经胼胝体—透明隔间腔—穹窿间入路到第三脑室的显微解剖学研究
发布时间：2018-12-13 14:20
【摘要】： 目的:通过对成年国人湿性头颅标本的显微解剖和数据测量,了解前纵裂、胼胝体、透明隔、穹窿、第三脑室等与经胼胝体-透明隔间腔-穹窿间手术入路有关的显微解剖结构,量化各项数据,为经胼胝体-透明隔间腔-穹窿间入路切除第三脑室及第三脑室后部肿瘤提供显微解剖学数据,以利于术中保护重要组织结构,增加手术的安全性,提高手术成功率,减少术后并发症。 方法:对6例成年国人尸头标本,分别用红色及蓝色乳胶灌注动脉及静脉,在5～25倍手术显微镜下模仿经胼胝体-透明隔间腔-穹窿间入路的手术操作并进行解剖,观察并详细记录逐层暴露第三脑室区显微结构的步骤。术毕后将头颅标本均沿正中矢状面锯开,观察并测量眉间到冠矢点的距离、冠矢点到中央沟的距离、冠矢点之前第一根引流静脉到冠矢点的距离(右侧)、冠矢点之后第一根引流静脉到冠矢点的距离(右侧)、在冠矢点到室间孔的连线上冠矢点到胼胝体的距离、胼胝体在冠矢点到室间孔连线上的厚度、在冠矢点到室间孔的连线上冠矢点到第三脑室底的距离、前联合后缘到室间孔后缘的距离、中间块前后径、前联合到后联合的距离、室间孔后缘到中脑水管前缘的距离。最后,对数据进行统计学分析,得出统计学结论。各结果以均数±标准差(x±s)表示。 结果:从眉间中点到冠矢点的距离相对恒定,本组实验测得眉间到冠矢点的距离为:130.8±3.5(126.0～135.0)mm;从正中矢状面测得冠矢点到中央沟的距离为:46.2±4.7(40.0～52.0)mm;冠矢点之前第一根引流静脉到冠矢点的距离(右侧)最近的为17.0mm,最远的为84.0mm,其中83.0%(5例)位于冠状缝之前50.0mm以外;冠矢点之后第一根引流静脉到冠矢点的距离(右侧)最近的为4.0mm,最远的为22.0mm,其中83.0%(5例)位于冠状缝之后20.0mm以内;在冠矢点到室间孔的连线上冠矢点到胼胝体的距离为48.7±3.6(42.0～52.0)mm;胼胝体在冠矢点到室间孔连线上的厚度为5.9±0.8(5.0～7.0)mm;在冠矢点到室间孔的连线上冠矢点到第三脑室底的距离为90.0±3.2(85.0～94.0) mm;前联合后缘到室间孔后缘的距离为10.3±0.5(9.5～11.0)mm;中间块前后径为4.9±0.4(4.5～5.5)mm;前联合到后联合的距离为22.0±2.2(20.0～24.0)mm;室间孔后缘到中脑水管前缘的距离为19.8±1.2(18.0～21.0) mm。 结论:经胼胝体-透明隔间腔-穹窿间入路在技术上是相对安全的,按照脑胚胎发育间隙沿中线结构逐层进入,不损伤大脑皮质,到达第三脑室最近,对侧脑室血管的损伤明显减少,无需过度牵拉,即可看到双侧重要结构,通过调整显微镜角度,可观察到第三脑室前、中、及部分第三脑室后部的解剖结构。此入路要对以下关键解剖结构加以重视并进行保护:引流到上矢状窦的粗大引流静脉、胼周动脉、胼胝体、穹窿联合、大脑内静脉及其属支、前联合。此入路的可操作空间相对狭小,需不断调整显微镜的角度以增加对病变的暴露。对第三脑室前、中部病变的显露较好,到达第三脑室后部的距离相对较远,但对于第三脑室后部以及松果体区病变向第三脑室前部突出者,此入路无疑也是可以优先考虑的。第三脑室解剖结构复杂,严谨的实验室显微外科练习对提高手术安全性、预防术后并发症是至关重要的。
[Abstract]:Objective: To study the micro-anatomical structure and quantify the data of the anterior longitudinal fissure, the papillary body, the transparent septum, the hole, the third ventricle and the like, which are related to the surgical approach to the cavity of the transseptal body-transparent compartment, through the microdissection and data measurement of the wet head specimen of the adult Chinese. in ord to provide that micro-anatomical data for the tumor of the third ventricle and the third ventricle through the through-hole in-hole and the hole-to-hole approach, the invention can protect the important tissue structure in the operation, increase the safety of the operation, improve the success rate of the operation and reduce the postoperative complications. Methods: Six adult cadaveric specimens were perfused with red and blue latex, and the operation was simulated by a 5-25-fold operation microscope. The anatomy, observation, and detailed recording of the microstructure of the third ventricular zone exposed to layer by layer The method comprises the following steps of: sawing a head specimen along a median sagittal plane after the operation is completed, observing and measuring the distance between the eyebrow and the crest point, the distance between the coronal point and the central groove, and the distance of the first drainage vein to the sagittal point before the coronal point; right), the distance (right side) of the first drainage vein to the coronal point after the crown point, the distance between the crown vector point and the intercell hole, the distance between the crown vector point and the crown vector body, the thickness of the crown body at the connecting line of the crown vector point to the inter-chamber hole, the crown vector point to the third ventricle bottom at the connecting line of the crown vector point to the inter-chamber hole, the distance from the leading and trailing edge to the rear edge of the inter-chamber aperture, the distance between the anterior and posterior diameters of the intermediate block, the distance from the anterior joint to the posterior joint, the posterior edge of the inter-chamber orifice to the leading edge of the midbrain water tube, The distance. Finally, the data is statistically analyzed and the statistics are obtained. study conclusion. The results are standard deviation (x% s) Results: The distance from the middle point to the crown point of the eyebrow is relatively constant. The distance between the eyebrow and the crest point is 130. 8-3.5 (126. 0-135. 0) mm. The distance from the sagittal plane to the central groove is: 46. 2-4.7 (40. 0 ~ 52. 0) mm; the distance (right) of the first drainage vein to the coronal point before the crown point was 170.0mm, the most distal was 80.0mm, of which 83.0% (5) was located 50. 0mm prior to the coronal suture; the distance (right side) of the first drainage vein to the coronal point after the crown point was nearest 4.0mm, the most distal Of the 22. 0mm, 83.0% (5 cases) were located within 20. 0mm after the coronal suture; the distance from the crown point to the intercell hole was 48. 7 to 3.6 (42. 0-52. 0) mm on the line of the crown point to the inter-chamber hole, and the thickness of the hammer body on the connection line between the crown point and the chamber was 50.9 to 0.8 (5.0) (5.0. 0). The distance from the crown point to the bottom of the third ventricle was 90. 0. 3. 2 (85. 0-94. 0) mm. The distance between the leading and trailing edge to the rear edge of the chamber was 10. 3 to 0. 5 (9.5 to 11. 0) mm, and the anterior and posterior diameter of the intermediate block was 4. 9 to 0.4 (4.5 to 5. 5) mm, and the distance of the anterior joint to the posterior joint was 22. 0 to 2.2 (20. 0 ~ (24. 0) mm; the distance between the posterior edge of the intercell hole and the leading edge of the midbrain water tube was 19.8-1.2 (18. 0 ~ 21. 0) mm. Conclusion: It is relatively safe to enter the through-hole in the cavity of the transparent compartment-transparent compartment. According to the development gap of the brain, it enters in layer by layer along the midline structure, does not damage the cerebral cortex, and reaches the most recent of the third ventricle, and the damage to the lateral ventricle's blood vessels It is obviously reduced, without excessive pulling, the important structure of the double side can be seen, and by adjusting the angle of the microscope, the front, middle and the part of the third ventricle can be observed. The anatomy of the posterior part of the third ventricle. The approach is to attach importance to and protect the following key anatomical structures: the gross drainage vein, the peripheral artery, the papillary body, the hole, the hole, the brain, The inner vein and its branches and anterior joint. The operation space of the inlet is relatively small, and it is necessary to adjust the microscope continuously. The angle is to increase exposure to the lesion. The exposure of the central lesion to the third ventricle is relatively good, the distance to the posterior of the third ventricle is relatively far, but for the third ventricle posterior and the pineal region lesion to the front of the third ventricle, this entry There is no doubt that the third ventricle is complex in anatomy and rigorous laboratory microsurgery to improve the safety of the operation and to prevent
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322.8
本文编号：2376678
[Abstract]:Objective: To study the micro-anatomical structure and quantify the data of the anterior longitudinal fissure, the papillary body, the transparent septum, the hole, the third ventricle and the like, which are related to the surgical approach to the cavity of the transseptal body-transparent compartment, through the microdissection and data measurement of the wet head specimen of the adult Chinese. in ord to provide that micro-anatomical data for the tumor of the third ventricle and the third ventricle through the through-hole in-hole and the hole-to-hole approach, the invention can protect the important tissue structure in the operation, increase the safety of the operation, improve the success rate of the operation and reduce the postoperative complications. Methods: Six adult cadaveric specimens were perfused with red and blue latex, and the operation was simulated by a 5-25-fold operation microscope. The anatomy, observation, and detailed recording of the microstructure of the third ventricular zone exposed to layer by layer The method comprises the following steps of: sawing a head specimen along a median sagittal plane after the operation is completed, observing and measuring the distance between the eyebrow and the crest point, the distance between the coronal point and the central groove, and the distance of the first drainage vein to the sagittal point before the coronal point; right), the distance (right side) of the first drainage vein to the coronal point after the crown point, the distance between the crown vector point and the intercell hole, the distance between the crown vector point and the crown vector body, the thickness of the crown body at the connecting line of the crown vector point to the inter-chamber hole, the crown vector point to the third ventricle bottom at the connecting line of the crown vector point to the inter-chamber hole, the distance from the leading and trailing edge to the rear edge of the inter-chamber aperture, the distance between the anterior and posterior diameters of the intermediate block, the distance from the anterior joint to the posterior joint, the posterior edge of the inter-chamber orifice to the leading edge of the midbrain water tube, The distance. Finally, the data is statistically analyzed and the statistics are obtained. study conclusion. The results are standard deviation (x% s) Results: The distance from the middle point to the crown point of the eyebrow is relatively constant. The distance between the eyebrow and the crest point is 130. 8-3.5 (126. 0-135. 0) mm. The distance from the sagittal plane to the central groove is: 46. 2-4.7 (40. 0 ~ 52. 0) mm; the distance (right) of the first drainage vein to the coronal point before the crown point was 170.0mm, the most distal was 80.0mm, of which 83.0% (5) was located 50. 0mm prior to the coronal suture; the distance (right side) of the first drainage vein to the coronal point after the crown point was nearest 4.0mm, the most distal Of the 22. 0mm, 83.0% (5 cases) were located within 20. 0mm after the coronal suture; the distance from the crown point to the intercell hole was 48. 7 to 3.6 (42. 0-52. 0) mm on the line of the crown point to the inter-chamber hole, and the thickness of the hammer body on the connection line between the crown point and the chamber was 50.9 to 0.8 (5.0) (5.0. 0). The distance from the crown point to the bottom of the third ventricle was 90. 0. 3. 2 (85. 0-94. 0) mm. The distance between the leading and trailing edge to the rear edge of the chamber was 10. 3 to 0. 5 (9.5 to 11. 0) mm, and the anterior and posterior diameter of the intermediate block was 4. 9 to 0.4 (4.5 to 5. 5) mm, and the distance of the anterior joint to the posterior joint was 22. 0 to 2.2 (20. 0 ~ (24. 0) mm; the distance between the posterior edge of the intercell hole and the leading edge of the midbrain water tube was 19.8-1.2 (18. 0 ~ 21. 0) mm. Conclusion: It is relatively safe to enter the through-hole in the cavity of the transparent compartment-transparent compartment. According to the development gap of the brain, it enters in layer by layer along the midline structure, does not damage the cerebral cortex, and reaches the most recent of the third ventricle, and the damage to the lateral ventricle's blood vessels It is obviously reduced, without excessive pulling, the important structure of the double side can be seen, and by adjusting the angle of the microscope, the front, middle and the part of the third ventricle can be observed. The anatomy of the posterior part of the third ventricle. The approach is to attach importance to and protect the following key anatomical structures: the gross drainage vein, the peripheral artery, the papillary body, the hole, the hole, the brain, The inner vein and its branches and anterior joint. The operation space of the inlet is relatively small, and it is necessary to adjust the microscope continuously. The angle is to increase exposure to the lesion. The exposure of the central lesion to the third ventricle is relatively good, the distance to the posterior of the third ventricle is relatively far, but for the third ventricle posterior and the pineal region lesion to the front of the third ventricle, this entry There is no doubt that the third ventricle is complex in anatomy and rigorous laboratory microsurgery to improve the safety of the operation and to prevent
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322.8
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