthine approach were significant in 6 sides because the top of the bulb of jugular vein was close to or even higher than the peak of the arch under posterior semicircular canal. 2 Sublabyrinthine approach and horizontal semicircular canal were 28.42 掳卤2.64 掳(25.78 掳卤31.06 掳). The possibility of opening the internal auditory canal via the sublabyrinthine pathway is that 85 / 34 / 40.3 of the specimens exposed to the internal auditory canal via the sublabyrinthine approach have better mastoid gasification. In most cases, the distance from vertical segment of facial nerve to middle part of sigmoid sinus was transverse diameter, and the average distance was 6.84 mm. The distance from the posterior semicircular canal to the apex of jugular vein was longitudinal diameter, and the average distance was 4.56 mm. It is the decisive parameter of the sublabyrinthine approach. 5 the modified sublabyrinthine approach makes the possibility of opening the internal auditory canal 90 / 36 / 40, and the surgical field is more spacious. [conclusion] 1. There is no significant difference between CT scanning and actual anatomical measurement. Therefore, thin slice CT scanning of temporal bone before operation can be used to guide the removal of petrosal bone safely and effectively. 2. 2.Translabyrinthine approach and modified resection of the internal auditory canal showed that the lesion of the petrous apex could protect the semicircular canal, prevent the labyrinth from being damaged, and preserve the hearing and vestibular function. It is a clinical application of the surgical approach. The posterior semicircular canal arch resection of the modified operation, so that the operation space above the field is relatively expanded, so as to avoid the injury to the jugular bulb as far as possible. The indications of the sublabyrinthine approach are further expanded. 3.Translabyrinthine approach is easy to be affected by sigmoid sinus anterior position, high jugular bulb and poor sublabyrinthine vaporization, which often leads to narrow visual field and difficult operation. We should master all kinds of relationships between different structures and make reasonable operative approach with detailed imaging examination before operation.
【学位授予单位】：昆明医学院
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R322

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