鼻内镜上颌窦手术四种入路视野的差异与互补性研究

发布时间：2018-01-20 23:34

本文关键词： 内窥镜检查上颌窦视野手术入路中鼻道下鼻道解剖　出处：《中国医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的鼻内窥镜的出现和广泛应用,使在处理上颌窦疾病时更加方便,手术方式更多样化。出现了很多经典的微创手术入路包括鼻腔内的或鼻内镜联合鼻外入路。但内窥镜下术野的可控范围,常受到手术入路狭小的限制及窦腔特殊解剖结构的不利影响。鼻内窥镜上颌窦手术不同入路下术野的可控范围直接影响着该术式处理疾病的有效范围。为探讨鼻内镜上颌窦手术四种不同入路视野的差异与互补程度,我们在尸头标本上经四种不同手术入路,使用鼻内镜对上颌窦腔进行了检查。方法将选取的4侧上颌窦腔解剖,模拟手术入路,在每侧窦腔上依次行上颌窦前壁开窗入路,中鼻道开窗入路,下鼻道开窗入路,鼻腔外侧壁切开入路。在每一入路开窗后,依次使用三种角度鼻内镜经该开窗口对上颌窦腔进行检查,调整鼻内镜方向和位置,测出最大视野,应用鼻内镜摄录系统,将镜下的观测过程保存记录。由三位耳鼻喉科医师共同确认在各上颌窦上各手术入路鼻内镜下视野。进而研究鼻内镜上颌窦手术四种入路视野的差异及互补程度。结果 4侧上颌窦腔,0°、30°、70°三种角度鼻内镜联合应用,经上颌窦前壁开窗口及经鼻腔外侧壁切开入路均可窥清上颌窦腔各壁；经中鼻道开窗入路可检查部位：窦腔顶壁后半部,开窗口向后至顶后壁的小部分内壁,后壁上1／2,后外壁及底壁典型者可扩展至外壁上2／3部分；经下鼻道开窗入路可检查部位：窦腔后外壁,顶壁,前壁下2／3部分,窦底,内壁的后部1／2及开窗口以下的内壁,各窦壁典型者可扩展至前壁。使用0°鼻内镜经前壁开窗口检查上颌窦腔时,气化良好的上颌窦的开窗口向上及向外的前壁不易窥及,尤其是开窗口上部的前壁,包括泪前隐窝。气化良好较深窦底不利于经下鼻道开窗入路使用0°及30°鼻内镜对窦底的检查。窦底及后外壁典型窦腔有利于30°鼻内镜经下鼻道开窗口对前壁外侧的检查,有利于70°鼻内镜经中鼻道开窗口对窦腔外壁的检查。窦腔的气化程度对三种角度鼻内镜经鼻腔外侧壁切开入路下的最大视野影响轻微。结论上颌窦手术4种入路鼻内镜下视野范围不完全相同,在3种角度鼻内镜联合应用时,经上颌窦前壁开窗口及经鼻腔外侧壁切开入路对上颌窦腔的检查较好,无解剖死角；经中鼻道开窗及下鼻道开窗入路对窦壁的视野都是不完全的,都存在不能窥及的部位；在中鼻道开窗基础上联合下鼻道开窗入路,对窦壁的视野范围有所增加,但仍不能窥及内壁前半部,前内壁交角处,如泪前隐窝较深者,则更难窥及。窦腔的气化程度及形态特征对上颌窦手术不同入路鼻内镜下视野有着不同的影响。
[Abstract]:objective
The nasal endoscope and the wide application of mirror, make more convenient in the treatment of maxillary sinus disease, surgery more diversified. The minimally invasive surgical approach includes many classic combined nasal nasal or nasal endoscopic approach. But endoscopic controllable surgical field under microscope, the adverse effects are always limited the surgical approach and sinus cavity narrow special anatomic structure. Endoscopic maxillary sinus surgery in different controllable surgical field road directly affects the effective range of the surgical treatment of the disease. To investigate endoscopic maxillary sinus surgery four different approaches view the difference and complementarity, we in the cadaveric head specimens with four different surgical approaches, the use of endoscopic maxillary sinus were examined.
Method
The 4 side of maxillary sinus were dissected, simulate the surgical approach, followed by maxillary sinus anterior wall fenestration approach in each side of the sinus cavity, middle meatus fenestration approach, inferior nasal meatus fenestration approach, lateral nasal wall incision approach. After fenestration of each approach, followed by the use of three through the open window view of endoscopic examination of maxillary sinus, nasal endoscope to adjust the orientation and position of measured maximum vision, endoscopic camera system, the microscopic observation records. By three in the Department of ENT physicians to confirm the maxillary sinus surgical approach under nasal endoscope. The difference of vision endoscopic maxillary sinus surgery in visual field of four kinds and the degree of complementarity.
Result
The 4 side of maxillary sinus, 0 degrees, 30 degrees, 70 degrees angle of three kinds of combined application of nasal endoscopy, the anterior wall of maxillary sinus open window and nasal lateral incision approach can peep clear maxillary sinus wall; middle nasal meatus fenestration approach can check the site: the top wall of sinus cavity after half. The inner wall of a small portion of the top wall of the rear window, a rear wall 1 / 2, after the outer wall and the bottom wall can be extended to the outer wall of the typical 2 / 3 part; inferior nasal meatus fenestration approach can check the site: the sinus cavity after the outer wall, a top wall, the anterior wall of the lower 2 / 3 parts, sinus 1 / 2, the inner wall of the rear wall and window below, the sinus wall typically can be extended to the front wall.
The use of 0 degrees of nasal endoscopic examination window on the front wall of maxillary sinus, open the window to the gasification good maxillary sinus anterior wall and outward and is not easy to see, especially on the front wall of the upper part of the window, including the anterior lacrimal fossa. Good deep sinus gasification is not conducive to the examination of windowing of inferior nasal meatus approach 0 degrees and 30 degrees of nasal endoscopic sinus. Sinus after sinus wall and typical for 30 degrees of nasal endoscopic nasal tract open window on the front wall outside the examination to 70 degrees of nasal endoscopic nasal sinus open window on the wall. Check the sinus pneumatization cavity of three angles of nasal endoscopic nasal lateral incision into the largest field road under the influence of minor.
conclusion
The range of vision of maxillary sinus surgery 4 approach under nasal endoscope is not exactly the same, in view of the combination of the 3 kinds of nasal endoscopy, the anterior wall of maxillary sinus and open the window by nasal lateral incision approach of maxillary sinus anatomy examination is good, no dead; through the middle meatus and inferior nasal meatus fenestration in the window the road of sinus wall view is not complete, there are parts of the endoscope and; in the middle meatus fenestration combined with inferior nasal meatus fenestration approach, the sinus wall view range increased, but still can not see the front wall and the front wall, such as the angle at the anterior lacrimal fossa is deep who is more difficult to see. And pneumatization and morphological characteristics of sinus cavity of maxillary sinus endoscope via different approaches have different effects.

【学位授予单位】：中国医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.9

【参考文献】