本文選題：顯微解剖 + 內(nèi)鏡　； 參考：《鄭州大學》2009年碩士論文

【摘要】：目的:探討海綿竇區(qū)內(nèi)鏡下的顯微解剖,為經(jīng)鼻蝶入路內(nèi)鏡輔助下海綿竇內(nèi)腫瘤手術(shù)切除提供解剖學依據(jù)。 材料和方法:在8具(16側(cè))成人尸頭標本上,利用0度、30度角,直徑為4mm的神經(jīng)內(nèi)鏡進行研究,全部經(jīng)鼻中甲入路,切除蝶竇前壁到達蝶竇后壁,磨除蝶竇后壁的骨質(zhì)層,進入海綿竇區(qū)進行研究測量拍照。 結(jié)果:1.海綿竇呈粗細不等,反復(fù)分支,反復(fù)匯合的網(wǎng)狀結(jié)構(gòu),這些網(wǎng)狀結(jié)構(gòu)與頸內(nèi)動脈相互毗鄰,并可于手術(shù)顯微鏡下完整分離,使外科醫(yī)生切除海綿竇腫瘤成為可能。2.海綿竇內(nèi)側(cè)壁的膠原纖維層明顯較海綿竇上壁和外側(cè)壁為薄,海綿竇內(nèi)側(cè)壁實際上是由鞍膈發(fā)出的纖維構(gòu)成的薄壁。左右海綿竇的內(nèi)側(cè)壁即為垂體硬膜囊的兩側(cè)外側(cè)壁,作為垂體和海綿竇的邊界并將兩者分隔開來。3.內(nèi)鏡下蝶竇后壁的骨質(zhì)層分為五個相互垂直的區(qū)域:中央?yún)^(qū)、雙側(cè)對稱的旁中央?yún)^(qū)及外側(cè)區(qū)。中央?yún)^(qū)的主要結(jié)構(gòu)有:蝶骨平臺、鞍結(jié)節(jié)、蝶鞍和斜坡凹陷;旁中央?yún)^(qū)的主要結(jié)構(gòu)有:視神經(jīng)管的內(nèi)三分之一和頸內(nèi)動脈隆突;外側(cè)區(qū)主要包含四個骨性隆突(視神經(jīng)管隆突、海綿竇尖隆突、上頜竇隆突和下頜竇隆突)和三個隱窩(視神經(jīng)-頸內(nèi)動脈隱窩、眼神經(jīng)-上頜神經(jīng)隱窩〈V1-V2〉、上頜神經(jīng)-下頜神經(jīng)隱窩〈V2-V3〉)。這三個隱窩在外側(cè)區(qū)形成了三個解剖三角:視柱三角(由視神經(jīng)、頸內(nèi)動脈、動眼神經(jīng)圍成)、V1-V2三角、V2-V3三角。4.內(nèi)鏡下蝶竇后壁,通過其各自的骨性隆突可以明顯的看到海綿竇內(nèi)頸內(nèi)動脈的兩個分段,即尾側(cè)的斜坡旁段和頭側(cè)的鞍旁段,斜坡旁段的頸內(nèi)動脈可被進一步分為兩個部分:位于海綿竇外的尾側(cè)的破裂孔段和位于海綿竇內(nèi)的三叉神經(jīng)段。當?shù)]內(nèi)的粘膜被去除后,可以看到頸內(nèi)動脈的破裂孔段。鞍旁頸內(nèi)動脈呈一個凸向前外側(cè)的“C”形。它可被進一步分為四個部分,從尾側(cè)到頭側(cè)分別為:潛隱段、下水平段、前垂直段、上水平段。 結(jié)論:1海綿竇是由粗細不等的靜脈所組成的一個不規(guī)則的靜脈叢,反復(fù)分支吻合,不完全包繞頸內(nèi)動脈。2海綿竇的內(nèi)側(cè)壁由覆蓋于垂體的內(nèi)層硬膜構(gòu)成。3.內(nèi)鏡下通過蝶竇后壁的骨質(zhì)層五分區(qū)可順利進入海綿竇區(qū),海綿竇內(nèi)頸內(nèi)動脈的分段,使臨床切除海綿竇內(nèi)腫瘤時避免損傷重要血管神經(jīng)成為可能。
[Abstract]:Objective: to study the endoscopic microanatomy of cavernous sinus and to provide anatomic basis for endoscopic resection of cavernous sinus tumors. Materials and methods: a total of 8 adult cadaveric heads were studied by endoscopy with 0 degrees angle of 30 degrees and diameter of 4mm. The anterior wall of sphenoid sinus was removed to the posterior wall of sphenoid sinus, and the bone layer of posterior wall of sphenoid sinus was removed. The cavernous sinus area was studied and photographed. The result is 1: 1. The cavernous sinus presents a reticular structure of varying thickness, branching repeatedly and repeatedly converging. These reticular structures are adjacent to the internal carotid artery and can be completely separated under a surgical microscope, making it possible for surgeons to remove tumors of the cavernous sinus. The collagen fiber layer of the medial wall of the cavernous sinus is thinner than that of the superior wall and the lateral wall of the cavernous sinus. The medial wall of the cavernous sinus is actually a thin-walled wall formed by the fibers from the saddle diaphragm. The medial wall of the left and right cavernous sinus is the lateral wall of the pituitary dural sac, which serves as the boundary between the pituitary gland and the cavernous sinus and separates the two sides. The bone layer of the posterior wall of the sphenoid sinus is divided into five vertical regions: the central region, the bilateral symmetric paracentral area and the lateral area. The main structures of the central region are: the sphenoid plateau, the Sellar tubercle, the Sella and the clival depression. The main structures of the paracentral region are: the medial 1/3 of the optic canal and the Carina of the internal carotid artery; the lateral region mainly contains four bony Carina (optic canal Carina). Cavernous sinus apical protuberance, maxillary sinus protuberance and mandibular sinus protuberance) and three recesses (optic nerve-internal carotid artery recess, ophthalmic nerve-maxillary recess < V1-V2 >, maxillary nerve-mandibular nerve recess < V2-V3 >). The three recesses form three anatomical triangles in the lateral region: the optic column triangle (the optic nerve, the internal carotid artery, and the oculomotor nerve are surrounded by the V _ 1-V _ 2 triangle and V _ 2-V _ 3 triangle .4). Endoscopically, the posterior wall of the sphenoid sinus can be seen in two segments of the internal carotid artery in the cavernous sinus through their respective bony protuberances, that is, the paraphoric segment of the caudal side and the parasellar segment of the cephalic side. The internal carotid artery in the parapulmonary segment can be further divided into two parts: the ruptured foramen in the caudal part outside the cavernous sinus and the trigeminal nerve segment in the cavernous sinus. When the mucous membrane in the sphenoid sinus is removed, the ruptured hole of the internal carotid artery can be seen. The medial parasellar carotid artery presents a "C" shape protruding anterolateral. It can be further divided into four parts: the latent segment, the lower horizontal segment, the anterior vertical segment and the upper horizontal segment from the caudal to the cephalic side. Conclusion the cavernous sinus of the cavernous sinus is an irregular venous plexus composed of veins of different thicknesses, which are repeatedly branched and anastomosed. The medial wall of the cavernous sinus, which is not completely wrapped around the internal carotid artery .2, is composed of an internal dural covering the pituitary gland. Endoscopic approach to the cavernous sinus through the bone layer of the posterior wall of sphenoid sinus into the cavernous sinus and the segmentation of the internal carotid artery in the cavernous sinus make it possible to avoid the injury of important vessels and nerves in clinical excision of tumors in the cavernous sinus.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2009
【分類號】：R651;R322

【參考文獻】

相關(guān)期刊論文 前10條

1 劉志雄;海綿竇的顯微解剖及其臨床意義[J];國外醫(yī)學.神經(jīng)病學神經(jīng)外科學分冊;2001年05期

2 王海軍,王滌宇,徐杰;海綿竇內(nèi)側(cè)壁的應(yīng)用解剖[J];解剖學雜志;2004年03期

3 張保中,薛志廣,余新光,張紀,周定標;海綿竇三角的顯微外科解剖[J];軍醫(yī)進修學院學報;1999年01期

4 王繼群，許庚，卜國鉉;蝶竇外側(cè)壁的應(yīng)用解剖[J];中華耳鼻咽喉科雜志;1994年03期

5 吳建東,惠國楨,夏春林;海綿竇內(nèi)顱神經(jīng)血液供應(yīng)顯微外科解剖研究[J];中華神經(jīng)外科雜志;2001年02期

6 江濤,王忠誠,于春江,張保中,張紀;海綿竇顯微外科相關(guān)三角解剖學研究[J];中華神經(jīng)外科雜志;1999年01期

7 汪華僑,龐水發(fā),陳增保,王海軍;頸內(nèi)動脈海綿竇段分支及其臨床意義[J];中華顯微外科雜志;1999年S1期

8 尹嘉,曹瑞華,丁學華,廖建春,張光霽,樓美清,駱純,盧亦成;經(jīng)海綿竇腦神經(jīng)的顯微外科解剖及其臨床意義[J];中國臨床解剖學雜志;2002年06期

9 陳革,凌鋒,杜建新,李萌,陳亞亮;內(nèi)鏡下經(jīng)鼻蝶入路治療鞍區(qū)病變的解剖學研究[J];中國微侵襲神經(jīng)外科雜志;2005年05期

10 王任直;康軍;蘇長保;任祖淵;楊義;馬文斌;李永寧;幸兵;連偉;魏宇魁;趙兵;;海綿竇內(nèi)側(cè)壁的顯微解剖與擴大經(jīng)蝶竇入路治療侵襲海綿竇的垂體腺瘤(附103例分析)[J];中國微侵襲神經(jīng)外科雜志;2008年03期

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