翼腭窝的断层与应用解剖学研究

发布时间：2019-01-17 20:22

【摘要】： 目的翼腭窝藏于颌面深部,是前颅区与侧颅区的交界,交通广泛,发生于此的肿瘤、类肿瘤不易发现,手术不易充分暴露和彻底切除。随着医学的发展和进步,国内外学者对此从宏观到影像学进行大量报道,但用连续薄切片技术研究尚不多见。鉴此,我们用改进火棉胶包埋薄切片(0.25mm)的技术及应用解剖学方法,对翼腭窝进行断层与应用解剖学研究,为翼腭窝手术入路提供形态学与临床应用解剖学依据。方法取固定成尸头标本30例,取前颅底。标本经20%HCl脱钙,梯度脱水(将组织块按照顺序浸泡在浓度依次为70%、80%、95%、无水乙醇和乙醚乙醇的液体中),梯度浸胶(将组织块按顺序依次放入浓度为5%、8%和15%的火棉胶中浸泡),包埋,焊块,用德国制造JUNGAG型大脑切片机,在水平面、矢状面和冠状面切成0.25mm薄切片(三维),对翼腭窝的形态、毗邻、窝内主要结构的位置走行及周围结构进行观测。并用80侧干燥颅骨对翼腭窝区进行测量,并获取一些数据。结果对水平面、矢状面及冠状面的不同层面进行描述,翼腭窝形态多样,左右形态和位置均可不对称。翼腭窝骨壁轮廓清晰完整,同一平面左右翼腭窝至中鼻道的距离为1.0-5.0mm。在水平面上,经视神经管层面,翼腭窝的形状呈小三角形或弧形,可呈“)(”形。在不同标本,除有小三角形、弧形外,还有横置“S”形、楔形、、正“L”形、哑铃形、短棒状或斜向外上的窄长条形。翼腭窝在经中鼻甲根部层面呈横置的四边形,行向外上,腔最宽阔,窝内左右侧动脉的位置不对称,而且可发现翼腭动脉的走行也不对称,可发现动脉的断端,由此可看出动脉的走形应为波浪状。在矢状面上,经上颌尖牙层面,神经和动脉趋于前壁并向中线靠拢,并且可清晰发现动脉的主干和分支。在冠状面上,经视神经孔层面,翼腭窝为上宽下窄的倒置楔形,神经位于动脉内侧。结论将水平断层、冠状断层及矢状断层有效地结合,对诊断翼腭窝疾病和指导手术更加有效。中鼻道是鼻内窥镜经鼻腔进入翼腭窝手术入路的门户,据断层解剖学本研究设计了一条新型入路,即经鼻腔中鼻道从鼻腔外侧壁直接穿入翼腭窝。新型手术入路不经过上颌窦,运用器械从中鼻道深入至翼腭窝的内侧壁深度,打开薄骨板,直接进入翼腭窝,由此处入路手术创伤小、出血少,安全系数高、术后并发症少。在术前对翼腭窝进行的影像学检测,以提高手术的成功率。
[Abstract]:Objective the pterygopalatine is located in the deep part of the maxillofacial region, which is the junction between the anterior cranial region and the lateral cranial area. With the development and progress of medicine, scholars at home and abroad have carried out a lot of reports from macroscopic to imaging, but the use of continuous thin slice technology is still rare. In view of this, we studied the pterygopalatine fossa sectional and applied anatomy by using the improved technique and applied anatomy method of 0.25mm, and provided the morphological and clinical applied anatomical basis for the operation approach of pterygopalatine fossa (pterygopalatine fossa). Methods 30 cases of fixed cadaveric head were collected and the anterior skull base was taken. The specimens were decalcified by 20%HCl, then dehydrated by gradient (the tissue mass was immersed in the liquid with concentration in order of 70, 80 and 95, anhydrous ethanol and ethyl ether ethanol), and the gradient soaking glue (putting the tissue mass into the concentration of 5 in order), Immersing in 8% and 15% of the colloid), embedding, soldering, JUNGAG type brain slicer made in Germany, cut into 0.25mm thin sections (3 D) in horizontal plane, sagittal plane and coronal plane, adjacent to pterygopalatine fossa, and the shape of the pterygopalatine fossa, adjacent to the pterygopalatine fossa. The location of the main structures in the nest and the surrounding structures were observed. The pterygopalatine fossa was measured with 80 dry skulls and some data were obtained. Results the horizontal plane the sagittal plane and the coronal plane were described. The pterygopalatine fossa was varied in shape and asymmetrical in left and right shape and position. The bone wall of pterygopalatine fossa was clear and complete, and the distance between left and right pterygopalatine fossa and middle nasal canal was 1.0-5.0 mm. On the horizontal plane, the pterygopalatine fossa is shaped in a small triangle or arc through the optic canal. In addition to small triangles, arcs, transverse "S"-shaped, wedge-shaped, positive "L"-shaped, dumbbell-shaped, short rod-shaped or oblique-outward narrow strip. The pterygopalatine fossa is transverse quadrilateral through the root of the middle turbinate, with the widest cavities, the asymmetry of the left and right arteries in the fossa, and the asymmetry of the path of the pterygopalatine artery, and the broken end of the artery. From this we can see that the shape of the artery should be wavy. On the sagittal plane, the nerve and artery tend to the anterior wall and close to the midline through the maxillary canine, and the trunk and branches of the artery can be clearly found. On the coronal plane, the pterygopalatine fossa is an inverted wedge across the optic foramen, and the nerve is located in the medial artery. Conclusion the combination of horizontal fault, coronal fault and sagittal fault is more effective in diagnosing pterygopalatine fossa disease and guiding operation. The middle nasal canal is the portal of the endoscopic approach to enter the pterygopalatine fossa through the nasal cavity. According to the sectional anatomy, a new approach was designed, namely, the medial nasal canal entered the pterygopalatine fossa directly from the lateral wall of the nasal cavity. The new surgical approach does not pass through maxillary sinus. The new approach uses instruments to penetrate deep into the medial wall of pterygopalatine fossa, open thin bone plate and enter pterygopalatine fossa directly. From this approach, the surgical trauma is small, the bleeding is less, the safety factor is high, and the postoperative complications are less. Imaging examination of pterygopalatine fossa was performed before operation to improve the success rate.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R322-3

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