本文選題：擴大經(jīng)蝶竇入路 + 手術(shù)入路��； 參考：《山東大學(xué)》2006年碩士論文

【摘要】：經(jīng)蝶竇入路經(jīng)過近百年的發(fā)展以其微創(chuàng)、并發(fā)癥發(fā)生率低和術(shù)后死亡率低已經(jīng)成為鞍區(qū)腫瘤的首選手術(shù)入路。1987年Weiss首先命名并描述了進一步切除鞍結(jié)節(jié)和蝶骨平臺后部、切開鞍隔上硬膜的擴大經(jīng)蝶竇入路。這一改良為鞍上結(jié)構(gòu)與腫瘤鞍上部分的顯露提供了很好的術(shù)野，同時避免了腦牽拉。經(jīng)過不斷改進，近年來擴大經(jīng)蝶入路應(yīng)用范圍逐步擴大，用于處理向前到蝶骨平臺、向側(cè)方侵及海綿竇、向后達鞍背中上斜坡的腫瘤均已成為可能。本研究模擬擴大經(jīng)蝶入路，對相關(guān)顯微解剖結(jié)構(gòu)進行測量，以期為臨床手術(shù)提供參考數(shù)據(jù)，初步探討其基于解剖基礎(chǔ)的改進策略。 目的：觀察測量擴大經(jīng)蝶竇入路相關(guān)的顯微解剖結(jié)構(gòu)，為臨床手術(shù)提供參考和依據(jù)。 方法：5例顱骨干標(biāo)本，觀察熟悉相關(guān)骨性結(jié)構(gòu)及其解剖關(guān)系；3例尸頭正中矢狀面切開共6側(cè)，顯微鏡下解剖相關(guān)結(jié)構(gòu)并測量和拍照；5例完整尸頭，與3例帶硬膜顱底標(biāo)本顯微鏡下模擬手術(shù)入路，對涉及的結(jié)構(gòu)進行顯微解剖學(xué)觀測和拍照，其中3例尸頭模擬神經(jīng)內(nèi)鏡輔助手術(shù)。 結(jié)果：①以前鼻棘為入路起點，至蝶竇口、篩后孔、蝶腭孔、翼管前口、展神經(jīng)硬膜入口的距離分別為(56.61±4.67)mm、(64.88±4.43)mm、(50.12±2.20)mm、(59.94±3.31)mm、(61.00±2.73)mm。以鼻腔底平面為基線，上述諸結(jié)構(gòu)連線在矢狀面投影線與基線夾角(基底角，下同，見圖1)分別為(33.1±3.7)°、(36.3±7.43)°、(29.1±3.6)°、(23.9±3.3)°、(28.1±3.6)°。②視神經(jīng)隆起僅位于蝶竇內(nèi)的27.3％，隆起僅位于篩竇內(nèi)27.3％，，同時位于篩竇和蝶竇內(nèi)40.9％；蝶竇內(nèi)視神經(jīng)—頸內(nèi)動脈隱窩出現(xiàn)率68.2％，鼻前棘至隱窩距離(76.16±5.32)mm，基底角(35.8±4.2)°。③眼動脈起始點距鼻前棘分別為(72.88±6.78)mm，基底角(30.3±3.7)°，鼻前棘至破裂孔距離(79.38±5.32)mm，基底角(32.7±3.9)°，蝶竇內(nèi)頸內(nèi)動脈隆起出現(xiàn)率68.2％，擴大經(jīng)蝶竇入路切除海綿竇腹側(cè)、視神經(jīng)—頸內(nèi)動脈隱窩、視神經(jīng)管后部以及巖尖部分骨質(zhì)可較充分游離頸內(nèi)動脈，尤其在神經(jīng)內(nèi)鏡輔助下海綿竇內(nèi)及前床突周圍分支發(fā)出點均可探及。④展神經(jīng)硬膜入口雙側(cè)距離(19.76±1.98)mm，與后床突垂直距離(25.66
[Abstract]:Transsphenoidal approach has become the preferred approach for Sellar region tumors after nearly 100 years of development, with low incidence of complications and low postoperative mortality. In 1987, Weiss first named and described the further resection of Sellar nodules and posterior sphenoid plateau. Incision of the suprasellar dura mater via transsphenoidal approach. This improvement provides a good surgical field for the exposure of the suprasellar structure and the suprasellar part of the tumor, while avoiding brain retraction. After continuous improvement, the application scope of transsphenoidal approach has been gradually expanded in recent years to deal with tumors that advance to the sphenoid platform, lateral into the cavernous sinus and reach back to the middle and upper slope of the saddle. In this study we simulated the expansion of transsphenoidal approach and measured the related microanatomical structures in order to provide reference data for clinical operation and discuss the improvement strategy based on anatomical basis. Objective: to observe and measure the microanatomical structure related to the expanded transsphenoidal approach and to provide reference for clinical operation. Methods the bone structure and its anatomic relationship were observed in 5 cases of cranial dry bones. 6 sides of the middle sagittal plane of 3 cadaveric heads were dissected. The related structures were dissected under microscope and 5 cases of intact cadaveric heads were measured and photographed. Microanatomical observations and photographs of the structures involved were performed in 3 cases with dural skull base specimens under the microscope, including 3 cases of cadaveric head simulated neuroendoscopy assisted surgery. Results the distance from the anterior nasal spine to the orifice of sphenoid sinus, posterior ethmoid foramen, sphenopalatine foramen, anterior orifice of pterygoid canal and the dural orifice of abductor nerve was 56.61 鹵4.67mm, 64.88 鹵4.43m, 59.94 鹵3.31mm and 59.94 鹵2.73mmmrespectively. Taking the bottom plane of the nasal cavity as the baseline, the lines of the above structures are at the angle between the projection line of the sagittal plane and the baseline (the base angle, the same as below). Fig.1) the optic nerve eminence is only 27.3mm in the sphenoid sinus, and only 27.3mm in the ethmoid sinus, 40.9% in the ethmoid sinus and 40.9 in the sphenoid sinus. The occurrences of the optic nerve and carotid artery recess in the sphenoid sinus are 68.2mm, the distance between the anterior nasal spine and the recess is 76.16 鹵5.32mm, the distance between the anterior nasal spine and the recess is 76.16 鹵5.32mm. 35.8 鹵4.2) 擄.3 the distance between anterior nasal artery and anterior nasal spine was 72.88 鹵6.78 mm, 30.3 鹵3.7 擄, 79.38 鹵5.32 mm and 32.7 鹵3.9 擄, respectively. The incidence of internal carotid artery protuberance in sphenoid sinus was 68.2 擄, and the ventral cavernous sinus was resected via transsphenoidal approach. The medial carotid artery recess, the posterior part of the optic canal and the petrous apex of the optic nerve can fully dissociate the internal carotid artery. In particular, the bilateral distance between the adductor dural entrance (19.76 鹵1.98) and the vertical distance from the posterior clinoid process to the posterior clinoid process can be detected at the point of origin within the cavernous sinus and around the anterior clinoid process under endoscopy.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2006
【分類號】：R322

【參考文獻】

相關(guān)期刊論文 前1條

1 黃安煬,劉運生,王延金;前入路的斜坡側(cè)壁顯微解剖研究與臨床應(yīng)用[J];中華神經(jīng)外科疾病研究雜志;2003年02期

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