本文選題：內(nèi)窺鏡 + 乙狀竇前-迷路后入路　； 參考：《福建醫(yī)科大學(xué)》2006年碩士論文

【摘要】：目的： 經(jīng)乙狀竇前-迷路后入路在內(nèi)窺鏡輔助下對(duì)橋小腦角區(qū)、巖斜區(qū)進(jìn)行解剖學(xué)研究，并與乙狀竇后入路比較，探討乙狀竇前入路中影響內(nèi)窺鏡的解剖學(xué)因素、兩種入路各自優(yōu)缺點(diǎn)，為臨床應(yīng)用提供參考。 方法： 在15具30側(cè)成年國(guó)人尸頭(福爾馬林固定，動(dòng)脈已灌注紅色乳膠染料)上模擬乙狀竇前-迷路后手術(shù)入路操作，逐層解剖，明確相關(guān)解剖結(jié)構(gòu)毗鄰關(guān)系、測(cè)量相關(guān)數(shù)據(jù)。內(nèi)窺鏡下觀察橋小腦角、巖斜區(qū)顱內(nèi)結(jié)構(gòu)，探討影響內(nèi)窺鏡操作因素。完成內(nèi)窺鏡觀察后，開顱，去除腦組織。觀察、測(cè)量手術(shù)入路相關(guān)數(shù)據(jù)以及巖靜脈、Meckel囊等解剖結(jié)構(gòu)。在一例新鮮頭顱標(biāo)本上模擬兩種手術(shù)入路操作，結(jié)合解剖學(xué)數(shù)據(jù)比較其各自的優(yōu)缺點(diǎn)。 結(jié)果： 寬大、前移的乙狀竇以及顱內(nèi)復(fù)雜的血管神經(jīng)關(guān)系可能影響內(nèi)窺鏡的操作。內(nèi)窺鏡利用解剖間隙可到達(dá)橋小腦角區(qū)、巖斜區(qū)，無(wú)需過度的牽拉小腦、腦干，可以清晰觀察到普通顯微鏡無(wú)法觀察到的隱蔽結(jié)構(gòu)、死角。在乙狀竇前入路，，內(nèi)窺鏡甚至可以觀察到腦干腹側(cè)結(jié)構(gòu)。到達(dá)靶區(qū)的距離比竇后入路短。 結(jié)論： 乙狀竇前入路具有據(jù)巖斜區(qū)距離短、方便腦干腹側(cè)的操作、對(duì)腦組織牽拉輕微等優(yōu)點(diǎn)。熟悉該區(qū)域的解剖學(xué)特點(diǎn)及影響內(nèi)窺鏡應(yīng)用的因素，有助于該入路的臨床應(yīng)用。乙狀竇后入路操作簡(jiǎn)單，距顱內(nèi)深部結(jié)構(gòu)遠(yuǎn)，需要一定的小腦的牽拉，而且不易處理腦干腹側(cè)的病變。內(nèi)窺鏡的輔助應(yīng)用有助于減少腦組織的牽拉、觀察到顯微鏡下不易發(fā)現(xiàn)的細(xì)節(jié)與隱蔽結(jié)構(gòu)；避免重要結(jié)構(gòu)的損傷與減少腫瘤的殘余。
[Abstract]:Objective: to study the anatomy of cerebellopontine angle area and petroclival region by transsigmoid antral approach and retrosigmoid approach under endoscope, and compare with retrosigmoid sinus approach. To explore the anatomical factors affecting endoscope in the anterior sigmoid approach, the advantages and disadvantages of the two approaches were discussed, which provided reference for clinical application. Methods: the heads of 30 adult Chinese cadavers were fixed with formalin. The antesigmoid sinus and labyrinthine approach were simulated on the artery. The anatomic structures were dissected layer by layer, and the adjacent relationship of the related anatomical structures was determined, and the relevant data were measured. The cranial structures of cerebellopontine angle and petroclival region were observed under endoscope to investigate the factors affecting the operation of endoscopy. After endoscope observation, craniotomy, brain tissue removal. The data related to the surgical approach and the anatomic structure of Meckel's sac of the petrosal vein were observed and measured. Two surgical approaches were simulated on a fresh head specimen and their advantages and disadvantages were compared with anatomical data. Results: the large, anterior sigmoid sinus and complex intracranial vascular-nerve relationship may affect the operation of endoscope. By using anatomic space, endoscope can reach the cerebellopontine angle area, petroclival area, without excessive pulling cerebellum and brain stem, and can clearly observe the concealed structure and dead angle which can not be observed by ordinary microscope. The ventral structure of the brain stem could even be observed by endoscope through the anterior sigmoid approach. The distance to the target area was shorter than that of the posterior sinus approach. Conclusion: the anterior sigmoid sinus approach has the advantages of short distance of diagonal region, convenient operation of ventral brainstem and slight traction of brain tissue. Familiarity with the anatomical features of the region and the factors affecting the application of endoscope are helpful to the clinical application of the approach. The retrosigmoid approach is simple, far from the deep structure of the brain, and requires a certain traction of the cerebellum, and it is not easy to deal with the ventral lesions of the brain stem. The auxiliary application of endoscope can help to reduce the pulling of brain tissue, observe the details and hidden structures that are difficult to find under microscope, avoid the damage of important structures and reduce the residual of tumor.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2006
【分類號(hào)】：R322

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 呂波;乙狀竇后入路聽神經(jīng)瘤相關(guān)面神經(jīng)及內(nèi)聽道顯微解剖學(xué)研究[D];安徽醫(yī)科大學(xué);2012年

本文編號(hào)：2065836