内镜下经鼻蝶到海绵窦区手术入路的解剖学研究

发布时间：2018-04-19 20:18

本文选题：显微解剖 + 内镜　；参考：《郑州大学》2009年硕士论文

【摘要】：目的:探讨海绵窦区内镜下的显微解剖,为经鼻蝶入路内镜辅助下海绵窦内肿瘤手术切除提供解剖学依据。材料和方法:在8具(16侧)成人尸头标本上,利用0度、30度角,直径为4mm的神经内镜进行研究,全部经鼻中甲入路,切除蝶窦前壁到达蝶窦后壁,磨除蝶窦后壁的骨质层,进入海绵窦区进行研究测量拍照。结果:1.海绵窦呈粗细不等,反复分支,反复汇合的网状结构,这些网状结构与颈内动脉相互毗邻,并可于手术显微镜下完整分离,使外科医生切除海绵窦肿瘤成为可能。2.海绵窦内侧壁的胶原纤维层明显较海绵窦上壁和外侧壁为薄,海绵窦内侧壁实际上是由鞍膈发出的纤维构成的薄壁。左右海绵窦的内侧壁即为垂体硬膜囊的两侧外侧壁,作为垂体和海绵窦的边界并将两者分隔开来。3.内镜下蝶窦后壁的骨质层分为五个相互垂直的区域:中央区、双侧对称的旁中央区及外侧区。中央区的主要结构有:蝶骨平台、鞍结节、蝶鞍和斜坡凹陷;旁中央区的主要结构有:视神经管的内三分之一和颈内动脉隆突;外侧区主要包含四个骨性隆突(视神经管隆突、海绵窦尖隆突、上颌窦隆突和下颌窦隆突)和三个隐窝(视神经-颈内动脉隐窝、眼神经-上颌神经隐窝〈V1-V2〉、上颌神经-下颌神经隐窝〈V2-V3〉)。这三个隐窝在外侧区形成了三个解剖三角:视柱三角(由视神经、颈内动脉、动眼神经围成)、V1-V2三角、V2-V3三角。4.内镜下蝶窦后壁,通过其各自的骨性隆突可以明显的看到海绵窦内颈内动脉的两个分段,即尾侧的斜坡旁段和头侧的鞍旁段,斜坡旁段的颈内动脉可被进一步分为两个部分:位于海绵窦外的尾侧的破裂孔段和位于海绵窦内的三叉神经段。当蝶窦内的粘膜被去除后,可以看到颈内动脉的破裂孔段。鞍旁颈内动脉呈一个凸向前外侧的“C”形。它可被进一步分为四个部分,从尾侧到头侧分别为:潜隐段、下水平段、前垂直段、上水平段。结论:1海绵窦是由粗细不等的静脉所组成的一个不规则的静脉丛,反复分支吻合,不完全包绕颈内动脉。2海绵窦的内侧壁由覆盖于垂体的内层硬膜构成。3.内镜下通过蝶窦后壁的骨质层五分区可顺利进入海绵窦区,海绵窦内颈内动脉的分段,使临床切除海绵窦内肿瘤时避免损伤重要血管神经成为可能。
[Abstract]:Objective: to study the endoscopic microanatomy of cavernous sinus and to provide anatomic basis for endoscopic resection of cavernous sinus tumors. Materials and methods: a total of 8 adult cadaveric heads were studied by endoscopy with 0 degrees angle of 30 degrees and diameter of 4mm. The anterior wall of sphenoid sinus was removed to the posterior wall of sphenoid sinus, and the bone layer of posterior wall of sphenoid sinus was removed. The cavernous sinus area was studied and photographed. The result is 1: 1. The cavernous sinus presents a reticular structure of varying thickness, branching repeatedly and repeatedly converging. These reticular structures are adjacent to the internal carotid artery and can be completely separated under a surgical microscope, making it possible for surgeons to remove tumors of the cavernous sinus. The collagen fiber layer of the medial wall of the cavernous sinus is thinner than that of the superior wall and the lateral wall of the cavernous sinus. The medial wall of the cavernous sinus is actually a thin-walled wall formed by the fibers from the saddle diaphragm. The medial wall of the left and right cavernous sinus is the lateral wall of the pituitary dural sac, which serves as the boundary between the pituitary gland and the cavernous sinus and separates the two sides. The bone layer of the posterior wall of the sphenoid sinus is divided into five vertical regions: the central region, the bilateral symmetric paracentral area and the lateral area. The main structures of the central region are: the sphenoid plateau, the Sellar tubercle, the Sella and the clival depression. The main structures of the paracentral region are: the medial 1/3 of the optic canal and the Carina of the internal carotid artery; the lateral region mainly contains four bony Carina (optic canal Carina). Cavernous sinus apical protuberance, maxillary sinus protuberance and mandibular sinus protuberance) and three recesses (optic nerve-internal carotid artery recess, ophthalmic nerve-maxillary recess < V1-V2 >, maxillary nerve-mandibular nerve recess < V2-V3 >). The three recesses form three anatomical triangles in the lateral region: the optic column triangle (the optic nerve, the internal carotid artery, and the oculomotor nerve are surrounded by the V _ 1-V _ 2 triangle and V _ 2-V _ 3 triangle .4). Endoscopically, the posterior wall of the sphenoid sinus can be seen in two segments of the internal carotid artery in the cavernous sinus through their respective bony protuberances, that is, the paraphoric segment of the caudal side and the parasellar segment of the cephalic side. The internal carotid artery in the parapulmonary segment can be further divided into two parts: the ruptured foramen in the caudal part outside the cavernous sinus and the trigeminal nerve segment in the cavernous sinus. When the mucous membrane in the sphenoid sinus is removed, the ruptured hole of the internal carotid artery can be seen. The medial parasellar carotid artery presents a "C" shape protruding anterolateral. It can be further divided into four parts: the latent segment, the lower horizontal segment, the anterior vertical segment and the upper horizontal segment from the caudal to the cephalic side. Conclusion the cavernous sinus of the cavernous sinus is an irregular venous plexus composed of veins of different thicknesses, which are repeatedly branched and anastomosed. The medial wall of the cavernous sinus, which is not completely wrapped around the internal carotid artery .2, is composed of an internal dural covering the pituitary gland. Endoscopic approach to the cavernous sinus through the bone layer of the posterior wall of sphenoid sinus into the cavernous sinus and the segmentation of the internal carotid artery in the cavernous sinus make it possible to avoid the injury of important vessels and nerves in clinical excision of tumors in the cavernous sinus.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R651;R322

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