本文選題：側(cè)顱底　切入點(diǎn)：解剖　出處：《安徽醫(yī)科大學(xué)》2008年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的:側(cè)顱底腫瘤位置深在,毗鄰重要的顱神經(jīng)和動(dòng)、靜脈,傳統(tǒng)的開(kāi)顱手術(shù)和頜面進(jìn)路手術(shù),不但并發(fā)癥和死亡率高,手術(shù)進(jìn)路也常損壞面容。加之手術(shù)暴露困難,難以徹底切除病變,術(shù)后復(fù)發(fā)率高,因此側(cè)顱底曾被認(rèn)為是手術(shù)禁區(qū)。近年來(lái)隨著醫(yī)學(xué)影像學(xué)、耳顯微醫(yī)學(xué)、麻醉醫(yī)學(xué)、重癥監(jiān)護(hù)醫(yī)學(xué)的發(fā)展,側(cè)顱底外科的診療技術(shù)也有了長(zhǎng)足的發(fā)展。本研究通過(guò)對(duì)20具(40側(cè))黃種成人尸頭側(cè)顱底區(qū)域重要解剖標(biāo)志進(jìn)行觀察與測(cè)量,得出相關(guān)實(shí)驗(yàn)結(jié)果,用于指導(dǎo)臨床:側(cè)顱底手術(shù)前設(shè)計(jì)最合理的手術(shù)路徑;側(cè)顱底手術(shù)中盡可能充分暴露手術(shù)野,避免損傷重要血管、神經(jīng),防止長(zhǎng)時(shí)間和過(guò)度牽拉腦組織;同時(shí)也可增加內(nèi)鏡顱底手術(shù)的安全性及減少顱底導(dǎo)航技術(shù)的配準(zhǔn)誤差。 方法:本組實(shí)驗(yàn)標(biāo)本中男性12具,女性8具(性別、年齡由解剖教研室提供),按1—40的順序進(jìn)行編號(hào)。從外科手術(shù)的角度出發(fā),按編號(hào)順序?qū)?cè)顱底區(qū)域進(jìn)行解剖,行實(shí)驗(yàn)項(xiàng)目的觀察與測(cè)量。解剖方法:尸頭固定于解剖架上,顴根與頂骨最高點(diǎn)連線的中、上1/3處平行于眶-耳平面鋼鋸鋸除顱骨,進(jìn)行顱底內(nèi)面觀察與測(cè)量。切除下頜骨及其周?chē)街∪?進(jìn)行顱底外面觀察與測(cè)量。電鉆行擴(kuò)大乳突輪廓化上至中顱窩硬腦膜,暴露竇腦膜角,暴露上、外、后三組骨半規(guī)管;乙狀竇全程顯露至頸靜脈球;自顱內(nèi)段至顳骨外段全程顯露面神經(jīng),行面神經(jīng)改道及面神經(jīng)的主動(dòng)前移;頸部解剖頸內(nèi)動(dòng)脈至頸內(nèi)動(dòng)脈管外口,電鉆磨除骨質(zhì)顯現(xiàn)巖骨段頸內(nèi)動(dòng)脈,顱內(nèi)暴露頸內(nèi)動(dòng)脈至前床突段上部。 結(jié)果:本研究結(jié)果包括三項(xiàng)內(nèi)容:1、以骨性頸靜脈孔靜脈部、骨性頸靜脈孔神經(jīng)部、顴弓后根、莖突根部及星點(diǎn)為解剖基點(diǎn),觀察測(cè)量與側(cè)顱底重要結(jié)構(gòu)的解剖關(guān)系、解剖距離及解剖角度。2、測(cè)量迷路三角(竇腦膜角、頸靜脈球、鼓竇入口),迷路后三角(竇腦膜角、頸靜脈球、后半規(guī)管),乳突表面三角(星點(diǎn)、乳突尖、顴根)解剖面積。3、測(cè)量顳骨內(nèi)面神經(jīng)各段的長(zhǎng)度;測(cè)量面神經(jīng)垂直段改道及水平段、垂直段聯(lián)合改道后延長(zhǎng)的可利用面神經(jīng)長(zhǎng)度;行面神經(jīng)長(zhǎng)路徑(從莖乳孔至膝狀神經(jīng)節(jié))和短路徑(從莖乳孔至外膝部)主動(dòng)前移,在莖乳孔處面神經(jīng)前移10mm的共同前提下,分別測(cè)量不同徑路頸靜脈球上緣、外膝部面神經(jīng)前移的最大距離和角度。采用SPSS10.0統(tǒng)計(jì)軟件計(jì)算各測(cè)量數(shù)據(jù),計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差((?)±s)表示。 結(jié)論: 1.從外科手術(shù)的角度出發(fā),以臨床手術(shù)醫(yī)師的視野,行成人側(cè)顱底解剖學(xué)研究,能讓研究結(jié)果更有征對(duì)性,進(jìn)而能為臨床提供更有力的參考。 2.頸靜脈球變異大,而骨性頸靜脈孔靜脈部變異小,本研究采用骨性頸靜脈孔靜脈部作為解剖基點(diǎn)測(cè)量其與體表骨性標(biāo)志的距離,結(jié)果更準(zhǔn)確,術(shù)者了解此結(jié)果可減小側(cè)顱底術(shù)中損傷頸靜脈球的可能性。以骨性頸靜脈孔神經(jīng)部為解剖基點(diǎn)所得到的解剖數(shù)據(jù)可為術(shù)中更好地保護(hù)后組顱神經(jīng)提供參考。 3.以莖突根部、顴弓根、星點(diǎn)為解剖基點(diǎn)所得到的解剖數(shù)據(jù)可降低臨床側(cè)顱底手術(shù)中損傷護(hù)重要血管、神經(jīng)的風(fēng)險(xiǎn);增加內(nèi)鏡顱底手術(shù)的安全性;減少顱底導(dǎo)航技術(shù)的配準(zhǔn)誤差。 4.迷路三角、迷路后三角、乳突表面三角面積的測(cè)定為臨床側(cè)顱底手術(shù)方案的設(shè)計(jì)、手術(shù)徑路的選擇提供參考。 5.顳骨內(nèi)面神經(jīng)改道可延長(zhǎng)神經(jīng)的可利用長(zhǎng)度,減少面神經(jīng)端端吻合時(shí)的張力。面神經(jīng)主動(dòng)前移可為術(shù)者提供更廣闊的手術(shù)視野。莖乳孔處面神經(jīng)前移應(yīng)和神經(jīng)周?chē)睦w維鞘一同進(jìn)行,防止損傷莖乳動(dòng)脈。
[Abstract]:Objective: lateral skull base tumors located in deep, adjacent to the important cranial nerve and vein, traditional craniotomy and maxillofacial surgery approach, not only the high morbidity and mortality, surgical approach is often damaged. In addition to face difficult surgical exposure, it is impossible to completely remove lesions, recurrence rate is high, so the lateral skull base was considered is the operation area. In recent years with medical imaging, ear micro medicine, anesthesiology, the development of critical care medicine, diagnosis and treatment of lateral skull base surgery technology has made great progress. This study based on 20 (40 sides) adult cadaveric head yellow lateral skull base region important anatomic landmarks were observed and measured, draw relevant the experimental results are used to guide clinical design before surgery of lateral skull base surgery: the most reasonable path; lateral skull base surgery in fully exposed surgical field as far as possible, avoid injury of important blood vessels, nerves, prevent the long time and excessive brain retraction At the same time, it can also increase the safety of endoscopic skull base surgery and reduce registration error of skull base navigation.
Methods: the experimental group were male 12, female 8 (gender, age from Department of Anatomy), 1 - 40 of the number in the sequence. Starting from a surgical point, according to the regional anatomy of the lateral skull base number order, observation and measurement for experiment. Methods: cadaveric head anatomy fixed on the anatomical shelf, zygomatic root and parietal connections in the highest point, 1/3 parallel to the orbital plane in ear steel saw skull, surface observation and measurement of skull base. Resection of the mandible and its attached muscles were observed and measured. The skull base was expanding drill mastoidectomy to middle cranial fossa dura exposure, exposure, meningeal sinus angle, after three groups of semicircular canals; sigmoid sinus to show the whole jugular bulb; since the intracranial segment of extratemporal segment to show the whole facial nerve, to advance the initiative of facial nerve and facial nerve rerouting; neck anatomy of internal carotid artery to internal carotid artery In the outer mouth, the electric drill grind away the bone segment of the internal carotid artery and expose the internal carotid artery to the upper part of the front of the anterior bed.
Results: the results of this study include three contents: 1, in the vein of the bony jugular foramen, jugular foramen nerve, the dorsal root of the zygomatic arch, anatomy of styloid process and star point, to observe the relationship between anatomical measurement and lateral skull base structure, anatomy and anatomical distance measuring.2 angle, the labyrinthine triangle (sinus meningeal angle, jugular bulb, tympanic antrum entrance), retrolabyrinthine triangle (sinus dural angle, jugular bulb, posterior semicircular canal), mastoid surface triangle (star, mastoid tip, zygomatic root) anatomical area of.3, measuring the intratemporal facial nerve segment length measurement; facial nerve vertical section and horizontal section of diversion the vertical section of diversion, combined with prolonged use of facial nerve length; facial nerve (long path from the stylomastoid foramen to the geniculate ganglion) and short path (from the stylomastoid foramen to the knee) initiative forward, in the stylomastoid foramen at facial nerve forward 10mm, were measured in different path of neck the ball on the edge of the vein, The maximum distance and angle of the anterior movement of the facial nerve in the external genu were calculated by the SPSS10.0 statistical software, and the measurement data were expressed in a mean number of standard deviations ((?) + s).
Conclusion:
1., from the perspective of surgical operation, the lateral skull base anatomical study of adults can be made more satisfactory by clinical operation doctors' vision, which can provide more powerful references for clinical research.
2. jugular bulb variation, and the variation of the vein of the jugular foramina is small, this study adopts the jugular Kong Jingmai Department of anatomy as a basic point to measure the surface and the bony landmarks of the distance, the more accurate results of the understanding of this result can reduce the possibility of damage to the jugular bulb during the operation. The lateral skull base bony jugular foramen the nerve part of anatomical data for anatomy points obtained during operation to better protect cranial nerves and provide reference.
3. the anatomical data obtained from the base of the styloid process, the zygomatic arch and the star point can reduce the risk of injury and protection of important vessels and nerves in clinical lateral skull base surgery, increase the safety of endoscopic skull base surgery, and reduce the registration error of the skull base navigation technology.
The 4. labyrinth triangle, the posterior triangle of the labyrinth, and the trigonometric area of the mastoid surface are the design of the clinical lateral skull base operation scheme, and the choice of the surgical path is a reference.
5. intratemporal facial nerve rerouting can prolong the nerve can be used to reduce the length of facial nerve anastomosis of the facial nerve tension. The initiative forward can provide a broader vision for the surgical operation. The fibrous sheath around the stylomastoid foramen at the facial nerve and nerve should forward together, to prevent damage to the stylomastoid artery.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R322

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 夏寅,王天鐸,陳瑛;翼點(diǎn)入路及顳下窩入路應(yīng)用解剖[J];山東醫(yī)科大學(xué)學(xué)報(bào);2000年02期

2 蔡錫類,鄭凱爾,陳聯(lián)軍,賀志浩,王云仙,顧乃群,王紹恭,惲振先;顱底卵圓孔、棘孔和破裂孔形態(tài)的X線檢查研究[J];實(shí)用放射學(xué)雜志;1993年01期

3 蔡錫類;顱底卵圓孔、棘孔和相鄰結(jié)構(gòu)變異的X線研究[J];實(shí)用放射學(xué)雜志;1994年12期

4 張淑香,何凡,王燕ib;顳骨內(nèi)面神經(jīng)解剖及測(cè)量[J];天津醫(yī)藥;2002年11期

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本文編號(hào)：1564554