鼻内镜下鼻眼相关区域的临床解剖研究

发布时间：2018-04-25 08:21

本文选题：鼻内镜 + 鼻腔　；参考：《山西医科大学》2011年硕士论文

【摘要】：目的：通过尸头解剖观测,明确鼻内镜下鼻眼相关区域手术的重要解剖关系,为临床医师实施该区域手术提供解剖学依据。同时在尸头标本上模拟手术入路的解剖操作,为临床手术提供参考。方法：选取经10%甲醛溶液固定的成人尸头60例。按既定研究方法对尸头进行精细解剖研究,对鼻眼相关区域的重要解剖结构进行观测,并用专业设备对鼻腔相关结构进行多方位拍摄。结果：1)视神经管的四壁中内侧壁最长(男10.58±1.03 mm,女9.24±0.96mm)且最薄(男0.56±0.16mm,女0.48±0.31mm)；2)眼动脉发出后,行于视神经硬膜鞘下壁内,一般沿视神经管的内下方向前外下方走形；3)视神经管内侧壁与筛窦、蝶窦毗邻关系复杂(可分为全部毗邻蝶窦、全部毗邻筛窦、与筛窦蝶窦同时相邻等三型),特别是最后组筛房、蝶上筛房的关系直接影响到手术的操作方式。4)泪囊长度(男15.47-2.13mm,女15.13-2.87mm),宽度(男7.46+0.93mm,女6.82-0.73mm),泪骨菲薄,其中段厚度男性只有1.26-0.35mm,女性只有1.10+0.22mm。而上颌骨额突后缘处的厚度男性为3.71-0.28mm,女性为2.93-0.15mm。5)鼻丘气房依气化范围分为1度(24.17%),2度(58.33%),3度(17.5%),通过此分度可明确鼻丘气房与泪囊窝的位置关系,有利于泪囊鼻腔造口术的手术定位。6)在明确重要解剖结构的基础上对三类鼻眼相关手术进行尸头模拟操作,为临床手术提供解剖参考。结论：由于边际学科的学科交叉性较大,手术解剖较为复杂,经鼻内镜鼻眼相关手术对眼科和耳鼻咽喉科医师来讲具有一定的挑战性。手术的成功与否与手术相关区域解剖标志的认识和掌握程度密切相关。因此在手术开展之前对手术医师进行针对性的尸头解剖培训至关重要。
[Abstract]:Objective: to determine the important anatomical relationship of nasal and ophthalmic surgery under nasal endoscope, and to provide anatomical basis for clinicians to perform this region operation. At the same time, anatomic operation of surgical approach was simulated on cadaveric specimen, which provided reference for clinical operation. Methods: 60 adult cadaveric heads fixed with 10% formaldehyde solution were selected. According to the established research method, the anatomical structure of the head of cadaver was studied, the important anatomical structure of the related region of nose and eye was observed, and the related structure of nasal cavity was photographed in various directions with professional equipment. Results the medial wall of the optic canal was the longest (male 10.58 卤1.03 mm, female 9.24 卤0.96 mm) and thinnest (0.56 卤0.16 mm for male, 0.48 卤0.31 mm for female 0.48 卤0.31 mm). The medial wall of the optic canal and ethmoid sinus are generally along the inner and lower part of the optic canal. The relationship between the sphenoid sinus and the sphenoid sinus is complex (all adjacent to the sphenoid sinus, all adjacent to the ethmoid sinus). The relationship between the sphenoid sinus and the ethmoid sinus, especially the ethmoidal chamber and the suprasphenoidal chamber in the last group, had a direct influence on the operation mode. 4) the length of the lacrimal sac (male 15.47-2.13mm, female 15.13-2.87mm), width (male 7.460.93mm, female 6.82-0.73mm), lacrimal bone thinning, lacrimal sac length (male 15.47-2.13mm, female 15.13-2.87mm, female 6.82-0.73mm). The segment thickness was only 1.26-0.35 mm for men and 1.10 0.22 mm for women. The thickness of the posterior margin of the maxillary frontal process was 3.71-0.28mm for males and 2.93-0.15mm.5 for females.) the nasal colliculus gas chamber was divided into 1 degree (24.17%) and 2 degrees (58.3333) and 3 degrees (17.5%) according to the range of gasification. The relationship between the nasal colliculus gas chamber and the lacrimal sac fossa could be determined by this classification. On the basis of defining the important anatomical structure, the anatomic operation of three kinds of naso-eye related surgery is simulated, which provides anatomic reference for clinical operation. Conclusion: due to the large interdisciplinary nature of marginal disciplines and complicated surgical anatomy, transnasal endoscopic naso-ophthalmic surgery is challenging for ophthalmologists and otolaryngologists. The success of the operation is closely related to the understanding and mastery of the anatomical markers in the surgical area. Therefore, it is very important to train the surgeon on autopsy of cadaveric head before the operation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R765.9

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