鼻内镜下鼻腔外侧壁入路翼腭窝解剖学研究

发布时间：2018-07-05 07:42

本文选题：翼腭窝 + 鼻内窥镜　；参考：《新疆医科大学》2009年硕士论文

【摘要】： 目的:通过鼻内镜下鼻腔外侧壁中鼻道经腭骨入路、中鼻道经上颌窦入路、下鼻甲切除经上颌窦入路三种手术入路方式对翼腭窝进行相关应用解剖学研究,为临床鼻内镜下翼腭窝手术提供详实的解剖学理论和实践基础。方法:①通过对10具(20侧)成人新鲜尸头分别采用鼻内镜下中鼻道经腭骨入路、经上颌窦入路、下鼻甲切除经上颌窦入路进行解剖,观测手术径路中穿经结构以及重要血管神经的毗邻关系。②内镜下解剖后行正中矢状锯开,进一步咬除翼腭窝周围骨质充分显露翼腭窝、颞下窝、眶上裂及蝶窦外侧壁并观察测量。结果:①翼腭窝及其周围结构解剖关系复杂,翼腭窝内有颌内动脉及其分支、上颌神经及其分支、翼腭神经节等重要神经血管结构,毗邻眶尖、颈内动脉、视神经等重要结构,是鼻腔进入侧颅底的通道。②颌内动脉翼腭窝段变异较大,颌内动脉翼腭段按顺序发出分支占25%(5/20),眶下动脉和上牙槽后动脉共干分出占50%(10/20),分别由颌内动脉发出占40%(8/20);颌内动脉同时发出眶下动脉、腭降动脉、蝶腭动脉占10%(2/20);眶下动脉和腭降动脉共干发出占10%(2/20);翼管动脉和圆孔动脉分别由颌内动脉发出及共干发出各占50%(10/20);颌内动脉翼腭段、腭降动脉、蝶腭动脉三支呈“Y”型35%(7/20),“T”型20%(4/20),“M”型15%(3/20),中间型30%(6/20);鼻后外侧动脉和鼻中隔后动脉于翼腭窝内由蝶腭动脉发出占55%(11/20),出翼腭窝分出占20%(4/20),鼻中隔后动脉在蝶腭孔后方骨孔单独走行占5%(1/20),蝶腭动脉在翼腭窝内分出三支出蝶腭孔占20%(4/20)。④蝶腭孔、眶下管、圆孔和翼管是翼腭窝重要骨性标志,鼻内镜下鼻腔外侧壁三种手术入路暴露翼腭窝的范围不同,并且翼腭窝可作为进入颞下窝和蝶窦的通路。结论:①鼻内镜下经鼻腔外侧壁三种手术入路可不同程度暴露翼腭窝,视野清晰,为翼腭窝手术路径提供了一个安全便捷的入路方式,并可根据病变范围变通手术径路。②熟知翼腭窝及其周围恒定的解剖标志可在术中保持方向感,围绕这三种手术入路进行测量所得结果,有助于为手术中准确定位更深层次的结构提供依据,提高手术安全性。③经此入路可进入颞下窝、蝶窦等临近解剖区域,处理临近区域病变。
[Abstract]:Objective: to study the applied anatomy of pterygopalatine fossa through three operative approaches: transpalatine osseous approach, middle nasal canal transmaxillary sinus approach and inferior turbinate resection via maxillary sinus approach under nasal endoscope. To provide a detailed anatomical and practical basis for clinical endoscopic pterygopalatine fossa surgery. Methods 10 adult fresh cadaveric heads (20 sides) were dissected by endoscopic transpalatine approach, maxillary sinus approach, inferior turbinate resection via maxillary sinus approach. After endoscopic anatomy, the median sagittal sawing was performed to remove the bone around the pterygopalatine fossa to reveal the pterygopalatine fossa and infratemporal fossa. The supraorbital fissure and lateral wall of sphenoid sinus were observed and measured. Results the anatomical relationship between the pterygopalatine fossa and its surrounding structures was complicated. There were some important structures in the pterygopalatine fossa, including the internal maxillary artery and its branches, the maxillary nerve and its branches, the pterygopalatine ganglion, and adjacent to the orbital apex, the internal carotid artery, the optic nerve, etc. The passage from nasal cavity to the lateral skull base was found to vary greatly in the pterygopalatine fossa segment of the internal maxillary artery. The branches of pterygopalatine segment of internal maxillary artery were 25% (5 / 20), 50% (10 / 20) of inferior orbital artery and posterior superior alveolar artery, and 40% (8 / 20) of internal maxillary artery, respectively. The sphenopalatine artery accounted for 10% (2 / 20), the inferior orbital artery and the descending palatine artery for 10% (2 / 20), the pterygoid artery and foramen artery for 50% (10 / 20), the pterygopalatine segment and the descending palatal artery for 50% (10 / 20), respectively. The three branches of sphenopalatine artery were "Y" type 35% (7 / 20), "T" type 20% (4 / 20), "M" type 15% (3 / 20), intermediate type 30% (6 / 20), posterior nasal artery and posterior septal artery in pterygopalatine fossa 55% (11 / 20), pterygopalatine fossa 20% (4 / 20), posterior nasal septum artery in sphenopalatine artery 20% (4 / 20), posterior nasal septum artery in pteropalatine fossa 55% (11 / 20), pterygopalatine fossa 20% (4 / 20). The sphenopalatine foramen was separated from the pterygopalatine fossa by the sphenopalatine artery in 20% (4 / 20) of the sphenopalatine foramen. The suborbital canal, foramen roundus and pterygoid canal are important bony markers of pterygopalatine fossa. Under nasal endoscope, the range of pterygopalatine fossa is different, and the pterygopalatine fossa can be used as the access to inferior temporal fossa and sphenoid sinus. Conclusion the pterygopalatine fossa can be exposed in different degrees by three kinds of transnasal endoscopic approaches through the lateral wall of nasal cavity. The visual field is clear, which provides a safe and convenient approach for the operation of pterygopalatine fossa. According to the range of pathological changes, the operative path .2 familiar with the constant anatomic mark of pterygopalatine fossa and its surroundings can maintain a sense of direction during the operation. The results are measured around the three operative approaches. It is helpful to provide the basis for the accurate location of deeper structures in the operation and improve the safety of the operation. 3. The approach can enter the inferior temporal fossa, the sphenoid sinus and other adjacent anatomical areas, and deal with the adjacent area lesions.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R765;R322

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