本文選題：乙狀竇后鎖孔入路　切入點(diǎn)：模具硅膠　出處：《山西醫(yī)科大學(xué)》2009年碩士論文

【摘要】： 【目的】腦干前外側(cè)區(qū)域,部位深,周圍解剖結(jié)構(gòu)復(fù)雜,乙狀竇后入路是切除該區(qū)域病變的主要入路之一。該課題應(yīng)用鎖孔入路的新理念,模擬乙狀竇后鎖孔入路,研究該入路的顯微解剖和顯微技巧,為臨床應(yīng)用提供理論指導(dǎo)和技術(shù)支持。 【方法】(1)測量10具干性顱骨與乙狀竇后鎖孔入路相關(guān)的重要解剖標(biāo)志間的距離。(2)對10具濕性成人尸頭標(biāo)本,采用手推恒壓法用有色模具硅膠進(jìn)行灌注。(3)模擬乙狀竇后鎖孔入路:側(cè)臥位,頭稍向健側(cè)前屈,以乳突的內(nèi)側(cè)緣為最高點(diǎn),枕骨鱗部基本處于水平位。以星點(diǎn)為起點(diǎn)向下的5cm垂直縱行切口。外側(cè)邊與上邊剛顯露橫竇和乙狀竇,大小為3.0×4.0 cm的橢圓形骨窗。切開硬膜,顯微鏡下進(jìn)行顯微解剖學(xué)觀察。 【結(jié)果(】1)乙狀竇后鎖孔入路,骨窗關(guān)鍵孔應(yīng)位于星點(diǎn)下方1.0cm,距乙狀竇溝后緣0.5cm。骨窗大小為直徑3.0 cm左右,外側(cè)邊與上邊剛顯露橫竇下緣和乙狀竇后緣。(2)10具標(biāo)本中,其中直徑1mm動脈灌注成功10例全部成功;靜脈灌注成功率較動脈低,直徑1mm靜脈灌注成功80%左右。隨著血管變細(xì),灌注成功率下降。(3)乙狀竇后鎖孔入路可以充分顯露三叉神經(jīng)和頸靜脈孔之間的腦干側(cè)方區(qū)域。 【結(jié)論】(1)乙狀竇后鎖孔入路中,熟悉顱骨表面標(biāo)志和顱內(nèi)結(jié)構(gòu)對應(yīng)關(guān)系對骨窗關(guān)鍵孔及骨窗大小、位置有指導(dǎo)意義。(2)在頭頸部的解剖研究中,用模具硅橡膠灌注頭頸部血管標(biāo)本是一種較好方法。(3)熟悉乙狀竇后相關(guān)各解剖結(jié)構(gòu)關(guān)系對手術(shù)操作過程中避免損傷重要結(jié)構(gòu)有重要意義。,
[Abstract]:[objective] the anterolateral region of the brain stem is deep and the surrounding anatomical structure is complex. The posterior sigmoid approach is one of the main approaches for the resection of the lesions in this region. The new concept of keyhole approach is used to simulate the retrosigmoid keyhole approach. To study the microanatomy and microtechnique of the approach, to provide theoretical guidance and technical support for clinical application. [methods] the distance between the dry skull and the important anatomic markers associated with the retrosigmoid keyhole approach was measured in 10 cadavers from 10 wet adult cadavers. The method of hand push and constant pressure was used to make use of colored mould silica gel for perfusion. 3) simulating the retrosigmoid keyhole approach: lateral position, head slightly bent to the healthy side, with the medial edge of the mastoid process as the highest point. The scale of occipital bone was basically horizontal. The vertical longitudinal incision of 5cm with star point as the starting point was used. The lateral and upper sides had just exposed the transverse sinus and sigmoid sinus, and the size of the oval bone window was 3.0 脳 4.0 cm. The dura dural was cut open, and the microscopic anatomy was performed under the microscope. [results] in the retrosigmoid keyhole approach, the critical foramen of bone window should be located at 1.0 cm below the star point and 0.5 cm from the posterior margin of sigmoid sinus. The size of bone window was about 3.0 cm in diameter. The lateral and upper sides were just exposed to the inferior margin of transverse sinus and the posterior edge of sigmoid sinus. The success rate of venous perfusion was lower than that of artery, and the success rate of diameter 1mm was about 80%. The retrosigmoid keyhole approach can fully reveal the lateral region of the brain stem between the trigeminal nerve and the jugular foramen. [conclusion] in the retrosigmoid keyhole approach, familiarity with the relationship between the cranial surface markers and the intracranial structure has instructive significance for the size and location of the critical foramen and the bone window in the head and neck. It is a good method to infuse the vascular specimens of head and neck with mould silicone rubber. It is important to know the relationship between the related anatomical structures of the posterior sigmoid sinus and avoid the injury of the important structures during the operation.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R651;R322

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