本文選題：蝶腭動(dòng)脈 + 篩前動(dòng)脈��； 參考：《南華大學(xué)》2012年碩士論文

【摘要】：目的： 通過(guò)對(duì)蝶腭孔的位置和蝶腭動(dòng)脈分支在鼻腔外側(cè)壁的穿出點(diǎn)進(jìn)行觀測(cè)，探討傳統(tǒng)中鼻道入路蝶腭動(dòng)脈結(jié)扎術(shù)的不足；通過(guò)觀測(cè)鼻后外側(cè)動(dòng)脈分支在鼻腔外側(cè)壁的分布，探討下鼻甲動(dòng)脈電凝的可行性；通過(guò)對(duì)篩動(dòng)脈的解剖和臨床資料的研究與分析，探尋一種可供選擇的結(jié)扎術(shù)式。 材料和方法： 1.干性半側(cè)顱骨50例。16具頭頸部標(biāo)本，其中12具防腐標(biāo)本，4具為新鮮標(biāo)本。臨床資料（影像，內(nèi)鏡）。 2.干性半側(cè)顱骨標(biāo)本50例，觀察蝶腭孔的位置，測(cè)量蝶腭孔的相關(guān)數(shù)據(jù)，測(cè)量篩前孔至鼻前棘的距離及其連線與鼻底的夾角。 3．16具防腐和新鮮頭部標(biāo)本灌注后，其中10具行正矢中狀切，5具沿中鼻甲后端平面行冠狀切，1具新鮮標(biāo)本用于制作鑄型。 4.在20側(cè)頭部正中矢狀切標(biāo)本上，對(duì)鼻腔外側(cè)壁結(jié)構(gòu)進(jìn)行解剖，測(cè)量鼻后外側(cè)動(dòng)脈穿出點(diǎn)至上頜竇自然口、至鼻后孔、至中鼻甲后端的距離；測(cè)量鼻后中隔動(dòng)脈穿出點(diǎn)至中鼻甲后端水平距離和垂直距離、及至中鼻甲附著部的距離。觀察鼻后外側(cè)動(dòng)脈在中鼻道的分支分布，測(cè)量下鼻甲動(dòng)脈起點(diǎn)至中鼻甲附著部、下鼻甲附著部的垂直距離，至中鼻甲后端附著部、下鼻甲后端附著部的水平距離（在下鼻甲附著部的水平測(cè)量），至上頜竇自然口的距離。在5具冠狀切的標(biāo)本，充分顯露蝶竇前壁，測(cè)量鼻后中隔動(dòng)脈上、下支至蝶竇口的垂直距離及其外徑；去除眶頂和篩頂，充分顯示篩前動(dòng)脈主干走行。 5.觀察鑄型標(biāo)本中蝶腭動(dòng)脈分支和篩動(dòng)脈的主干走行。 6.分析臨床典型內(nèi)鏡和影像資料。 結(jié)果： 1.蝶腭孔的位置：第一類：蝶腭孔位于中鼻道和后鼻道后部的移行區(qū)域，38例占76%，，其前緣的中部與篩嵴后端接觸；第二類：蝶腭孔緊鄰篩嵴且位于其后上，12例占24%。蝶腭孔相關(guān)數(shù)據(jù)測(cè)量：篩嵴至鼻前棘的距離：54.15±7.82mm；篩嵴至前鼻棘的連線與鼻底的夾角：(21.4±3.6)°；篩嵴至下鼻甲水平部的距離：13.11±2.12mm；篩嵴至腭骨水平板的距離：18.27±1.13mm。 2.蝶腭動(dòng)脈分支穿出點(diǎn)的相關(guān)數(shù)據(jù)測(cè)量：鼻后外側(cè)動(dòng)脈穿出點(diǎn)至上頜竇自然口的距離：21.60±3.03mm；至鼻后孔的距離：9.41±2.05mm；至中鼻甲后端的距離：8.21±1.74mm。鼻后中隔動(dòng)脈穿出點(diǎn)至中鼻甲后端水平距離：7.72±2.04mm；至中鼻甲后端的垂直距離：8.11±2.45mm；至中鼻甲附著部的距離：4.31±1.69mm。相對(duì)于中鼻甲在鼻腔外側(cè)壁的附著部而言，鼻后中隔動(dòng)脈穿出點(diǎn)均較恒定的位于其后上方。鼻后中隔動(dòng)脈上、下支至蝶竇口的垂直距離及其外徑：上支距蝶竇口的距離：8.50±0.20mm；下支距蝶竇口的距離：13.22±0.30mm；上支外徑：0.93±0.06mm；下支外徑：1.01±0.21mm。 3.在20側(cè)標(biāo)本中，有19例（95%），其鼻后外側(cè)動(dòng)脈分為中鼻甲動(dòng)脈和下鼻甲動(dòng)脈兩個(gè)分支，分別供應(yīng)中鼻甲、下鼻甲，僅有1例標(biāo)本（5%）的鼻后外側(cè)動(dòng)脈發(fā)出三個(gè)分支，即兩支下鼻甲動(dòng)脈，一支為中鼻甲動(dòng)脈；鼻后外側(cè)動(dòng)脈在鼻腔外側(cè)壁發(fā)出分支的高度也不盡相同，近端分叉和遠(yuǎn)端分叉分別占95%(19例)和5%（1例）；在12例（60%）標(biāo)本中觀測(cè)到上頜竇后囟支，其中起源于中鼻甲動(dòng)脈的為10例，起源于下鼻甲動(dòng)脈的為2例。在3例（15%）標(biāo)本中，可見(jiàn)腭降動(dòng)脈的分支從后面加入到下鼻甲動(dòng)脈；下鼻甲動(dòng)脈起點(diǎn)的相關(guān)數(shù)據(jù)測(cè)量：下鼻甲動(dòng)脈起點(diǎn)到中鼻甲附著部的垂直距離：2.50±1.22mm;下鼻甲動(dòng)脈起點(diǎn)到下鼻甲附著部的垂直距離:9.50±2.10mm;下鼻甲動(dòng)脈起點(diǎn)到中鼻甲后端附著部的距離:8.21±2.80mm;下鼻甲動(dòng)脈起點(diǎn)到下鼻甲后端附著部的水平距離:9.20±1.82mm;下鼻甲動(dòng)脈起點(diǎn)到上頜竇自然口的距離:20.22±3.01mm。 4.篩前動(dòng)脈主干穿過(guò)三個(gè)腔：眼眶、篩竇、顱前窩，該血管在篩竇內(nèi)呈水平位向前內(nèi)走行，于嗅窩前部穿入鼻腔。篩動(dòng)脈竇內(nèi)段部分緊貼篩頂走行，部分離篩頂有一段距離。篩前孔到鼻前棘的距離為58.13±4.01mm,篩前孔至鼻前棘連線與鼻底的夾角為(65.5±4.5)°。 結(jié)論： 1．通過(guò)兩步法分別結(jié)扎蝶腭動(dòng)脈兩主干是一種可供選擇的方法。 2．下鼻甲手術(shù)前為減少術(shù)中出血，可在下鼻甲后端前上1cm左右，靠經(jīng)下鼻甲附著部電凝下鼻甲動(dòng)脈。 3．沿眶紙板鼻腔側(cè)和篩頂?shù)膴A角區(qū)域?qū)ふ医Y(jié)扎篩動(dòng)脈是一種可以嘗試的方法。
[Abstract]:Objective:
Through the observation of the location of the sphenopalatine hole and the perforating point of the sphenopalatine artery in the lateral wall of the nasal cavity, the shortcomings of the traditional transsphenoidal ligation of the sphenopalatine artery were discussed. The feasibility of the electrocoagulation of the inferior turbinate artery was explored by observing the distribution of the lateral nasal lateral artery in the lateral wall of the nasal cavity, and the anatomical and clinical data of the sifted artery were analyzed. Research and analysis to explore an alternative way of ligation.
Materials and methods:
1. 50 cases of dry half side skull were.16 with head and neck specimens, 12 of them were anticorrosive specimens, 4 were fresh specimens. Clinical data (imaging, endoscopy).
2. the 50 cases of dry semi cranial bone specimens were used to observe the location of the sphenopalatine foramen and the related data of the sphenopalatine holes. The distance between the anterior sieves and the anterior nasal spines and the angle between the line and the bottom of the nose were measured.
After perfusion of 3.16 anticorrosive and fresh head specimens, 10 of them were cut in the middle of the normal vector, and 5 were cut along the posterior end of the middle turbinate, and 1 fresh specimens were used to make the cast.
4. on 20 sides of the median sagittal section of the head, the structure of the lateral nasal wall was dissected, and the distance from the posterior nasal cavity to the natural mouth of the maxillary sinus, to the posterior nasal hole and to the posterior end of the middle turbinate was measured; the distance from the posterior nasal septum to the posterior nasal turbinate and the distance to the attachment of the middle turbinate was measured. The branches of the posterolateral artery were distributed in the middle nasal canal, measuring the distance between the starting point of the inferior turbinate artery to the attachment of the middle turbinate, the vertical distance of the inferior turbinate attachment, the attachment of the posterior turbinate, the horizontal distance of the posterior inferior turbinate attachment part (level at the inferior turbinate attachment part), the distance from the maxillary sinus natural mouth. The 5 coronoid specimens were fully demonstrated. The anterior wall of the sphenoid sinus is used to measure the vertical distance and the outer diameter of the superior septal artery, the lower branch of the nasal septum to the mouth of the sphenoid sinus, and the removal of the orbital top and the ethmoid top, which fully displays the main artery of the anterior ethmoid artery.
5. to observe the branches of the sphenopalatine artery and the ethmoidal artery in cast specimens.
6. analysis of typical clinical endoscopy and imaging data.
Result錛

本文編號(hào)：1984696