鼻内镜下鼻咽癌挽救手术及相关颅底的应用解剖学研究
发布时间：2018-09-05 19:49
【摘要】：目的对鼻咽癌鼻内镜下挽救手术所涉及的鼻咽旁间隙及相关的颅底区域进行解剖学研究,了解经鼻内镜下鼻咽癌挽救手术中相关颅底区域重要解剖结构在内镜下的空间相互关系,寻找合适的解剖标志,指导临床手术。 方法选择8具(16侧)用10%福尔马林防腐固定的生长发育正常成年人的尸头标本,分别用红、蓝两种染色的乳胶灌注动、静脉系统,在行螺旋CT扫描后开放全组鼻窦,分别模拟以下三种手术:经中鼻道或经上颌窦后壁进入翼腭窝、颞下窝;经翼突(或翼腭窝)进路行内镜下鼻颅底手术;经鼻内镜鼻咽癌切除术,并对鼻咽部、咽旁间隙及相应区域的颅底进行解剖,辨认重要的解剖结构及相互的空间关系。在尸头上并分别测量鼻小柱距翼管神经与颈内动脉膝部交界处、距咽鼓管峡部的距离、距颈内动脉的距离;咽鼓管峡距颈内动脉管外口的距离,在CT上测量翼管的长度,通过翼管后口的矢状线到颈动脉管口内缘的距离,咽鼓管峡到颈内动脉管的最短距离,翼管后口到咽鼓管峡的距离,翼管后口到颈动脉管口的距离。 结果○1翼管在蝶窦内的出现率受蝶窦气化程度影响,但翼管总是很恒定的指向破裂孔,追踪其包绕的翼管神经可定位颈内动脉膝部,在翼管神经下方操作可以磨除破裂孔的纤维软骨而不会伤及颈内动脉;圆孔与翼管的位置关系在翼腭窝内恒定不变,经翼突(或翼腭窝)进路行内镜下鼻颅底手术时通过追踪上颌神经,翼管神经可以定位颈内动脉的水平段、海绵窦前缘及美克尔腔;在鼻内镜下鼻咽癌挽救手术中咽鼓管的峡部位于卵圆孔的后外侧,咽鼓管的软骨部在内镜下全切困难,以通过卵圆孔的下颌神经为标志能最大化切除咽鼓管的软骨部;咽旁间隙的颈内动脉位于头长肌的外侧,茎突咽筋膜的后方和咽鼓管峡部后下方约0.5cm,而颈内动脉内侧缘距离翼管后口外侧约1cm的矢状面上;○2尸头测量结果:鼻小柱距翼管与颈内动脉膝部交界处为84.97±4.27mm、距离咽鼓管峡部96.33±2.07mm、距离颈内动脉的分别为101.56±2.56mm;○3 CT上测量结果:翼管的长度16.31±2.16mm,通过翼管后口的矢状线到颈动脉管口内缘的距离9.98±2.22mm,咽鼓管峡到颈内动脉管口的最短距离4.46±0.96mm,翼管后口到颈动脉管外口的距离为20.08±2.70mm,到咽鼓管峡的距离为17.74±1.17mm。 结论对部分放疗后复发或残留鼻咽癌行鼻内镜下挽救手术是可行的,翼管、卵圆孔、头长肌、咽鼓管峡、茎突咽筋膜是鼻咽癌内镜手术中的重要标志;在鼻内镜下鼻咽癌挽救手术中咽鼓管的软骨部在内镜下全切困难,以翼管及卵圆孔为标志可扩大手术切缘;翼管及圆孔是鼻内镜经翼突(翼腭窝)进路颅底手术中的重要解剖标志。
[Abstract]:Objective to study the anatomy of the parapharyngeal space and the associated skull base area involved in nasoscopic salvage surgery for nasopharyngeal carcinoma (NPC). To understand the spatial relationship of the important anatomical structures in the skull base region in nasopharyngeal carcinoma salvage surgery under nasal endoscope, to find the appropriate anatomical markers to guide the clinical operation. Methods A total of 8 cadaveric heads (16 sides) with 10% formalin as anticorrosive fixation were selected and perfused with red and blue latex respectively. After spiral CT scanning, the nasal sinuses were opened. The following three operations were simulated: through the middle nasal canal or through the posterior wall of the maxillary sinus into the pterygopalatine fossa, into the infratemporal fossa; through the pterygoid process (or pterygopalatine fossa) to perform endoscopic nasal skull base surgery; The parapharyngeal space and the skull base of the corresponding region were dissected to identify the important anatomical structure and spatial relationship. The length of the pterygoid canal on CT was measured on the head of the cadaver, the distance between the nasal column and the genu of the pterygoid canal and the genu of the medial carotid artery, the distance from the isthmus of the eustachian tube to the internal carotid artery, the distance between the isthmus of the eustachian duct and the external orifice of the internal carotid artery, and the length of the pterygoid canal on CT. The distance from the sagittal line of the posterior orifice of the pterygoid canal to the inner edge of the orifice of the carotid artery, the shortest distance from the gorge of the eustachian tube to the internal carotid artery, the distance from the posterior orifice of the pterygoid canal to the isthmus of the eustachian tube, and the distance from the posterior orifice of the p@@ Results the occurrences of pterygoid canal in sphenoid sinus were affected by the degree of sphenoid sinus vaporization. However, the pterygoid canal always pointed to the ruptured hole, and the nerve around the pterygoid canal could locate the knee of the internal carotid artery. Under the pterygoid canal nerve, the fibrous cartilage of the ruptured foramen can be removed without harming the internal carotid artery; the relationship between the foramen circle and the pterygoid canal is constant in the pterygopalatine fossa. By tracking the maxillary nerve, the pterygoid canal nerve can locate the horizontal segment of the internal carotid artery, the anterior edge of the cavernous sinus and the Meckel's cavity by endoscopic naso-skull base operation via the pterygoid process (or pterygopalatine fossa). The isthmus of the eustachian tube is located on the lateral side of the foramen ovale during the nasoscopical salvage operation of nasopharyngeal carcinoma. The cartilage of the eustachian tube is difficult to be totally cut under endoscope. The mandibular nerve passing through the foramen ovale can maximize the excision of the cartilage of the eustachian tube. The internal carotid artery in the parapharyngeal space was located on the lateral side of the longus, the posterior fascia of the styloid pharyngeal fascia and the posterior inferior part of the eustachian duct isthmus about 0.5 cm, while the medial margin of the internal carotid artery was about the sagittal face of 1cm from the lateral side of the posterior orifice of the pterygoid canal. The length of the pterygoid canal was 16.31 卤2.16mm, the length of the pterygoid canal was 16.31 卤2.16mm, the length of the pterygoid canal was 16.31 卤2.16mm, the distance from the eustachian canal isthmus was 96.33 卤2.07mm, and the distance from the internal carotid artery was 101.56 卤2.56mm. The distance from the line to the inner edge of the carotid canal was 9.98 卤2.22 mm, the shortest distance from the eustachian duct isthmus to the internal carotid artery was 4.46 卤0.96 mm, the distance from the posterior orifice of the pterygoid canal to the external orifice of the carotid artery was 20.08 卤2.70 mm, and the distance to the isthmus of the eustachian tube was 17.74 卤1.17 mm. Conclusion it is feasible to perform endoscopic salvage surgery for recurrent or residual nasopharyngeal carcinoma after partial radiotherapy. Pterygoid canal, foramen ovale, longus capitis, isthmus of eustachian tube and fascia of styloid pharynx are important markers in endoscopic surgery for nasopharyngeal carcinoma. The cartilage of the eustachian tube was difficult to be removed under endoscope in nasopharyngeal carcinoma salvage operation, and the surgical margin could be enlarged by using pterygoid canal and foramen ovale as marks. The pterygoid canal and foramen are important anatomic markers in the skull base operation via the pterygopalatine fossa under nasal endoscope.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.63
本文编号：2225289
[Abstract]:Objective to study the anatomy of the parapharyngeal space and the associated skull base area involved in nasoscopic salvage surgery for nasopharyngeal carcinoma (NPC). To understand the spatial relationship of the important anatomical structures in the skull base region in nasopharyngeal carcinoma salvage surgery under nasal endoscope, to find the appropriate anatomical markers to guide the clinical operation. Methods A total of 8 cadaveric heads (16 sides) with 10% formalin as anticorrosive fixation were selected and perfused with red and blue latex respectively. After spiral CT scanning, the nasal sinuses were opened. The following three operations were simulated: through the middle nasal canal or through the posterior wall of the maxillary sinus into the pterygopalatine fossa, into the infratemporal fossa; through the pterygoid process (or pterygopalatine fossa) to perform endoscopic nasal skull base surgery; The parapharyngeal space and the skull base of the corresponding region were dissected to identify the important anatomical structure and spatial relationship. The length of the pterygoid canal on CT was measured on the head of the cadaver, the distance between the nasal column and the genu of the pterygoid canal and the genu of the medial carotid artery, the distance from the isthmus of the eustachian tube to the internal carotid artery, the distance between the isthmus of the eustachian duct and the external orifice of the internal carotid artery, and the length of the pterygoid canal on CT. The distance from the sagittal line of the posterior orifice of the pterygoid canal to the inner edge of the orifice of the carotid artery, the shortest distance from the gorge of the eustachian tube to the internal carotid artery, the distance from the posterior orifice of the pterygoid canal to the isthmus of the eustachian tube, and the distance from the posterior orifice of the p@@ Results the occurrences of pterygoid canal in sphenoid sinus were affected by the degree of sphenoid sinus vaporization. However, the pterygoid canal always pointed to the ruptured hole, and the nerve around the pterygoid canal could locate the knee of the internal carotid artery. Under the pterygoid canal nerve, the fibrous cartilage of the ruptured foramen can be removed without harming the internal carotid artery; the relationship between the foramen circle and the pterygoid canal is constant in the pterygopalatine fossa. By tracking the maxillary nerve, the pterygoid canal nerve can locate the horizontal segment of the internal carotid artery, the anterior edge of the cavernous sinus and the Meckel's cavity by endoscopic naso-skull base operation via the pterygoid process (or pterygopalatine fossa). The isthmus of the eustachian tube is located on the lateral side of the foramen ovale during the nasoscopical salvage operation of nasopharyngeal carcinoma. The cartilage of the eustachian tube is difficult to be totally cut under endoscope. The mandibular nerve passing through the foramen ovale can maximize the excision of the cartilage of the eustachian tube. The internal carotid artery in the parapharyngeal space was located on the lateral side of the longus, the posterior fascia of the styloid pharyngeal fascia and the posterior inferior part of the eustachian duct isthmus about 0.5 cm, while the medial margin of the internal carotid artery was about the sagittal face of 1cm from the lateral side of the posterior orifice of the pterygoid canal. The length of the pterygoid canal was 16.31 卤2.16mm, the length of the pterygoid canal was 16.31 卤2.16mm, the length of the pterygoid canal was 16.31 卤2.16mm, the distance from the eustachian canal isthmus was 96.33 卤2.07mm, and the distance from the internal carotid artery was 101.56 卤2.56mm. The distance from the line to the inner edge of the carotid canal was 9.98 卤2.22 mm, the shortest distance from the eustachian duct isthmus to the internal carotid artery was 4.46 卤0.96 mm, the distance from the posterior orifice of the pterygoid canal to the external orifice of the carotid artery was 20.08 卤2.70 mm, and the distance to the isthmus of the eustachian tube was 17.74 卤1.17 mm. Conclusion it is feasible to perform endoscopic salvage surgery for recurrent or residual nasopharyngeal carcinoma after partial radiotherapy. Pterygoid canal, foramen ovale, longus capitis, isthmus of eustachian tube and fascia of styloid pharynx are important markers in endoscopic surgery for nasopharyngeal carcinoma. The cartilage of the eustachian tube was difficult to be removed under endoscope in nasopharyngeal carcinoma salvage operation, and the surgical margin could be enlarged by using pterygoid canal and foramen ovale as marks. The pterygoid canal and foramen are important anatomic markers in the skull base operation via the pterygopalatine fossa under nasal endoscope.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.63
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