【摘要】： 目的:從咽旁間隙腫瘤手術(shù)進(jìn)路的角度觀察測(cè)量側(cè)顱底區(qū)骨性結(jié)構(gòu)的有關(guān)解剖數(shù)據(jù),為手術(shù)中準(zhǔn)確定位顱底相關(guān)重要解剖結(jié)構(gòu),保全腦神經(jīng)和重要血管提供較詳實(shí)的依據(jù);通過對(duì)尸頭模擬經(jīng)頸側(cè)進(jìn)路及經(jīng)咽側(cè)壁進(jìn)路,明確手術(shù)進(jìn)路中穿經(jīng)的解剖結(jié)構(gòu)以及重要血管神經(jīng)的相互毗鄰關(guān)系,加以保護(hù),減少手術(shù)并發(fā)癥。 方法: 1.在30具(60側(cè))成人顱骨上,對(duì)莖突根部、乳突、鼓乳裂最下點(diǎn)與咽旁間隙相關(guān)的側(cè)顱底骨性標(biāo)志的最短直線距離及與正中矢狀面的前夾角等進(jìn)行測(cè)量,并測(cè)量側(cè)顱底區(qū)重要孔道直徑。 2.研究觀察咽旁間隙相關(guān)側(cè)顱底區(qū)的范圍及周圍毗鄰結(jié)構(gòu),測(cè)量咽旁間隙顱底區(qū)的長度和寬度。 3.在10具(20側(cè))成人濕性尸頭(包含上頸部),應(yīng)用頸側(cè)進(jìn)路及咽側(cè)壁進(jìn)路,對(duì)咽旁間隙及毗鄰結(jié)構(gòu)進(jìn)行外科解剖研究,著重對(duì)莖突隔、后四組顱神經(jīng)、頸內(nèi)動(dòng)脈等結(jié)構(gòu)進(jìn)行觀測(cè)。 結(jié)果: 1.獲得了莖突根部、乳突、鼓乳裂最下點(diǎn)分別與有關(guān)骨性結(jié)構(gòu)的距離和角度數(shù)據(jù),顯示左側(cè)與右側(cè)比較有顯著差異。 2.側(cè)顱底區(qū)重要孔道測(cè)量(最大徑)顯示左側(cè)與右側(cè)比較有顯著差異。 3.咽旁間隙顱底區(qū)測(cè)量:長度:左、右側(cè)分別為33.11±2.95mm,34.88±2.36mm(P0.01);寬度:左、右側(cè)分別為17.31±2.22 mm,17.15±1.65 mm(P0.05)。 4.乳突尖至下頜骨升支、乳突前緣至下頜骨升支、第一頸椎橫突至下頜骨升支等的最短距離分別為22.94±3.08 mm,14. 50±3.57mm,20.34±9.03mm。 5.20側(cè)標(biāo)本中有30%副神經(jīng)位于第一頸椎橫突外側(cè)走行,其余位其前面經(jīng)過;有20%舌下神經(jīng)弓形向前下走行時(shí)位于二腹肌后腹下緣下0.5~1.0cm。 結(jié)論: 1.乳突尖、鼓乳裂及莖突根部等骨性標(biāo)志在手術(shù)中易于觸摸、定位。對(duì)所選測(cè)量點(diǎn)間的距離及角度進(jìn)行測(cè)量,可定位重要結(jié)構(gòu)位置,明確手術(shù)進(jìn)路的深度,估測(cè)其方位。 2.莖突根部是咽旁間隙的關(guān)鍵解剖標(biāo)志,手術(shù)宜保護(hù)其后方的頸內(nèi)動(dòng)脈、頸內(nèi)靜脈、后組腦神經(jīng)和其淺面的頸外動(dòng)脈、面神經(jīng)等重要結(jié)構(gòu)。 3.以破裂孔內(nèi)緣與莖突根部的連線作為咽旁前、后間隙在顱底區(qū)的分界線。蝶骨翼突內(nèi)側(cè)板、莖突、蝶骨大翼及顳骨巖部、破裂孔等作為莖突前間隙的標(biāo)志;頸靜脈孔及附近骨質(zhì)、枕骨的外側(cè)、枕骨髁等作為莖突后間隙的標(biāo)志。以翼突內(nèi)側(cè)板根部至頸靜脈窩外后緣的距離作為咽旁間隙顱底區(qū)的長度,蝶棘至頸靜脈窩內(nèi)后緣的距離作為其寬度。 4.第一頸椎橫突在手術(shù)中易于觸摸,可作為尋找、保護(hù)副神經(jīng)的重要骨性標(biāo)志;部分舌下神經(jīng)弓形向前下走行時(shí)位于二腹肌后腹下緣下,在頸清掃術(shù)中注意避免傷及。 5.咽旁間隙的手術(shù)入路空間狹小,如何充分暴露術(shù)野是非常重要的。切除頜下腺、腮腺下極、莖突或乳突骨質(zhì),切斷二腹肌、莖突肌肉組織、莖突下頜韌帶,行下頜骨半脫位等,可獲得充分的視野。
[Abstract]:Objective: To observe the anatomical data of the bone structure of the lateral skull base region from the perspective of the operative route of the parapharyngeal space tumor, and provide a more detailed basis for the accurate positioning of the important anatomical structures in the skull base, preserving cranial nerves and important blood vessels in the operation. Through simulating the cervical side route and the pharynx side wall route, the anatomical structure and the adjacent relationship between the important vascular nerves in the surgical approach are clearly identified, so as to protect and reduce the complications of the operation. Methods: 1. On the 30 (60-side) adult skull, the shortest straight distance between the root of the stem, the mastoid, the lowest point of the drum and the lateral clearance of the lateral skull base and the anterior included angle of the sagittal plane were measured. in ord to measure that diameter of the major pore canal in the lateral skull base region. and the length and width of the skull base region of the parapharyngeal space are measured. 3. An adult wet corpse head (including an upper neck) on 10 (20 sides) is applied, a cervical side approach and a pharyngeal wall route are applied, the parapharpharyngeal space and the adjacent structure are carried out anatomy of the family The structure of the posterior four groups of cranial nerves and internal carotid artery were observed. The distance and angle data of the root, mastoid and drum of the stem are respectively related to the bone structure. There was a significant difference between the left and right sides of the display. 2. Significant differences were noted on the left and right sides of the lateral skull base area (maximum diameter). 3. Interpharyngeal clearance skull base area measurement: length: left, right, 33. 11, 2.95mm, respectively The width: the left and right sides were 17. 31, 2.22 mm, 17. 15 and 1.65 mm respectively (P0. 01). 05). 4. The mastoid tip to the mandibular ascending branch and the shortest distance of the leading edge of the mastoid to the mandibular ascending branch, the first cervical vertebra transverse process to the mandible ascending branch, and the like are 22. 94, 3.08 mm, 14.50, 3.57mm, 20.34 and 9.03mm respectively. 5. 30% of the secondary nerves in the 20-side specimen are located outside the first cervical transverse process. and 20% of the hypoglossal nerve arch is positioned at the lower edge of the abdominal lower abdomen of the second abdominal muscle 0.5 -1. 0c. Conclusion: 1. The bone markers, such as mastoid tip, mastoid process and root, are easy to touch and locate in the operation. The distance between the selected measurement points and the position of the important structure can be positioned, the depth of the operation route can be determined, and the orientation of the operation route can be estimated. 2. The root of the stem is the key anatomical marker of the parapharacular clearance. It is advisable to protect the internal carotid artery, the internal jugular vein, the posterior cerebral nerve and the external carotid artery and the facial nerve of the posterior internal carotid artery, the internal jugular vein, the posterior group and the superficial cervical artery. Structure. 3. The line connecting the inner edge of the rupture hole to the root of the stem and the root of the stem is taken as the boundary between the skull base region and the posterior gap at the boundary of the skull base region. A sign of the anterior clearance of the stem as a marker of the anterior clearance of the stem; the jugular foramen and the nearby bone, the outer side of the occipital bone, the occipital condyle and the like as the sign of the posterior clearance of the stem; and the root of the medial plate of the wings to the jugular fossa. The distance from the outer trailing edge is taken as the length of the skull base region of the parapharyngeal space, and the distance between the butterfly spine and the posterior edge of the jugular fossa The first cervical transverse process is easy to touch during the operation and can be used as an important bone marker for finding and protecting the secondary nerve; and a part of the hypoglossal nerve
【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】：2007
【分類號(hào)】：R323.1

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