鼻内镜下经鼻—上颌窦三种手术入路翼腭窝的比较解剖学研究

发布时间：2019-05-18 13:17

【摘要】： 目的:本研究的目的是在鼻内镜下定位翼腭窝内主要血管和神经结构,为鼻内镜翼腭窝区手术入路提供解剖学基础。材料和方法:鼻内镜下对6具新鲜尸头的12侧翼腭窝进行解剖,解剖前使用染色硅胶进行血管内灌注。完成鼻内镜下上颌窦后壁入路、扩大上颌窦后壁入路以及鼻腔外侧壁切开入路的比较解剖学研究以及翼腭窝内血管神经结构的解剖学定位研究。结果:筛嵴和蝶腭孔、眶下管隆突以及上颌动脉压迹是鼻内镜下定位翼腭窝内主要血管神经结构三个重要的标志。鼻内镜下上颌窦后壁入路可以良好地显露翼腭窝上部的结构,扩大上颌窦后壁入路和鼻腔外侧壁切开入路均可以显露翼腭窝区全部结构以及颞下窝内侧区的结构,前者对于内侧区域的暴露有优势,后者对于外侧区域的暴露有优势。翼外肌平面是鼻内镜经鼻-上颌窦入路的外侧界线。结论:解剖研究显示,这些内镜标志对于定位翼腭窝内的主要血管和神经结构十分重要,能够使术者进入翼腭窝区后对相关血管和神经更加的精确的定位并减少并发症。术前可以根据翼腭窝区的病变范围、下鼻甲和鼻泪管是否受侵犯、上颌窦内的病变范围以及手术的类型四个主要因素,选择最合理鼻内镜下经鼻-上颌窦手术入路。
[Abstract]:Objective: the purpose of this study was to locate the main blood vessels and nerve structures in pterygopalatine fossa under nasal endoscope, and to provide anatomical basis for endoscopic approach to pterygopalatine fossa surgery. Materials and methods: the 12 flanking palatine fossa of 6 fresh cadavers were dissected under nasal endoscope and perfused with stained silica gel before anatomy. The comparative anatomical study of endoscopic posterior wall approach of maxillary sinus, expansion of posterior wall approach of maxillary sinus and incision approach of lateral wall of nasal cavity was completed, as well as the anatomical localization of vascular and nerve structure in pterygopalatine fossa. Results: ethmoid crest and sphenopalatine foramen, suborbital protruding process and maxillary artery indentation are three important markers for endoscopic localization of the main vessels and nerves in pterygopalatine fossa. The superior structure of pterygopalatine fossa can be well exposed by endoscopic posterior wall approach of maxillary sinus, and all the structures of pterygopalatine fossa and medial area of infratemporal fossa can be exposed by enlarged posterior wall approach of maxillary sinus and incision approach of lateral wall of nasal cavity. The former has an advantage in the exposure of the medial region and the latter has an advantage in the exposure of the lateral region. The plane of lateral pterygoid muscle is the lateral boundary of nasal endoscopic transnasal maxillary sinus approach. Conclusion: anatomical studies show that these endoscopic markers are very important for the localization of the main blood vessels and nerve structures in the pterygopalatine fossa, which can enable the operator to locate the related blood vessels and nerves more accurately and reduce the complications after entering the pterygopalatine fossa. According to the lesion scope of pterygopalatine fossa, whether inferior turbinate and nasolacrimal duct were invaded, the lesion scope in maxillary sinus and the type of operation, the most reasonable transnasal and maxillary sinus approach could be selected before operation.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322

【相似文献】