鼻内镜下下鼻甲前入路上颌窦手术视野的解剖学研究

发布时间：2018-03-07 12:13

本文选题：鼻内镜　切入点：上颌窦　出处：《青岛大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的：通过对鼻腔和上颌窦相关解剖结构的观测,寻找影响鼻内镜下经下鼻甲前入路的上颌窦手术视野的解剖学因素,以期求解决方法,为获得满意的手术视野提供指导。方法：取30例(60侧)外观无异常的经10%福尔马林固定的成人尸头(男21例,女9例),依鼻内镜下经中鼻道上颌窦手术的路径,完成在尸头标本上的0°、30°鼻内镜下上颌窦观察,确定视野盲区的存在；通过对尸头标本的解剖学观测,结合几何光学理论,辅以CT扫描影像学研究,寻找影响手术视野的因素,从而确定获得满意手术视野的方法。按照该方法进行尸头标本的鼻内镜上颌窦观察,对其的可行性加以论证。结果：①0°及30°鼻内镜下经中鼻道径路观察上颌窦各解剖结构,部分结构不能窥及,前者主要以前壁、底壁、内侧壁、顶壁前以及后外侧壁前、下为主,后者主要以前壁、底壁、内侧壁为主。②螺旋CT解剖学测量：30例(60侧)标本鼻泪管前界上端、中端、下端到上颌窦前壁与内侧壁交界的水平距离分别为0.00、2.17±1.02、3.33±1.03,鼻泪管前下到下鼻甲前缘的水平距离为4.91±0.53,到鼻底的垂直距离为17.01±0.63,左右侧测量数据差别无统计学意义(p0.05)。③在尸头标本上对以上径线进行测量：鼻泪管前界上端、中端、下端到上颌窦前壁与内侧壁交界的水平距离分别为0.00、1.90±1.03、3.29±1.04；鼻泪管前下到下鼻甲前缘的水平距离为5.13±0.62,到鼻底的垂直距离为16.83±0.97,左右侧测量数据差别无统计学意义(p0.05),应用解剖学测量数据与影像学测量数据差别无统计学意义(p0.05)；④1000例(2000侧)正常成人上颌窦CT分析：根据上颌窦底部气化程度分为3型,Ⅰ型662例,占66.20%,Ⅱ型265例占26.50%,Ⅲ型73例,占7.30%。30例(60侧)标本中Ⅰ型23例,Ⅱ型6例,Ⅲ型1例。⑤0°和30°鼻内镜下鼻甲前入路行上颌窦手术可以获得满意的手术视野,其结果与中鼻道入路差别有统计学意义(p0.05)。去除的骨质范围：下鼻甲附着缘以上部分上下径为9.43±1.27,前后径由上往下分别为9.76±0.83、11.39±0.50、12.85±0.66,下鼻甲附着缘以下部分上下径为13.52±0.83,前后径由上往下分别为19.89±1.37、16.59±0.77、12.48±0.91。但有1例Ⅲ型上颌窦标本其底壁不能完全观察到。结论：鼻内镜下下鼻甲前径路行上颌窦手术视野较中鼻道径路明显扩大,但有的个体仍有视野盲区存在,这与上颌窦气化程度有关,影像学检查为手术扩大视野提供方向。
[Abstract]:Objective: through the nasal cavity and maxillary sinus related anatomy and anatomy to find the factors that affect the endoscopic maxillary sinus surgery under the anterior turbinate, to seek solutions, to provide guidance for the surgical field was satisfactory.
Methods: 30 cases (60 sides) no abnormal appearance after 10% formalin fixed adult cadaveric heads (male 21 cases, female 9 cases), according to the endoscopic maxillary sinus surgery in the nasal route, completed in cadaveric head on 0 degrees, 30 degrees to observe the maxillary sinus under nasal endoscope. Determine the blind vision; through anatomic observation of cadaveric head specimens, combined with geometrical optics theory, the study combined with CT scan, find the influence factors of the operative field, so as to determine satisfactory surgical field. Observation of cadaveric head according to the method of endoscopic maxillary sinus, to demonstrate its feasibility.
Results: 0 degrees and 30 degrees in the endoscopic nasal meatus approach to observe the anatomical structure of the maxillary sinus, and the former part of the structure could not see, before the main wall, the bottom wall, medial wall and lateral wall of the top wall before and after, mainly, the latter mainly before the wall, the bottom wall, the inner wall. II. Spiral CT anatomical measurement: 30 cases (60 sides) were nasolacrimal duct before the top, in the end, end to the maxillary sinus and medial wall at the junction of the horizontal distance were 0.00,2.17 + 1.02,3.33 + 1.03, down to the nasolacrimal duct before the inferior turbinate front horizontal distance was 4.91 + 0.53, to the bottom of the vertical nose the straight distance is 17.01 + 0.63, left and right side measurements had no significant difference (P0.05). The measurement of the above line in cadaveric head: nasolacrimal duct before the upper circles, in the end, the lower end of the maxillary sinus and medial wall at the junction of the horizontal distance were 0.00,1.90 + 1.03,3.29 + 1.04; anterior nasolacrimal duct next to Inferior turbinate front horizontal distance was 5.13 + 0.62, the vertical distance to the nasal floor is 16.83 + 0.97, left and right side measurements had no significant difference (P0.05), and the measurement data of image measurement data applied anatomy of the difference was not statistically significant (P0.05); 1000 cases (2000 sides) of normal adult maxillary sinus CT according to the bottom of maxillary sinus pneumatization is divided into 3 types, type I 662 cases, accounting for 66.20%, 265 cases of type II accounted for 26.50%, 73 cases of type III and 7.30%.30 cases (60 sides) type were 23 cases, 6 cases of type II, 1 cases of type III. The surgical field 0 degrees and 30 degrees the inferior turbinate of anterior maxillary sinus surgery can achieve satisfactory results, and the middle meatus approach had significant difference (P0.05). The removal of bone: the inferior turbinate attachment margin above superoinferior diameter was 9.43 + 1.27, and the diameter from top to bottom were 9.76 + 0.83,11.39 + 0.50,12.85 + 0.66, inferior margin of attachment The upper and lower diameters of the following parts were 13.52 + 0.83, and the anteroposterior diameters were 19.89 + 1.37,16.59 + 0.77,12.48 + 0.91. from top to bottom respectively, but 1 cases of type III maxillary sinus specimens could not be observed completely.
Conclusion: endoscopic sinus surgery is significantly wider than the middle nasal approach for anterior maxillary sinus surgery. However, some individuals still have blind area. This is related to the degree of gasification of the maxillary sinus. Imaging examination provides direction for surgery to expand the field of vision.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.4

【参考文献】