本文選題：鼻旁竇 + 乳突小房��； 參考：《江蘇大學(xué)》2010年碩士論文

【摘要】： 目的:測(cè)量及比較炎癥組與對(duì)照組的上頜竇、蝶竇和乳突小房的體積;觀察蝶竇內(nèi)的頸內(nèi)動(dòng)脈、視神經(jīng)隆凸的出現(xiàn)率,分析頸內(nèi)動(dòng)脈隆凸的出現(xiàn)率與蝶竇體積的關(guān)系。在此基礎(chǔ)上,探討鼻竇炎、中耳炎與顱骨氣化的關(guān)系;鼻旁竇與乳突小房之間的氣化關(guān)系;探討蝶竇體積與頸內(nèi)動(dòng)脈隆凸出現(xiàn)的規(guī)律;及其經(jīng)蝶竇入路時(shí),提出手術(shù)中如何保護(hù)視神經(jīng)和頸內(nèi)動(dòng)脈的原則。 方法:1.收集鼻竇炎、中耳炎病人分別為30和15例,正常對(duì)照組350人。采用GE公司的Hispeed 64排128層螺旋CT掃描,掃描圖像經(jīng)重建后的層厚為1 mm。 2.首先是一般觀察蝶竇內(nèi)頸內(nèi)動(dòng)脈隆凸、視神經(jīng)隆凸所出現(xiàn)的比例。用Mimicsl2.0三維醫(yī)學(xué)圖像處理軟件,半自動(dòng)的方法逐層勾畫(huà)出上頜竇、蝶竇和乳突小房,由軟件自動(dòng)完成上述結(jié)構(gòu)的三維重建模型和體積。 結(jié)果:1.鼻旁竇體積的測(cè)量鼻竇炎組的上頜竇體積為7.01±2.86cm~3蝶竇體積為4.80±1.20 cm~3;對(duì)照組的上頜竇體積為30.17±13.54cm~3;蝶竇體積為17.79±6.93 cm~3;中耳炎組的乳突小房的體積為7.48±3.43 cm~3,對(duì)照組乳突小房的體積為13.09±6.31 cm~3;鼻竇炎與對(duì)照組的上頜竇和蝶竇體積相比較無(wú)統(tǒng)計(jì)學(xué)差異;中耳炎與對(duì)照組乳突小房體積之間相比較有顯著性差異。將上述對(duì)照組的上頜竇、蝶竇及其乳突小房的體積進(jìn)行分析,其沒(méi)有明顯的相關(guān)性。 2.蝶竇氣化程度與蝶竇內(nèi)隆凸關(guān)系的研究,蝶竇內(nèi)沒(méi)有出現(xiàn)頸內(nèi)動(dòng)脈隆凸的占總數(shù)70.75%;蝶竇腔內(nèi)出現(xiàn)一側(cè)隆凸的占總數(shù)8.49%;;蝶竇腔內(nèi)出現(xiàn)兩側(cè)隆凸的占總數(shù)20.74%;兩種情況相加,蝶竇內(nèi)有頸內(nèi)動(dòng)脈隆凸占總數(shù)的29.23%。根據(jù)上述調(diào)查結(jié)果,將受試者分為無(wú)頸內(nèi)動(dòng)脈隆凸組、單側(cè)頸內(nèi)動(dòng)脈隆凸組、雙側(cè)頸內(nèi)動(dòng)脈隆凸組,從每組中隨機(jī)選擇30例,測(cè)量蝶竇的體積,分析隆凸與蝶竇體積之間的關(guān)系。無(wú)頸內(nèi)動(dòng)脈隆凸組的體積為11.16±16.00(8.57～14.67)cm3;單側(cè)頸內(nèi)動(dòng)脈隆凸組14.20±1.80(11.76～20.86)cm3;雙側(cè)頸內(nèi)動(dòng)脈隆凸組25.03±2.21(18.37～31.24)cm3。 3.視神經(jīng)行走過(guò)程與臨床應(yīng)用要點(diǎn)主要分為兩種類型,一是氣化程度不高的蝶竇,未見(jiàn)蝶竇內(nèi)有視神經(jīng)管凸,但視神經(jīng)與其緊密相鄰;氣化程度非常良好的蝶竇,有14%視神經(jīng)管向蝶竇內(nèi)形成隆凸,行走于蝶竇的外側(cè)壁,甚至裸露在管腔內(nèi)。在進(jìn)行經(jīng)蝶竇入路時(shí),特別注意不要傷及與其相鄰的視神經(jīng),否則會(huì)造成很嚴(yán)重的后果。 4.頸內(nèi)動(dòng)脈行走過(guò)程氣化明顯的頸內(nèi)動(dòng)脈突入到蝶竇內(nèi)形成隆凸,有的形成半側(cè)管腔的突入,有的是整個(gè)管腔的突入,其血管與蝶竇之間隔一層很薄的骨質(zhì),有時(shí)似乎沒(méi)有骨質(zhì)血管直接裸露在蝶竇內(nèi);沒(méi)有形成隆凸的,之間的骨質(zhì)相對(duì)較厚。 結(jié)論:1.鼻旁竇體積的測(cè)量鼻竇炎的發(fā)病率與鼻旁竇的氣化無(wú)關(guān);中耳炎的發(fā)病率與乳突小房氣化程度相關(guān),氣化程度越低,中耳炎的發(fā)病率越高。 2.蝶竇氣化程度與頸內(nèi)動(dòng)脈隆凸的出現(xiàn)率是直接相關(guān)的,體積越大,頸內(nèi)動(dòng)脈隆凸的出現(xiàn)率就高�？梢愿鶕�(jù)蝶竇的氣化程度確定手術(shù)方案。 3.蝶竇氣化程度與視神經(jīng)管隆凸也是直接相關(guān)的,視神經(jīng)管隆凸的出現(xiàn)均伴隨蝶竇氣化程度良好和頸內(nèi)動(dòng)脈隆凸的出現(xiàn),視神經(jīng)有時(shí)直接裸露在蝶竇內(nèi),有時(shí)為一段的視神經(jīng)位于在蝶竇的側(cè)壁,根據(jù)視神經(jīng)管隆凸出現(xiàn)的規(guī)律,可確定手術(shù)的指導(dǎo)方案。
[Abstract]:Objective: to measure and compare the inflammatory group and the control group of the maxillary sinus, sphenoid sinus and mastoid volume; observation of internal carotid artery in sphenoid sinus, optic nerve protuberance rate, analysis of internal carotid artery carina of the relationship between the occurrence rate of sphenoid sinus volume. On this basis, to explore the relationship between sinusitis, otitis media and the relationship between skull gasification; gasification of paranasal sinus and mastoid; of sphenoid sinus and internal carotid artery volume carina the law; and the transsphenoidal approach, put forward how to protect the optic nerve and internal carotid artery surgery principle.
Methods: 1.. We collected 30 cases of sinusitis and 15 cases of otitis media, and 350 cases of the normal control group. The Hispeed 64 row 128 slice spiral CT scan of GE company was used to scan the images. The thickness of the reconstructed images was 1 mm..
2. is the first general observation of internal carotid artery in sphenoid sinus carina, optic nerve protuberance arising ratio. Using Mimicsl2.0 three-dimensional medical image processing software, semi-automatic method layer outline of maxillary sinus, sphenoid sinus and mastoid cells, automatically complete the three-dimensional modeling of the structure type and volume by the software.
Results: 1. paranasal sinusitis group measured volume of maxillary sinus volume was 7.01 + 2.86cm~3 + 1.20 sphenoid sinus volume is 4.80 cm~3; the control group of the maxillary sinus volume was 30.17 + 13.54cm~3; sphenoid volume was 17.79 + 6.93 cm~3; otitis media group of mastoid volume is 7.48 + 3.43 cm~3, control group of mastoid volume is 13.09 + 6.31 cm~3; and the control group of maxillary sinusitis and sphenoid sinus volume compared with no significant difference; there is a significant difference between the control group and otitis media between the mastoid volume. The control group of the maxillary sinus, sphenoid sinus and mastoid volume analysis no, the obvious correlation.
Study on the 2. degree of sphenoid sinus and sphenoid sinus palatinus relationship, no internal carotid artery carina in 70.75% of the total number of sphenoid sinus; sphenoid sinus cavity side carina accounted for 8.49%;; sphenoid sinus cavity appears on both sides of the carina accounted for 20.74%; two cases of sphenoid sinus in addition, internal carotid artery carina of the total 29.23%. according to the survey results, the subjects were divided into internal carotid artery carina group, unilateral internal carotid artery carina group, bilateral internal carotid artery carina group, 30 cases were randomly selected from each group, measured the volumes of sphenoid sinus, sphenoid sinus and carina analysis of the relationship between the volume. No internal carotid artery carina group volume is 11.16 + 16 (8.57 ~ 14.67) cm3; unilateral internal carotid artery carina group 14.20 + 1.80 (11.76 ~ 20.86) cm3; bilateral internal carotid artery carina group 25.03 + 2.21 (18.37 ~ 31.24) cm3.
3. optic nerve during walking and clinical application points are divided into two types, one is not high degree of pneumatization of sphenoid sinus, sphenoid sinus had no optic canal convex, but the optic nerve closely; very good degree of pneumatization of sphenoid sinus, 14% optic canal to the sphenoid sinus formed in the carina. Walking on the lateral wall of sphenoid sinus, even exposed in the lumen. In transsphenoidal approach, with particular attention to the adjacent optic nerve and not, otherwise it will cause serious consequences.
4. internal carotid artery during walking into the internal carotid artery was gasified in the sphenoid sinus formation of carina, some form of half side into the lumen, some entire lumen into the septum, a thin layer of bone between the vessel and the sphenoid sinus, sometimes seem to have bone vessels exposed in the sphenoid sinus; no carina and between the bone is relatively thick.
Conclusion: 1. the incidence of sinusitis is not related to the volume of paranasal sinus. The incidence of otitis media is related to the degree of mastoidectomy. The lower the degree of gasification, the higher the incidence of otitis media.
2., the degree of sphenoid sinus gasification is directly related to the occurrence rate of internal carotid artery protuberance. The larger the volume, the higher the incidence of internal carotid artery protuberance. We can determine the operative plan according to the degree of gasification of the sphenoid sinus.
3. degree of sphenoid sinus and optic canal carina is directly related to the optic nerve tube carina were accompanied by a good degree of sphenoid sinus and internal carotid artery carina of the optic nerve, sometimes exposed in the sphenoid sinus, optic nerve is sometimes located on a side wall of the sphenoid sinus, according to the optic canal carina appeared regularity, can determine the guidance scheme for surgery.

【學(xué)位授予單位】：江蘇大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R322

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本文編號(hào)：1739915