本文關鍵詞：海綿間竇及相關結(jié)構(gòu)的臨床應用解剖　出處：《第二軍醫(yī)大學》2006年碩士論文　論文類型：學位論文

  更多相關文章： 海綿間竇 海綿竇 海綿竇內(nèi)頸內(nèi)動脈 垂體 視神經(jīng) 經(jīng)蝶手術 鼻內(nèi)鏡 應用解剖

【摘要】：[目的] 本課題結(jié)合臨床手術需要，在手術顯微鏡和鼻內(nèi)鏡下，通過應用解剖學研究海綿間竇及相關結(jié)構(gòu)，為經(jīng)鼻蝶垂體瘤手術和擴大經(jīng)蝶手術避免損傷海綿間竇、減少手術并發(fā)癥及改進手術進路提供解剖學參考依據(jù)；通過模擬在鼻內(nèi)鏡下經(jīng)蝶和擴大經(jīng)蝶入路，對海綿間竇及其相關結(jié)構(gòu)進行解剖定位標志和解剖學觀測。 [方法] 在手術顯微鏡下對20(男12、女8)具，在鼻內(nèi)鏡下對5(男4、女1)具成年尸頭的海綿間竇及其相關結(jié)構(gòu)進行臨床應用解剖學研究。對前海綿間竇、下海綿間竇、后海綿間竇、鞍背竇和基底竇的出現(xiàn)率、位置、形態(tài)、大小等進行解剖學觀察。同時，對海綿間竇相關結(jié)構(gòu)，如：蝶竇，垂體，，海綿竇內(nèi)頸內(nèi)動脈，視神經(jīng)，視交叉，篩動脈的位置、結(jié)構(gòu)、形態(tài)等進行觀察測量。所得數(shù)據(jù)經(jīng)SAS軟件包進行統(tǒng)計學處理。 [結(jié)果] ①前、下、后海綿間竇，基底竇，鞍背竇的出現(xiàn)率分別為95％，75％，10％，100％和30％。在正中矢狀面上，各竇的前后徑分別為(2.15±0.90)mm，(5.14±2.54)mm，(1.30±0.40)mm，(2.26±0.91)mm，(2.01±0.80)mm；上下徑為(2.74±0.96)mm，(1.24±0.81)mm，(1.48±0.29)mm，(15.67±4.54)mm，(3.35±1.93)mm。②海綿竇內(nèi)頸內(nèi)動脈呈“S”形雙彎曲的出現(xiàn)率為37.5％(15側(cè))，呈中間型彎曲的52.5％(21側(cè))，呈直線型的10％(4側(cè))。③蝶竇的5種分型，本組標本Ⅰ型(甲介型)未見；Ⅱ型(鞍前型)出現(xiàn)率為25％(10側(cè))；Ⅲ型(半鞍型)為27.5％(11例)；Ⅳ型(全鞍型)為27.5％(11側(cè))；Ⅴ型(鞍枕型)為20％(8側(cè))。④鼻小柱根部至蝶竇口下極及蝶腭孔的距離分別為(60.40±3.21)mm和(62.14±1.93)mm；蝶腭動脈至蝶竇口下極的距離為(12.20±1.10)mm，在蝶腭孔處蝶腭動脈的外徑為(1.99±0.13)mm；蝶竇口下極至鼻中隔后上動脈及鼻中隔后下動脈的距離分別為(3.49±0.24)mm和(6.42±1.08)mm。⑤蝶竇后壁沿頸內(nèi)動脈隆凸兩側(cè)緣分別畫2條直線，4條垂線將蝶竇腔分為一個中間腔及兩個旁中間腔和兩個外側(cè)腔。⑥垂體、垂體上動脈、視神經(jīng)顱內(nèi)段、視交叉、視神經(jīng)管內(nèi)段及篩動脈觀察及測量。 [結(jié)論]海綿間竇的出現(xiàn)率及發(fā)育與蝶竇氣化類型有負相關的趨勢，下、前海綿間竇為經(jīng)蝶或擴大經(jīng)蝶蝶鞍區(qū)手術徑路必經(jīng)結(jié)構(gòu)，術中傷及發(fā)育良好的海綿
[Abstract]:[Objective] to study the intercavernous sinus and its related structures through applied anatomy under surgical microscope and nasal endoscope in order to meet the needs of clinical operation. To provide anatomic reference for transsphenoidal pituitary adenoma operation and expanded transsphenoidal surgery to avoid injury of intercavernous sinus, reduce operative complications and improve operative approach. The anatomic localization and anatomical observation of the intercavernous sinus and its related structures were carried out by simulating transsphenoidal approach and expanding transsphenoidal approach under nasal endoscope. [Methods] 20 (male 12, female 8) and 5 (male 4) under the operation microscope and nasal endoscope respectively. The incidence, location and morphology of anterior intercavernous sinus, inferior intercavernous sinus, posterior intercavernous sinus, dorsal Sellar sinus and basal sinus were studied. At the same time, the position and structure of the sphenoid sinus, pituitary, internal carotid artery, optic nerve, optic chiasma and ethmoidal artery were observed. The data were analyzed by SAS software package. [Results (1) the occurrence rates of anterior, inferior, posterior intercavernous sinus, basal sinus and dorsal Sellar sinus were 95% and 30%, respectively. The anteroposterior and posterior diameters of each sinus were 2.15 鹵0.90 mm and 5.14 鹵2.54 mm respectively. The diameter of each sinus was 1.30 鹵0.40 mm and 2.26 鹵0.91mm. 2.01 鹵0.80 mm; The upper and lower diameters were 2.74 鹵0.96 mm / L 1.24 鹵0.81 mil / 1.48 鹵0.29 m / m / l 15.67 鹵4.54 mm / mm. The incidence of "S" shape double curvature of the internal carotid artery in the cavernous sinus was 3.35 鹵1.93 鹵1.93 mm / .2. The occurrence rate of "S" double curvature in the cavernous sinus was 37.5%, and that in 15 sides of the cavernous sinus was 52.5% (21 sides). There were 5 types of 10 and 4 sides of sphenoid sinus with linear type, but no type I (type A) was found in this group. The occurrence rate of type 鈪

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