發(fā)布時(shí)間：2018-07-05 07:42

  本文選題：翼腭窩 + 鼻內(nèi)窺鏡��； 參考：《新疆醫(yī)科大學(xué)》2009年碩士論文

【摘要】： 目的:通過(guò)鼻內(nèi)鏡下鼻腔外側(cè)壁中鼻道經(jīng)腭骨入路、中鼻道經(jīng)上頜竇入路、下鼻甲切除經(jīng)上頜竇入路三種手術(shù)入路方式對(duì)翼腭窩進(jìn)行相關(guān)應(yīng)用解剖學(xué)研究,為臨床鼻內(nèi)鏡下翼腭窩手術(shù)提供詳實(shí)的解剖學(xué)理論和實(shí)踐基礎(chǔ)。方法:①通過(guò)對(duì)10具(20側(cè))成人新鮮尸頭分別采用鼻內(nèi)鏡下中鼻道經(jīng)腭骨入路、經(jīng)上頜竇入路、下鼻甲切除經(jīng)上頜竇入路進(jìn)行解剖,觀測(cè)手術(shù)徑路中穿經(jīng)結(jié)構(gòu)以及重要血管神經(jīng)的毗鄰關(guān)系。②內(nèi)鏡下解剖后行正中矢狀鋸開(kāi),進(jìn)一步咬除翼腭窩周?chē)琴|(zhì)充分顯露翼腭窩、顳下窩、眶上裂及蝶竇外側(cè)壁并觀察測(cè)量。結(jié)果:①翼腭窩及其周?chē)Y(jié)構(gòu)解剖關(guān)系復(fù)雜,翼腭窩內(nèi)有頜內(nèi)動(dòng)脈及其分支、上頜神經(jīng)及其分支、翼腭神經(jīng)節(jié)等重要神經(jīng)血管結(jié)構(gòu),毗鄰眶尖、頸內(nèi)動(dòng)脈、視神經(jīng)等重要結(jié)構(gòu),是鼻腔進(jìn)入側(cè)顱底的通道。②頜內(nèi)動(dòng)脈翼腭窩段變異較大,頜內(nèi)動(dòng)脈翼腭段按順序發(fā)出分支占25%(5/20),眶下動(dòng)脈和上牙槽后動(dòng)脈共干分出占50%(10/20),分別由頜內(nèi)動(dòng)脈發(fā)出占40%(8/20);頜內(nèi)動(dòng)脈同時(shí)發(fā)出眶下動(dòng)脈、腭降動(dòng)脈、蝶腭動(dòng)脈占10%(2/20);眶下動(dòng)脈和腭降動(dòng)脈共干發(fā)出占10%(2/20);翼管動(dòng)脈和圓孔動(dòng)脈分別由頜內(nèi)動(dòng)脈發(fā)出及共干發(fā)出各占50%(10/20);頜內(nèi)動(dòng)脈翼腭段、腭降動(dòng)脈、蝶腭動(dòng)脈三支呈“Y”型35%(7/20),“T”型20%(4/20),“M”型15%(3/20),中間型30%(6/20);鼻后外側(cè)動(dòng)脈和鼻中隔后動(dòng)脈于翼腭窩內(nèi)由蝶腭動(dòng)脈發(fā)出占55%(11/20),出翼腭窩分出占20%(4/20),鼻中隔后動(dòng)脈在蝶腭孔后方骨孔單獨(dú)走行占5%(1/20),蝶腭動(dòng)脈在翼腭窩內(nèi)分出三支出蝶腭孔占20%(4/20)。④蝶腭孔、眶下管、圓孔和翼管是翼腭窩重要骨性標(biāo)志,鼻內(nèi)鏡下鼻腔外側(cè)壁三種手術(shù)入路暴露翼腭窩的范圍不同,并且翼腭窩可作為進(jìn)入顳下窩和蝶竇的通路。結(jié)論:①鼻內(nèi)鏡下經(jīng)鼻腔外側(cè)壁三種手術(shù)入路可不同程度暴露翼腭窩,視野清晰,為翼腭窩手術(shù)路徑提供了一個(gè)安全便捷的入路方式,并可根據(jù)病變范圍變通手術(shù)徑路。②熟知翼腭窩及其周?chē)愣ǖ慕馄蕵?biāo)志可在術(shù)中保持方向感,圍繞這三種手術(shù)入路進(jìn)行測(cè)量所得結(jié)果,有助于為手術(shù)中準(zhǔn)確定位更深層次的結(jié)構(gòu)提供依據(jù),提高手術(shù)安全性。③經(jīng)此入路可進(jìn)入顳下窩、蝶竇等臨近解剖區(qū)域,處理臨近區(qū)域病變。
[Abstract]:Objective: to study the applied anatomy of pterygopalatine fossa through three operative approaches: transpalatine osseous approach, middle nasal canal transmaxillary sinus approach and inferior turbinate resection via maxillary sinus approach under nasal endoscope. To provide a detailed anatomical and practical basis for clinical endoscopic pterygopalatine fossa surgery. Methods 10 adult fresh cadaveric heads (20 sides) were dissected by endoscopic transpalatine approach, maxillary sinus approach, inferior turbinate resection via maxillary sinus approach. After endoscopic anatomy, the median sagittal sawing was performed to remove the bone around the pterygopalatine fossa to reveal the pterygopalatine fossa and infratemporal fossa. The supraorbital fissure and lateral wall of sphenoid sinus were observed and measured. Results the anatomical relationship between the pterygopalatine fossa and its surrounding structures was complicated. There were some important structures in the pterygopalatine fossa, including the internal maxillary artery and its branches, the maxillary nerve and its branches, the pterygopalatine ganglion, and adjacent to the orbital apex, the internal carotid artery, the optic nerve, etc. The passage from nasal cavity to the lateral skull base was found to vary greatly in the pterygopalatine fossa segment of the internal maxillary artery. The branches of pterygopalatine segment of internal maxillary artery were 25% (5 / 20), 50% (10 / 20) of inferior orbital artery and posterior superior alveolar artery, and 40% (8 / 20) of internal maxillary artery, respectively. The sphenopalatine artery accounted for 10% (2 / 20), the inferior orbital artery and the descending palatine artery for 10% (2 / 20), the pterygoid artery and foramen artery for 50% (10 / 20), the pterygopalatine segment and the descending palatal artery for 50% (10 / 20), respectively. The three branches of sphenopalatine artery were "Y" type 35% (7 / 20), "T" type 20% (4 / 20), "M" type 15% (3 / 20), intermediate type 30% (6 / 20), posterior nasal artery and posterior septal artery in pterygopalatine fossa 55% (11 / 20), pterygopalatine fossa 20% (4 / 20), posterior nasal septum artery in sphenopalatine artery 20% (4 / 20), posterior nasal septum artery in pteropalatine fossa 55% (11 / 20), pterygopalatine fossa 20% (4 / 20). The sphenopalatine foramen was separated from the pterygopalatine fossa by the sphenopalatine artery in 20% (4 / 20) of the sphenopalatine foramen. The suborbital canal, foramen roundus and pterygoid canal are important bony markers of pterygopalatine fossa. Under nasal endoscope, the range of pterygopalatine fossa is different, and the pterygopalatine fossa can be used as the access to inferior temporal fossa and sphenoid sinus. Conclusion the pterygopalatine fossa can be exposed in different degrees by three kinds of transnasal endoscopic approaches through the lateral wall of nasal cavity. The visual field is clear, which provides a safe and convenient approach for the operation of pterygopalatine fossa. According to the range of pathological changes, the operative path .2 familiar with the constant anatomic mark of pterygopalatine fossa and its surroundings can maintain a sense of direction during the operation. The results are measured around the three operative approaches. It is helpful to provide the basis for the accurate location of deeper structures in the operation and improve the safety of the operation. 3. The approach can enter the inferior temporal fossa, the sphenoid sinus and other adjacent anatomical areas, and deal with the adjacent area lesions.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類(lèi)號(hào)】：R765;R322

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