本文選題：經(jīng)巖骨前部入路　切入點：巖斜區(qū)　出處：《江西醫(yī)學(xué)院》2005年碩士論文　論文類型：學(xué)位論文

【摘要】：目的巖斜區(qū)位置深在、毗鄰的解剖結(jié)構(gòu)復(fù)雜而重要,該區(qū)域病變的手術(shù)治療一直是神經(jīng)外科難點之一。經(jīng)巖骨前部入路(Kawase 入路)是巖斜區(qū)病變的主要手術(shù)入路之一,但由于顳骨巖部內(nèi)耳蝸、頸內(nèi)動脈、膝狀神經(jīng)節(jié)及面聽神經(jīng)等結(jié)構(gòu)的準(zhǔn)確定位到目前為止尚缺乏統(tǒng)一的標(biāo)準(zhǔn),這大大影響了該入路的臨床應(yīng)用和發(fā)展。本研究旨在通過對顳骨巖部周圍重要結(jié)構(gòu)的觀察和測量,來量化各結(jié)構(gòu)之間的位置關(guān)系,系統(tǒng)全面地了解經(jīng)巖骨前部入路至巖斜區(qū)的顯微解剖,尋找更好更簡便的耳蝸、內(nèi)耳道及頸內(nèi)動脈巖部的定位方法和定位標(biāo)志,為手術(shù)磨除巖骨尖部及擴大巖斜區(qū)術(shù)野暴露范圍提供可靠依據(jù),進(jìn)一步探索和改進(jìn)經(jīng)巖骨前部入路的操作方法,為該入路的臨床應(yīng)用提供解剖學(xué)資料。 方法取成人干燥頭顱標(biāo)本10 具20 側(cè),觀察辨認(rèn)巖骨表面弓狀隆起、巖淺大神經(jīng)溝、面神經(jīng)管裂孔、三叉神經(jīng)壓跡、棘孔、內(nèi)耳門等結(jié)構(gòu),用磨鉆磨除巖尖骨質(zhì)暴露顳骨巖部內(nèi)耳蝸、骨半規(guī)管、內(nèi)耳道底、頸內(nèi)動脈管等重要結(jié)構(gòu),對各結(jié)構(gòu)之間的關(guān)系及距離進(jìn)行解剖觀察和測量;取10%福爾馬林固定的成人頭顱濕標(biāo)本10 具(20 側(cè)),彩色乳膠分別灌注動靜脈血管,在四疊體上丘水平切斷腦干,除去大腦半球和間腦, 保留腦干、小腦及完整的小腦幕,去除中顱窩硬腦膜,辨認(rèn)棘孔、三叉神經(jīng)、巖淺大神經(jīng)、弓狀隆起、面神經(jīng)管裂孔、巖骨嵴、巖上竇等結(jié)構(gòu)。磨除巖骨表面骨質(zhì)暴露頸內(nèi)動脈巖部、膝狀神經(jīng)節(jié)、耳蝸,觀察和測量巖骨周圍各結(jié)構(gòu)之間的位置關(guān)系;取10%福爾馬林固定彩色乳膠灌注的頭顱濕標(biāo)本6 具12 側(cè),在6～25 倍手術(shù)顯微鏡觀察下模擬經(jīng)巖骨前部入路手術(shù)操作,對手術(shù)入路全程進(jìn)行操作體會及解剖學(xué)觀測,并觀察手術(shù)視野的暴露范圍。用游標(biāo)卡尺及圓規(guī)對上述各結(jié)構(gòu)進(jìn)行測量,分別取三次測量值的平均值,對測量數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析,并對模擬手術(shù)操作中的心得體會進(jìn)行總結(jié)。
[Abstract]:The purpose of the petroclival region is deep, the complex anatomy of adjacent important surgical treatment of lesions in this area has been one of the difficulties in the Department of neurosurgery. Anterior transpetrosal approach (Kawase approach) is the main operation of petroclival lesions in one of the road, but because of the petrous bone in the cochlea, internal carotid artery, geniculate ganglion the facial nerve and accurate positioning structure so far is the lack of uniform standards, which greatly affected the clinical application and development of this approach. This study aims to observe and measure around the petrous bone structure, the relationship between the position of each node to quantify the systematic and comprehensive understanding of microscopic anatomy the anterior part of the petrosal bone approach to the petroclival region via different, looking for better and more convenient cochlea, positioning method and sign of ear canal and petrous portion of internal carotid artery, except the petrous apex and expand the petroclival region of field exposure range provided for grinding operation We can further explore and improve the operation method of the anterior approach of the anterior part of the bone, and provide the anatomical data for the clinical application of the approach.
Methods 10 adult dry skull specimens with 20 side observation to identify rock arcuate bone surface uplift, ditch the greater superficial petrosal nerve, hiatus of facial nerve, trigeminal nerve compression, foramen spinosum, inner door structure, the drill ground bone petrous apex exposed petrousbone cochlea, semicircular canal, internal ear bottom, internal carotid canal and other important structures, the relationship between the distance and structure were observed and measured; 10% formalin fixed 10 adult cadaveric heads (20 sides), arteriovenous were perfused with color latex, in the high level of brain stem quadrigeminal cut off, remove the cerebral hemisphere and the retention the brainstem, cerebellum and complete removal of the tentorium, middle fossa dura, identify the foramen spinosum, trigeminal nerve, greater superficial petrosal nerve, arcuate eminence, hiatus of facial nerve canal, petrous ridge, superior petrosal sinus structures. Grinding petrous bone bone exposed surface of petrous carotid, geniculate ganglion, ear The worm, the relationship between the position of observation and measurement of the surrounding rock bone structure; 10% formalin fixed cadaveric heads were perfused with color latex 6 with 12 side, simulation of anterior transpetrosal approach operation in 6~25 times of surgery under the microscope, the surgical approach of the whole operation and observation of anatomy, and to observe the exposure range the operation field. To measure the structure with vernier caliper and compasses, taking the average of three measurements respectively, the statistical analysis on the measurement data, and the simulating operation experiences were summarized.

【學(xué)位授予單位】：江西醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2005
【分類號】：R322

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