本文關(guān)鍵詞：額鼻區(qū)手術(shù)入路斷層解剖學(xué)研究及意義　出處：《天津醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 額鼻區(qū) 火棉膠 中鼻道 手術(shù)入路 斷層解剖學(xué) 應(yīng)用解剖學(xué)

【摘要】：目的額鼻區(qū)位于鼻的上方、視器的內(nèi)側(cè)、腦和腦血管的下方。主要結(jié)構(gòu)包括額竇、鼻額管(峽)及額隱窩。其交通廣泛,發(fā)生于此的腫瘤、類腫瘤易轉(zhuǎn)移,且難以徹底清除。隨著醫(yī)學(xué)的發(fā)展和進(jìn)步,國(guó)內(nèi)外學(xué)者對(duì)此從大體到影像學(xué)進(jìn)行大量報(bào)道,但未見(jiàn)用連續(xù)薄切片技術(shù)的研究。鑒此,我們用改進(jìn)火棉膠包埋薄切片(0.25mmm)的技術(shù)及應(yīng)用解剖學(xué)方法,對(duì)額鼻區(qū)進(jìn)行斷層與應(yīng)用解剖學(xué)研究,為額鼻區(qū)手術(shù)入路提供形態(tài)學(xué)與臨床應(yīng)用解剖學(xué)依據(jù)。 方法取固定成尸頭標(biāo)本30例,取前顱底。標(biāo)本經(jīng)20%HCl脫鈣,梯度脫水(將組織塊按照順序浸泡在濃度依次為70%、80%、95%、無(wú)水乙醇和乙醚乙醇的液體中),梯度浸膠(將組織塊按順序依次放入濃度為5%、8%和15%的火棉膠中浸泡),包埋,焊塊,用德國(guó)制造JUNGAG型大腦切片機(jī),在水平面、矢狀面和冠狀面切成0.25mm薄切片(三維),對(duì)額鼻區(qū)的形態(tài)、毗鄰特點(diǎn)進(jìn)行觀測(cè)。并用80側(cè)干燥顱骨及20側(cè)脫鈣尸頭標(biāo)本對(duì)額鼻區(qū)進(jìn)行測(cè)量,并獲取一些數(shù)據(jù)。 結(jié)果對(duì)水平面、矢狀面及冠狀面的不同層面進(jìn)行描述,額鼻區(qū)結(jié)構(gòu)形態(tài)多樣,左右形態(tài)和位置均不對(duì)稱。額鼻區(qū)的結(jié)構(gòu)整體形似沙漏,額竇是沙漏的上半部,鼻額管(峽)是沙漏的狹細(xì)部,額隱窩是沙漏的下半部。在水平面上,額竇可呈現(xiàn)三角形、手槍形、牛角管形、弧形、鐮刀形、短棒狀形甚至駝峰形；鼻額管上口形狀呈圓形、卵圓形、長(zhǎng)梭形,窄縫形；額隱窩呈梨形、矩形及扁窄的裂隙形。冠狀面上,額竇呈三角形、蝶翼形或四邊形；鼻額管呈弧形；額隱窩呈三角形或近似矩形。矢狀面上,額竇呈錐形、橫置的喇叭形或橢圓形,鼻額管呈“S”形,直線型及斜行狹長(zhǎng)的形態(tài)。 結(jié)論將水平斷層、冠狀斷層及矢狀斷層有效地結(jié)合,對(duì)診斷額鼻區(qū)疾病和指導(dǎo)手術(shù)更加有效。本研究結(jié)合斷層解剖學(xué)與應(yīng)用解剖學(xué),為FESS技術(shù)設(shè)計(jì)出一條新型手術(shù)入路,即經(jīng)鼻腔自然通道行額鼻區(qū)手術(shù)入路。從中鼻道進(jìn)入,找到篩泡和半月裂孔并以其為標(biāo)志,將手術(shù)器械向前上方延伸,找到鼻額管下口。用長(zhǎng)彎頭吸引切割器經(jīng)鼻額管從下向上進(jìn)行操作,進(jìn)行引流或竇腔內(nèi)腫物切除。由此處入路手術(shù)創(chuàng)傷小、出血少,安全系數(shù)高、術(shù)后并發(fā)癥少。在術(shù)前對(duì)額鼻區(qū)進(jìn)行影像學(xué)檢測(cè),以提高手術(shù)的成功率。
[Abstract]:Above the objective frontal nasal area is located in the medial nasal, the lower brain and cerebral blood vessels. The main structure includes frontal sinus, intranasal (GAP) and frontal recess. The traffic is widespread, happened in this tumor, tumor metastasis, and it is difficult to completely remove. Along with the development and progress of medicine in China foreign scholars from the general to imaging a lot of reports, but the study of continuous thin slice with no. In view of this, we use the improved celloidin slices (0.25mmm) technique and applied anatomy method, research and application of the frontonasal anatomy fault zone, to provide morphological and anatomical basis for clinical application value the nasal surgical approach.
Methods fixed cadaveric head specimens in 30 cases, the anterior skull base. Specimens were decalcified with 20%HCl, gradient dehydration (tissue soaked in the concentration in accordance with the order of the order of 70%, 80%, 95%, ethanol and ether ethanol liquid), gradient (dipping tissue successively into the concentration of 5%, 8% and 15% of the collodion embedding, immersion), welding block, manufacturing JUNGAG brain slicing machine in Germany, in the horizontal plane, sagittal and coronal thin slices cut into 0.25mm (San Wei), the amount of nasal shape, adjacent to the characteristics were observed. And to measure the amount of nasal side 80 dry skull and 20 lateral decalcified cadaveric head specimens, and get some data.
The results of the horizontal plane, to describe the different levels of sagittal and coronal structure, frontonasal region diversity, about shape and position are asymmetric. The overall structure of frontonasal region resembling an hourglass, the frontal sinus is part of the hourglass, intranasal (GAP) is the amount of detail narrow, hidden nest is lower the hourglass. In the horizontal plane, the frontal sinus can be triangular, shaped like a horn, tube shaped, curved, sickle shaped, short rod shaped and hump shaped; intranasal mouth is circular, oval, fusiform, narrow; frontal recess is pear shaped, rectangular shape and narrow slit. The coronal plane, frontal triangle, butterfly wing or quadrilateral; intranasal arc; frontal recess is triangular or rectangular. The sagittal, frontal conical, transverse horn shaped or oval, nasofrontal duct was "S" shape, straight and oblique strip shape.
Conclusion the level of fault, fault and coronal sagittal effectively combined, more effective in the diagnosis of frontonasal region disease and guiding surgery. On the basis of anatomy and applied anatomy, FESS technology to design a new surgical approach, namely nasal surgery, nasal region natural channel. The approach from entering find the bulla meatus, semilunar hiatus and its signs, surgical instruments will be forward extending above, find the nasofrontal duct mouth. With long nasal tube, elbow cutterbar from down to up, drainage or sinus tumor resection. The approach to surgical trauma, less bleeding, high safety, less postoperative complications. The preoperative imaging of frontonasal region detection, in order to improve the success rate of the operation.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R322-3

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本文編號(hào)：1371934