内镜下经口入路咽旁间隙手术的解剖标志

发布时间：2018-03-30 07:08

本文选题：咽旁间隙　切入点：经口入路　出处：《局解手术学杂志》2016年06期

【摘要】：目的观察内镜下经口入路咽旁间隙手术的解剖恒定标志,为处理咽旁间隙病变、提高手术成功率提供依据。方法对2015年1月至2015年9月获得的10具新鲜尸头进行CT多平面重建及三维重建,观察咽旁间隙等咽旁结构,然后应用内窥镜,于口内行内镜辅助咽旁间隙解剖。结果 CT图像上,极低密度的鼻咽向后外侧延伸形成咽隐窝,咽旁间隙位于咽隐窝的外侧,呈前窄后宽的低密度三角形阴影,翼内肌、翼外肌、咬肌、颞肌位于咽旁间隙的外侧,呈中密度阴影,茎突位于咽旁间隙的前部阴影,咽旁间隙后部颈内动脉呈中密度阴影。咽旁间隙内血管、神经显影不清晰。茎突位于颅底颞骨鼓部下,长(24.98±2.01)mm,咽旁间隙内结构均位于茎突及其周围深肌面,如茎突外侧有颈外动脉、面神经及乳突,茎突根部的内侧有颈静脉孔及舌下神经管外口,前内方有颈动脉管外口、棘孔和卵圆孔,后方有茎乳孔。左右侧茎突根部到周围毗邻组织结构的距离比较,差异无统计学意义(P0.05)。除茎突根部至茎乳孔外,男性茎突根部到周围毗邻组织结构的距离均大于女性,差异具有统计学意义(P0.05)。结论内镜辅助下经口入路咽旁间隙手术以茎突等作为解剖学标志,以茎突到毗邻解剖结构的距离为参考,有助于咽旁间隙周围神经、血管等的寻找和辨认。
[Abstract]:Objective to observe the anatomical constant marks of endoscopic parapharyngeal space operation through oral approach, and to provide the basis for the treatment of parapharyngeal space disease and the improvement of surgical success rate.Methods CT multiplanar reconstruction and 3D reconstruction were performed on 10 fresh cadaveric heads from January 2015 to September 2015. The parapharyngeal space and other parapharyngeal structures were observed. Then endoscopic anatomy of the parapharyngeal space was performed by endoscope.Results on CT images, the extremely low density nasopharynx extended to the posterolateral side to form a pharyngeal recess, and the parapharyngeal space was located on the lateral side of the pharyngeal recess, with a low density triangle shadow of anterior narrow posterior width, medial pterygoid muscle, lateral pterygoid muscle and masseter muscle.The temporal muscle was located on the lateral side of the parapharyngeal space with medium density shadow, the styloid process in the anterior part of the parapharyngeal space and the posterior internal carotid artery in the parapharyngeal space.The vessels and nerves in the parapharyngeal space were not clear.The styloid process is located under the tympanic part of the skull base and 24.98 卤2.01mm. the structure of the parapharyngeal space is located in the styloid process and its surrounding deep muscle surface, such as the external carotid artery, facial nerve and mastoid outside the styloid process, the medial foramen jugular vein and the external orifice of the sublingual nerve duct in the root of the styloid process.There are external orifice of carotid artery, foramen spinosus and foramen ovale in anterior and inner side, and caulomastoid foramen in the rear.There was no significant difference in the distance between the right and left stem process root and adjacent tissue structure (P 0.05).Except for the stem process root to the stem mammary foramen, the distance from the stem process root to the adjacent tissue structure of the male was larger than that of the female, and the difference was statistically significant (P 0.05).Conclusion Endoscope-assisted parapharyngeal space surgery with styloid process as anatomic marker and the distance from styloid process to adjacent anatomical structure as reference is helpful for the search and identification of peripheral nerves and blood vessels in parapharyngeal space.
【作者单位】：深圳市龙华新区中心医院耳鼻咽喉科;
【基金】：深圳市科技计划项目(GCYG20150402140827355)
【分类号】：R762;R322

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