【摘要】：目的:分別行經(jīng)胼胝體前縱裂(anterior interhemispheric keyhole approach AIKA)、眶上(supraorbital keyhole approach SKA)、翼點(pterional keyhole approach PKA)內(nèi)窺鏡輔助鎖孔入路的顯微解剖學(xué)研究:(1)明確此三種入路的最佳皮膚切口及骨窗的部位;(2)觀察三種入路對鞍區(qū)顯微解剖結(jié)構(gòu)的顯露情況;(3)測量此三種入路到達(dá)鞍區(qū)各解剖標(biāo)志的手術(shù)距離,整理并分析;(4)通過臨床應(yīng)用探討此三種鎖孔入路的手術(shù)適應(yīng)證;(5)通過內(nèi)窺鏡的使用剖析內(nèi)窺鏡在鎖孔手術(shù)中的應(yīng)用價值;(6)與常規(guī)“大骨瓣”開顱的縱裂入路、額下入路和翼點入路比較,總結(jié)鎖孔入路的優(yōu)缺點及臨床中應(yīng)注意的問題。 方法:(1) 在15具福爾馬林固定的成人尸頭上,分別經(jīng)AIKA、SKA、PKA全程模擬鎖孔手術(shù)入路操作。①AIKA:選擇距眉間上約4.5cm與額紋一致的橫行皮膚切口,長約5cm,于正中眉間上3cm處鉆孔,做長3.0cm、寬2.5cm大小骨窗,其前緣距眉間約3cm,剪開的硬膜翻向矢狀竇(superior sagittal sinus SSS),沿胼胝體前緣到達(dá)鞍區(qū)。②SKA:皮膚切口內(nèi)側(cè)位于眶上緣內(nèi)、中1/3交界處(眶上切跡),外側(cè)延伸至眉外少許。額骨顴突后鉆孔,骨窗平前顱窩底,向內(nèi)上開一大小約3.0×2.5cm的骨窗,經(jīng)額葉底面進(jìn)入鞍區(qū)。③PKA:切口內(nèi)側(cè)在眉毛與瞳孔垂直線交點的稍外側(cè),向外延長至眉外側(cè)2cm左右。于額骨顴突后鉆孔,骨窗要求前面緊貼前顱窩底,上緣為顳上線,外緣達(dá)蝶骨嵴外側(cè),長約3cm、寬約2.5cm。經(jīng)側(cè)裂池進(jìn)入鞍區(qū)。(2)在顯微鏡下觀察各入路對鞍區(qū)解剖結(jié)構(gòu)的顯露情況,測量相關(guān)數(shù)據(jù)。(3)使用內(nèi)窺鏡窺視各入路中顯微鏡不能直視的顯微解剖結(jié)構(gòu),(4)經(jīng)AIKA切除腫瘤6例,經(jīng)SKA切除34例,經(jīng)PKA切除31例。 結(jié)果:經(jīng)胼胝體前縱裂間隙可清楚地暴露中線處前交通動脈復(fù)合體、視交叉(optic
[Abstract]:Objective: to study the microanatomy of (anterior interhemispheric keyhole approach AIKA), supraorbital (supraorbital keyhole approach SKA), pterional (supraorbital keyhole approach SKA), endoscope assisted keyhole approach through anterior longitudinal fissure of corpus callosum: (1) to determine the best skin incision and the location of bone window of the three approaches; (2) to observe the location of the bony window; Observe the exposure of the three approaches to the microanatomical structure of the Sellar region; (3) measure the operative distance between the three approaches to the Sella region anatomic markers, (4) to discuss the indications of these three keyhole approaches through clinical application; (5) to analyze the application value of endoscope in keyhole operation; (6) to explore the longitudinal fissure approach with conventional "large bone flap" craniotomy. To compare subfrontal approach with pterional approach, the advantages and disadvantages of keyhole approach and clinical problems were summarized. Methods: (1) in 15 adult cadaveric heads fixed with formalin, we simulated the operation of keyhole operation by AIKAK SKAPKA. 1 AIKA: select the transverse skin incision about 4.5cm and frontostripe, which is about 5 cm long, and drill holes in 3cm in the middle of the brow. Long 3.0 cm, wide 2.5cm size bone window, its front edge is about 3 cm from the brow, cut dural inverted sagittal sinus (superior sagittal sinus SSS), along the anterior edge of corpus callosum to the Sellar region .2SKA: the medial incision is located in the superior orbital margin. The middle 1 / 3 junction (supraorbital notch) extends slightly outside the eyebrow. The posterior zygomaticoid process of the frontal bone was drilled, the bone window flattened the base of the anterior cranial fossa, and a 脳 2.5cm bone window was opened up to the bottom of the frontal lobe into the saddle area .3PKA: the medial side of the incision was slightly lateral to the vertical line between the eyebrow and the pupil and extended outwards to the lateral 2cm of the eyebrow. The posterior zygomaticoid process of the frontal bone was drilled, and the bone window was required to close to the base of the anterior cranial fossa. The upper margin was superior temporal line, and the outer margin reached to the lateral side of the sphenoid crest, about 3 cm long and 2.5 cm wide. The lateral fissure cistern entered the Sellar region. (2) the exposure of the anatomical structure of the Sellar region was observed under microscope, and the relevant data were measured. (3) the microanatomical structure of the Sellar region which could not be seen directly by microscope was observed by endoscope. (4) 6 cases of tumors were resected by AIKA. 34 cases were resected by SKA and 31 cases by PKA. Results: the anterior communicating artery complex at the midline could be exposed clearly through the space of the anterior longitudinal fissure of corpus callosum and the optic chiasma (optic).
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2005
【分類號】：R651;R322

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