擴大中顱底入路頸內(nèi)動脈巖骨段血管搭橋術(shù)的顯微解剖及動物實驗研究
發(fā)布時間：2019-01-04 07:23
【摘要】：第一部分：擴大中顱底入路頸內(nèi)動脈巖骨段的顯微解剖 目的研究經(jīng)擴大中顱底手術(shù)入路頸內(nèi)動脈巖骨段及其周圍毗鄰結(jié)構(gòu)的解剖學特點,為臨床手術(shù)提供解剖學基礎(chǔ)。 方法在6具動脈灌注乳膠的成人尸頭上模擬擴大中顱底手術(shù)入路,在顯微鏡下觀察頸內(nèi)動脈巖骨段及其分段、分支,巖淺大神經(jīng),膝狀神經(jīng)節(jié),耳蝸,內(nèi)聽道的解剖關(guān)系并進行測量。 結(jié)果頸內(nèi)動脈巖骨段共分為水平段、膝部、垂直段三段,經(jīng)擴大中顱底入路可暴露三段平均距離分別為9.1±1.1mm、3.8±0.3mm、10.2±1.5mm,血管直徑分別為5.5±0.4mm、5.4±1.Omm、5.2±0.7mm.本實驗未發(fā)現(xiàn)其具有分支。向前牽拉V3可增加巖骨段ICA的暴露長度4.0±0.5mm(P0.05)。棘孔,弓狀隆起,巖淺大神經(jīng),膝狀神經(jīng)節(jié)是擴大中顱底手術(shù)入路的重要解剖標志。頸內(nèi)動脈巖骨段,耳蝸,內(nèi)聽道等是擴大中顱底入路手術(shù)入路中的重要解剖結(jié)構(gòu)。 結(jié)論頸內(nèi)動脈巖骨段具有分支少,管徑粗的優(yōu)點,是進行顱內(nèi)外血管搭橋的適宜部位。向前牽拉V3可顯著增加巖骨段ICA的暴露長度(P0.05),為此處行血管搭橋手術(shù)提供了更長的操作距離。擴大中顱底入路行巖骨段ICA搭橋是一種處理該部位病變的良好輔助術(shù)式。 第二部分：顱內(nèi)外頸內(nèi)動脈系統(tǒng)高流量搭橋動物模型的建立 目的通過模擬擴大中顱底入路,建立大型動物頸外動脈-顱內(nèi)頸內(nèi)動脈系統(tǒng)高流量搭橋和圍手術(shù)期觀察模型,為顱內(nèi)外高流量血管搭橋手術(shù)應(yīng)用于臨床,摸索出一整套完成該項手術(shù)所需的臨床實踐培訓模式,為相關(guān)神經(jīng)外科,血管外科,顱底外科醫(yī)師提供一個模擬訓練的平臺。 方法比格犬2只,體重在9Kg-10Kg之間。術(shù)前肌注鹽酸氯胺酮10mg/Kg,實施基礎(chǔ)麻醉。建立靜脈通道,以鹽酸氯胺酮2mg/Kg進行麻醉誘導,氣管插管后,銜接麻醉機輔助呼吸。氯胺酮維持麻醉。選擇頸外動脈的直接終末支頜內(nèi)動脈未進骨的一段作為搭橋起點,大腦中動脈在側(cè)裂中的分支作為止點,取犬的股動脈為橋血管進行顱內(nèi)外搭橋手術(shù)。術(shù)后立即行全腦動脈數(shù)字剪影血管造影(DSA)觀察血管搭橋暢通情況 結(jié)果2只比格犬(2側(cè))均在顯微鏡下行頜內(nèi)動脈-大腦中動脈M2段高流量血管搭橋手術(shù),制成模型,手術(shù)順利,無麻醉意外發(fā)生,移植血管通暢,手術(shù)時間為7-9小時。術(shù)后DSA顯示大腦中動脈M2段經(jīng)移植血管供血,兩端吻合口及移植血管通暢。 結(jié)論犬顱內(nèi)外頸內(nèi)動脈系統(tǒng)高流量血管搭橋模型,具有材料相似,流量高,血壓相似,手術(shù)平穩(wěn),通暢率高的優(yōu)點,更加接近顱內(nèi)外頸內(nèi)動脈高流量搭橋的真實手術(shù)過程,可以為希望掌握高流量血管搭橋技術(shù)的外科醫(yī)師提供一個更接近于真實手術(shù)過程的模擬訓練平臺。
[Abstract]:Part I: microanatomy of the petrosal segment of the internal carotid artery via the extended middle skull base approach objective to study the anatomical characteristics of the petrosal bone segment of the internal carotid artery and its adjacent structures through the extended middle skull base approach, and to provide anatomic basis for clinical operation. Methods six adult cadaveric cadavers with arterial infusion of latex were used to simulate the enlarged middle skull base approach. The petrosal bone segment and its segments, branches, superficial petrosal nerve, geniculate ganglion and cochlea of the internal carotid artery were observed under microscope. The anatomical relationship of the internal auditory canal was measured. Results the petrous bone segment of the internal carotid artery was divided into three segments: horizontal segment, knee segment and vertical segment. The mean distance of the three segments exposed through the extended middle skull base approach was 9.1 鹵1.1 mm, 3.8 鹵0.3 mm and 10.2 鹵1.5 mm, and the diameter of the vessels was 5.5 鹵0.4 mm, respectively. 5.4 鹵1.Omm.5.2 鹵0.7mm. No branch was found in this experiment. Drawing V3 forward increased the exposure length of ICA in petrosal bone segment by 4.0 鹵0.5mm (P0.05). Foramen spinosus, arcuate eminence, superficial greater petrosal nerve and geniculate ganglion are important anatomic markers for expanding the approach of middle skull base operation. The petrosal segment, cochlea and internal auditory canal of the internal carotid artery are important anatomical structures in the extended middle skull base approach. Conclusion the petrous bone segment of the internal carotid artery has the advantages of less branches and thicker diameter, which is the suitable site for external intracranial artery bypass grafting. Pulling V3 forward can significantly increase the exposure length of ICA in petrosal bone segment (P0.05), which provides a longer operating distance for vascular bypass surgery. Extending the middle skull base approach to the petrosal bone segment ICA bypass is a good auxiliary procedure for the treatment of this site. Part two: establishment of animal model of high flow bypass graft of internal and external carotid artery system objective to establish a large animal model of large external carotid artery internal carotid artery system high flow bypass graft and perioperative period by simulating the expansion of the middle skull base approach. In order to apply high flow blood vessel bypass surgery to clinical practice, a set of clinical training models needed to complete the operation were found out, and a simulated training platform for neurosurgery, vascular surgery and skull base surgeons was provided. Methods two Beagle dogs were weight between 9Kg-10Kg. Ketamine hydrochloride 10 mg / kg was injected intramuscularly before operation to perform basic anesthesia. To establish an intravenous channel and induce anesthesia with ketamine hydrochloride 2mg/Kg. After tracheal intubation, the anesthesia machine was connected to assist breathing. Ketamine maintains anesthesia. The internal maxillary artery of the external carotid artery was chosen as the starting point, the branch of the middle cerebral artery in the lateral fissure as the stop point, and the femoral artery of the dog as the graft vessel. The smooth flow of artery bypass grafts was observed by digital silhouette angiography of global cerebral artery (DSA) immediately after operation. Results two Beagle dogs (2 sides) underwent high flow artery bypass grafting of internal maxillary artery to middle cerebral artery (M2 segment) under microscope. The model was made, the operation was smooth, no anaesthesia accident occurred, the vascular graft was patency, the operation time was 7-9 hours. DSA showed that the M 2 segment of the middle cerebral artery was supplied by the grafts and the anastomotic stoma and graft vessels were patency. Conclusion the canine model of high flow artery bypass with internal and external carotid artery system has the advantages of similar material, high flow rate, similar blood pressure, stable operation and high patency rate, which is closer to the true operation process of high flow bypass graft of internal and external carotid artery. It can provide a simulation training platform for surgeons who want to master high flow vascular bypass technique.
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R651.1;R322.8
[Abstract]:Part I: microanatomy of the petrosal segment of the internal carotid artery via the extended middle skull base approach objective to study the anatomical characteristics of the petrosal bone segment of the internal carotid artery and its adjacent structures through the extended middle skull base approach, and to provide anatomic basis for clinical operation. Methods six adult cadaveric cadavers with arterial infusion of latex were used to simulate the enlarged middle skull base approach. The petrosal bone segment and its segments, branches, superficial petrosal nerve, geniculate ganglion and cochlea of the internal carotid artery were observed under microscope. The anatomical relationship of the internal auditory canal was measured. Results the petrous bone segment of the internal carotid artery was divided into three segments: horizontal segment, knee segment and vertical segment. The mean distance of the three segments exposed through the extended middle skull base approach was 9.1 鹵1.1 mm, 3.8 鹵0.3 mm and 10.2 鹵1.5 mm, and the diameter of the vessels was 5.5 鹵0.4 mm, respectively. 5.4 鹵1.Omm.5.2 鹵0.7mm. No branch was found in this experiment. Drawing V3 forward increased the exposure length of ICA in petrosal bone segment by 4.0 鹵0.5mm (P0.05). Foramen spinosus, arcuate eminence, superficial greater petrosal nerve and geniculate ganglion are important anatomic markers for expanding the approach of middle skull base operation. The petrosal segment, cochlea and internal auditory canal of the internal carotid artery are important anatomical structures in the extended middle skull base approach. Conclusion the petrous bone segment of the internal carotid artery has the advantages of less branches and thicker diameter, which is the suitable site for external intracranial artery bypass grafting. Pulling V3 forward can significantly increase the exposure length of ICA in petrosal bone segment (P0.05), which provides a longer operating distance for vascular bypass surgery. Extending the middle skull base approach to the petrosal bone segment ICA bypass is a good auxiliary procedure for the treatment of this site. Part two: establishment of animal model of high flow bypass graft of internal and external carotid artery system objective to establish a large animal model of large external carotid artery internal carotid artery system high flow bypass graft and perioperative period by simulating the expansion of the middle skull base approach. In order to apply high flow blood vessel bypass surgery to clinical practice, a set of clinical training models needed to complete the operation were found out, and a simulated training platform for neurosurgery, vascular surgery and skull base surgeons was provided. Methods two Beagle dogs were weight between 9Kg-10Kg. Ketamine hydrochloride 10 mg / kg was injected intramuscularly before operation to perform basic anesthesia. To establish an intravenous channel and induce anesthesia with ketamine hydrochloride 2mg/Kg. After tracheal intubation, the anesthesia machine was connected to assist breathing. Ketamine maintains anesthesia. The internal maxillary artery of the external carotid artery was chosen as the starting point, the branch of the middle cerebral artery in the lateral fissure as the stop point, and the femoral artery of the dog as the graft vessel. The smooth flow of artery bypass grafts was observed by digital silhouette angiography of global cerebral artery (DSA) immediately after operation. Results two Beagle dogs (2 sides) underwent high flow artery bypass grafting of internal maxillary artery to middle cerebral artery (M2 segment) under microscope. The model was made, the operation was smooth, no anaesthesia accident occurred, the vascular graft was patency, the operation time was 7-9 hours. DSA showed that the M 2 segment of the middle cerebral artery was supplied by the grafts and the anastomotic stoma and graft vessels were patency. Conclusion the canine model of high flow artery bypass with internal and external carotid artery system has the advantages of similar material, high flow rate, similar blood pressure, stable operation and high patency rate, which is closer to the true operation process of high flow bypass graft of internal and external carotid artery. It can provide a simulation training platform for surgeons who want to master high flow vascular bypass technique.
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R651.1;R322.8
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