咽鼓管薄层断层解剖及临床应用

发布时间：2019-02-12 21:17

【摘要】：研究目的通过对人体标本鼻咽部及侧颅底的连续横断面薄层断层解剖学图像的观测,连续追踪观测咽鼓管及周围重要毗邻结构的位置关系,为安全的进行咽鼓管周围区域手术提供解剖学资料。研究方法筛选无明显器质性病变的成年男性头部标本15例(30侧),经固定、冷冻、包埋,以层厚0.1mm的厚度(机床0.001mm的铣削精度)、以Reid基线为基准行横断面铣切,每铣切完一层即通过电脑自带软件控制相机拍摄采集图像,获取咽鼓管区域连续断层图像,使用相关软件测量数据,与原图旁边的刻度尺对照,得实物真实距离,观察、测量咽鼓管及周围重要毗邻结构。结果咽鼓管于横断面上从首次出现到基本消失,共铣切197-254个断面,其中63-89个显示较完整骨部。 1、于咽鼓管咽口水平：咽鼓管两侧枕状粘膜间经测量,咽口宽度为(4.92±2.68)mm。于咽口所在平面,11侧未见下鼻甲后端,测量剩余19侧标本咽口到下鼻甲后端粘膜距离为(11.65±3.42)mm。 2、于咽鼓管中段可追踪观察到咽外侧间隙呈一个底大尖小的倒立锥体,颞下窝向上移行形成翼腭间隙的底,其后界与顶为蝶骨。 3、于咽鼓管鼓室口水平：测量咽鼓管骨部与颈动脉管间骨质厚度为(1.28±0.31)mm。结论及意义 1、对标本行冰冻铣切断层技术,避免传统锯切法造成的标本某些微细结构的变形及损坏,层厚仅为0.1mm,片间损耗极小,可保持标本的相对完整,获得的图像较传统图像清晰,清楚显示咽鼓管及周围有关结构的解剖位置,为该区域手术治疗提供了一定意义上的解剖学资料。 2、对咽鼓管咽口的观测表明：咽口前后枕粘膜间隙宽度的个体差异较大,形状多变,此对变应性鼻炎、分泌性中耳炎等多种疾病的诊断及治疗密切相关。 3、咽侧壁的咽隐窝及咽外侧间隙所属的侧颅底结构复杂,此区肿瘤多发,其偏后位置有颈内动静脉、舌咽神经、迷走神经等走行,清晰辨别解剖结构对判断此区肿瘤的组织来源及鉴别诊断有重要意义。 4、咽鼓管骨部内壁与颈内动脉相隔(1.28±0.31)mm的薄层骨质,提示中耳癌侵及咽鼓管时易转移,为安全的行使中耳及颅中窝相关手术提供资料。
[Abstract]:Objective to observe the position relationship of eustachian tube and its adjacent structures continuously by observing the thin sectional anatomy images of the nasopharynx and lateral skull base of human body. To provide anatomical data for the safe operation of the eustachian tube. Methods Fifteen adult male head specimens (30 sides) without obvious organic lesions were selected, and were fixed, frozen and embedded with the thickness of 0.1mm (milling accuracy of 0.001mm machine tool). The Reid baseline is used as the benchmark for cross section milling. After each layer is cut, the images are captured by the computer software control camera, and the continuous sectional images of the eustachian tube region are obtained. The relevant software is used to measure the data and compare with the scale next to the original image. Get the real distance, observe and measure the eustachian tube and its surrounding important adjacent structure. Results the eustachian tube appeared on the cross section from the first time to the basic disappearance, milling a total of 197-254 sections, of which 63-89 showed a complete bone. 1. The width of pharyngeal mouth was (4.92 卤2.68) mm., measured between the occipital mucosa of the eustachian tube and the eustachian tube. At the level of pharyngeal orifice, the posterior end of inferior turbinate was not seen in 11 sides. The distance between pharynx mouth and posterior mucosa of inferior turbinate in the remaining 19 specimens was (11.65 卤3.42) mm.. 2. In the middle part of the eustachian tube, the lateral pharyngeal space was found to be an inverted pyramidal with a large and small base, the bottom of the pterygopalatine space was formed from the inferior temporal fossa upward, and the sphenoid bone was the posterior boundary and the apex. 3The thickness of the bone between the eustachian tube and the carotid artery was (1. 28 卤0. 31) mm.. Conclusion and significance 1. The frozen milling fault technique is used to avoid the deformation and damage of some micro-structures caused by the traditional sawing method. The thickness of the layer is only 0.1 mm, the loss between slices is very small, and the specimen is relatively intact. Compared with the traditional images, the obtained images clearly show the anatomical location of the eustachian tube and its surrounding structures, which provides some anatomical data for surgical treatment in this area. 2. The observation of pharyngeal orifice of the eustachian tube showed that the width of the anterior and posterior occipital mucosal space of the pharynx was quite different and varied in shape, which was closely related to the diagnosis and treatment of allergic rhinitis, secretory otitis media and other diseases. 3, the lateral pharyngeal recess and the lateral skull base of the lateral pharynx space are complicated, the tumors in this area are multiple, the posterior position of the tumors are internal cervical arteriovenous, glossopharyngeal nerve, vagus nerve, etc. It is important to distinguish the anatomical structure of the tumor in this area. 4. The thin layer of bone between the internal wall of the eustachian tube and the internal carotid artery was (1. 28 卤0. 31) mm, which suggested that the carcinoma of the middle ear could metastasize easily when it invaded the eustachian tube, which provided information for the safe operation of the middle ear and the middle cranial fossa.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764.21

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