耳后发际入路内镜辅助腮腺浅叶切除术的解剖研究

发布时间：2018-06-13 19:12

本文选题：耳后发际入路 + 内镜术　；参考：《临床耳鼻咽喉头颈外科杂志》2014年21期

【摘要】：目的:为耳后发际入路内镜辅助腮腺浅叶切除术提供解剖学依据,并评价其可行性和安全性。方法:新鲜尸体15具(30侧),观测耳后发际区和腮腺区的解剖层次及重要结构;新鲜尸体5具(10侧),模拟内镜手术,术后解剖标本,观察有无神经、血管等损伤。结果:耳后发际区的分离层面在表浅肌肉腱膜系统与颈深筋膜浅层之间。胸锁乳突肌上部浅面由后上至前下依次为枕小神经、耳大神经、颈外静脉。耳大神经分支点至耳垂根部距离为(22.85±2.01)mm。腮腺区皮瓣的分离层面在咬肌筋膜与腮腺实质之间。面神经出茎乳孔,经茎突根部的浅面、外耳道软骨与二腹肌后腹之间进入腮腺。面神经总干分叉点与乳突尖距离为(19.10±3.10)mm,与下颌角距离为(39.49±5.78)mm。耳后动脉起自二腹肌后腹上方的颈外动脉后壁,主干跨面神经总干浅面。10侧模拟内镜手术顺利完成,术中无重要结构损伤,无需中转切口。结论:熟悉耳后发际区和腮腺区的解剖层次、标志及参数,耳后发际入路内镜辅助腮腺浅叶切除术安全、可行。
[Abstract]:Objective: to provide anatomic basis for endoscopic assisted superficial parotid lobectomy via retroauricular hairline approach and to evaluate its feasibility and safety. Methods: the anatomical levels and important structures of postauricular hair area and parotid gland were observed in 15 fresh cadavers and 10 sides of fresh cadavers. Results: the aponeurosis between the superficial muscle aponeurosis and the superficial cervical fascia. The superior surface of sternocleidomastoid muscle was followed by occipital minor nerve, great auricular nerve and external jugular vein. The distance from the branch of the great auricular nerve to the root of the ear lobe was 22.85 卤2.01mm. The separation level of parotid region flap lies between the masseter fascia and parotid gland parenchyma. The facial nerve enters the parotid gland through the superficial surface of the root of the styloid process and between the cartilage of the external auditory canal and the ventral part of the bicentral muscle. The distance between the branching point of the total trunk of the facial nerve and the mastoid tip was 19.10 卤3.10mm, and the distance from the mandibular angle was 39.49 卤5.78mm. The posterior auricular artery originated from the posterior wall of the external carotid artery above the posterior abdomen of the bicentric muscle, and the main trunk crossed the superficial surface of the total trunk of the facial nerve. 10 sides of the simulated endoscopic surgery were successfully completed. There was no significant structural injury during the operation and no transition incision was required. Conclusion: it is safe and feasible to be familiar with the anatomical levels, markers and parameters of posterior ear hair area and parotid gland area.
【作者单位】：广东省人民医院(广东省医学科学院)耳鼻咽喉头颈外科;中山大学孙逸仙纪念医院耳鼻咽喉头颈外科;
【基金】：广东省医学科研基金(No:A2011029) 广东省科技计划项目(No:2011B080701035)
【分类号】：R764

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