本文選題：內(nèi)鏡 + 經(jīng)鼻腔　； 參考：《南京醫(yī)科大學》2011年碩士論文

【摘要】：目的研究內(nèi)鏡經(jīng)鼻腔入路治療顱底中線區(qū)病變的解剖特點,指導手術實踐。 方法在10例成人尸頭標本上模擬內(nèi)鏡下經(jīng)鼻腔至顱底中線區(qū)域的手術入路。研究該入路下的手術可及范圍、路徑、各區(qū)域的解剖特點。確定術中具有指導意義的解剖標志。 結(jié)果采用經(jīng)雙鼻孔-鼻中隔粘膜間入路,可明顯提高術中操作的便利性,并能擴大視角。內(nèi)鏡經(jīng)鼻腔入路可充分顯露鞍區(qū)解剖結(jié)構。前、后組篩竇和雙側(cè)上、中鼻甲應根據(jù)需要選擇性去除。以兩側(cè)OCR(opto-carotid recess,頸內(nèi)動脈-視神經(jīng)隱窩)的連線定位,在鞍結(jié)節(jié)、蝶骨平臺處磨開骨質(zhì),向前可以暴露兩側(cè)達眶內(nèi)側(cè)壁、前達額竇的整個前顱底中線區(qū)域,向鞍上可以顯露鞍上池、視交叉池、終板池及其內(nèi)的重要組織結(jié)構,并可經(jīng)終板進入第三腦室。以OCR和頸內(nèi)動脈隆突定位,可以顯露海綿竇下壁和內(nèi)側(cè)壁,由此進入海綿竇內(nèi),可顯露其內(nèi)的血管、神經(jīng)。去除整個斜坡骨質(zhì),可顯露中腦、橋腦、延髓及其局部的重要血管、神經(jīng)。通過尸頭模擬手術,總結(jié)了以上各個區(qū)域手術的路徑和重要的解剖標志。測定蝶竇開口長軸的大小為4.4～6.8(5.5±0.9)mm,雙側(cè)蝶竇開口內(nèi)緣間最短處的距離為4.2～6.2(5.2±0.7)mm,鼻小柱至蝶竇開口、鞍底、鞍結(jié)節(jié)、OCR內(nèi)緣、斜坡凹陷、篩后動脈、篩前動脈的距離分別為52.6～78.3(63.4±7.6)mm、63.8～90.1(75.7±8.2)mm、71.4～92.5(80.5±6.4)mm、73.5～93.6(82.6±6.3)mm、76.4～96.8(84.8±6.8)mm、64.5～87.5(74.4±7.1)mm、60.3～77.5(67.8±5.6)mm,兩側(cè)OCR內(nèi)緣間的距離為15.0～26.0(22.7±3.7)mm,兩側(cè)頸內(nèi)動脈隆突間的距離為9.8～16.5(13.9±2.1)mm,兩側(cè)眶內(nèi)側(cè)壁間最寬處的距離為25.4～51.5(36.4±8.2)mm。 結(jié)論內(nèi)鏡經(jīng)鼻腔入路可用于治療整個顱底中線區(qū)的病變。該入路視角較顯微鏡下明顯擴大,手術可及范圍得到極大擴展,且具有可以直接到達病變區(qū)域、避免對腦組織、血管的牽拉等優(yōu)點。術中通過各個解剖標志的相互對照和組織結(jié)構間的毗鄰關系可以準確定位,避免術中迷失方向。
[Abstract]:Objective to study the anatomical characteristics of endoscopic transnasal approach in the treatment of skull base midline lesions and to guide the operation practice. Methods 10 adult cadaveric specimens were operated through nasal cavity to the midline of skull base under simulated endoscope. To study the range, path and anatomical characteristics of the operation under this approach. To determine the anatomical markers of guiding significance during the operation. Results the transnasal-nasal septum intermucosal approach can significantly improve the operation convenience and expand the visual angle. Endoscopic transnasal approach can fully reveal the anatomical structure of the Sellar region. Anterior and posterior ethmoid sinus and bilateral superior middle turbinate should be selectively removed as needed. Using bilateral opto-carotid recess (internal carotid artery-optic nerve recess), the bone was sharpened at the Sellar tubercle and the sphenoid plateau, and the bilateral medial orbital wall, the entire anterior midline region of the anterior skull base reached to the frontal sinus, and the suprasellar cistern could be exposed to the anterior skull base. The optic chiasma, the endplate cistern and its internal important tissue structure, and can enter the third ventricle through the endplate. The inferior wall and medial wall of cavernous sinus can be exposed by the localization of OCR and internal carotid artery protuberance, and the vessels and nerves of the cavernous sinus can be exposed. Removing the entire Clivus bone reveals the midbrain, pontine, medulla oblongata and its local important vessels and nerves. Through the simulated operation of cadaveric head, the surgical paths and important anatomical markers in each of the above regions were summarized. The length of long axis of sphenoid sinus orifice was 4. 4 鹵6. 8 mm (5.5 鹵0. 9) mm, and the shortest distance between bilateral sphenoid sinus orifice was 4. 2 鹵6. 2 (5.2 鹵0. 7) mm. The length of nasal column to sphenoid sinus orifice, Sellar floor, Sellar nodule OCR inner edge, clival depression, posterior ethmoidal artery were measured. 絳涘墠鍔ㄨ剦鐨勮窛紱誨垎鍒負52.6锝，

本文編號：2073168