本文關(guān)鍵詞：內(nèi)窺鏡輔助經(jīng)顳下鎖孔入路巖斜區(qū)的應(yīng)用解剖學(xué)研究　出處：《青島大學(xué)》2005年碩士論文　論文類型：學(xué)位論文

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【摘要】：[目的] 應(yīng)用內(nèi)窺鏡經(jīng)顳下鎖孔入路對(duì)巖斜區(qū)進(jìn)行局部解剖學(xué)研究。探討該入路對(duì)巖斜區(qū)病變的應(yīng)用解剖范圍。 [方法] 在6具(12側(cè))10%福爾馬林固定的成人尸頭標(biāo)本上進(jìn)行顳下鎖孔入路的相關(guān)解剖結(jié)構(gòu)觀察與測(cè)量;在4具(8側(cè))健康成人新鮮尸頭上,用生理鹽水經(jīng)一側(cè)頸內(nèi)動(dòng)脈或椎動(dòng)脈加壓灌注,沖洗殘留在血管Qg的血塊,并用交替沖洗法檢查Willis環(huán)發(fā)育是否良好。然后經(jīng)頸內(nèi)動(dòng)脈或椎動(dòng)脈灌注紅、藍(lán)乳膠。在此尸頭標(biāo)本上模擬顳下鎖孔入路進(jìn)行相關(guān)解剖結(jié)構(gòu)觀察與測(cè)量。頭后仰10°～15°,旋轉(zhuǎn)45°～75°,側(cè)曲15°;于外耳道前1cm,顴弓上緣取向后的弧型切口;在滑車神經(jīng)入小腦幕點(diǎn)的后方瓣形剪開小腦幕,磨除Day菱形區(qū)范圍內(nèi)的巖骨尖,并進(jìn)一步將骨質(zhì)磨除,范圍向前擴(kuò)大到三叉神經(jīng)壓跡和部分V_3下方;記錄入路的顯露范圍及可利用的空間,嘗試增加顯露和操作空間的方法;采用顯微鏡與內(nèi)窺鏡交替配合使用觀察巖斜區(qū)及后顱窩的解剖結(jié)構(gòu)。 [結(jié)果] 顳下鎖孔入路可以充分暴露巖斜區(qū)的中、上斜坡及腦干腹外側(cè)區(qū)的神經(jīng)、血管結(jié)構(gòu),巖骨尖適當(dāng)磨除可以擴(kuò)大中、上斜坡的顯露。計(jì)算出Day菱形區(qū)的面積為(235.5±15.8)mm~2,范圍213.5～249.7mm~2。擴(kuò)大磨除后的面積為(302.5±33.7)mm~2,范圍264.8～348.6mm~2。 [結(jié)論] 內(nèi)窺鏡輔助經(jīng)顳下鎖孔入路能很好地處理中、上斜坡及腦干腹外側(cè)區(qū)的病變,并能減少對(duì)周圍結(jié)構(gòu)的侵襲。
[Abstract]:[Objective] to study the local anatomy of petroclival region by endoscopic transtemporal keyhole approach. [Methods] the anatomical structure of subtemporal keyhole approach was observed and measured on 6 adult cadaver heads fixed with 10% formalin. The fresh heads of 4 healthy adults were perfused with normal saline through one side of internal carotid artery or vertebral artery to flush the blood clot which remained in blood vessel QG. The development of Willis ring was examined by alternate flushing method, and red was infused through internal carotid artery or vertebral artery. Blue latex. The anatomic structure was observed and measured by simulated subtemporal keyhole approach on the cadaveric head. Arc incision at 1 cm in front of external auditory canal after superior edge orientation of zygomatic arch; The posterior flap of the trochlear nerve into the tentorium of cerebellum was used to cut the tentorium cerebellum and remove the petrous bone tip in the rhombic area of Day, and to further remove the bony bone. The range was extended to the trigeminal nerve indentation and part of VSP 3. Record the exposure range and available space of the path, and try to increase the exposure and operation space; The anatomic structure of petroclival region and posterior cranial fossa was observed by microscope and endoscope alternately. [Results: the subtemporal keyhole approach could fully expose the nerve and vascular structure of the middle and upper Clivus and ventrolateral part of the brain stem and the petrous bone tip could be enlarged. The area of Day rhombic area is calculated to be 235.5 鹵15.8mm2. The range was 213.5 / 249.7mm / 2. The area after the expanded grinding was 302.5 鹵33.7 / mm / 2, and the range was 264.8mm / 348.6mm / 2. [Conclusion Endoscope-assisted transtemporal keyhole approach can effectively treat the lesions in the upper Clivus and ventrolateral part of the brain stem and reduce the invasion of the surrounding structures.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2005
【分類號(hào)】：R651;R322

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