嗅神經(jīng)及其伴行靜脈的臨床解剖學(xué)研究
發(fā)布時(shí)間：2018-07-17 16:25
【摘要】： 目的觀察嗅神經(jīng)及其伴行靜脈在顯微解剖、組織學(xué)及影像圖像上的形態(tài)特征,完善嗅神經(jīng)的形態(tài)學(xué)資料,探討篩孔靜脈在顱內(nèi)外感染中的意義,為鼻腔頂部、顱前窩等手術(shù)中保護(hù)病人嗅覺(jué)功能提供臨床解剖學(xué)資料,為經(jīng)鼻給藥通路治療中樞神經(jīng)系統(tǒng)疾病提供形態(tài)學(xué)依據(jù)。 方法①選取成人頭顱濕標(biāo)本30例(60側(cè))經(jīng)灌注明膠顏料后顯微解剖觀察嗅神經(jīng)的走形和分布、顱前窩底和面部靜脈的走行和分布,另選5例(10側(cè))成人頭顱濕標(biāo)本灌注墨水和造影劑,經(jīng)顯微解剖后取下嗅粘膜,進(jìn)行X線掃描;②選取成人頭顱干性標(biāo)本30例(60側(cè))進(jìn)行顯微解剖學(xué)觀測(cè);③隨機(jī)選取3例(6側(cè))經(jīng)灌注明膠顏料的上述濕性標(biāo)本,從每例標(biāo)本的上鼻甲和鼻中隔粘膜上分別取2塊組織,共12塊,進(jìn)行HE染色和VG染色,觀察嗅神經(jīng)及其伴行靜脈的組織學(xué)特點(diǎn);④收集51例(97側(cè))經(jīng)證實(shí)無(wú)面部靜脈異常的全腦血管數(shù)字減影血管造影(DSA)系列圖像的靜脈相,觀察顱前窩底及面部靜脈的走行和分布。 結(jié)果1、嗅神經(jīng)的形態(tài)觀察:①顯微解剖發(fā)現(xiàn)嗅神經(jīng)(嗅絲)由硬腦膜形成的嗅鞘包裹,嗅鞘內(nèi)存在一潛在的腔隙。嗅神經(jīng)位于嗅粘膜上,呈馬蹄鐵型分布,分鼻甲側(cè)和鼻中隔側(cè)。鼻甲側(cè)嗅神經(jīng)分布于上鼻甲和中鼻甲垂直部粘膜的篩骨面,鼻中隔側(cè)嗅神經(jīng)分布于鼻中隔粘膜的篩骨面,鼻甲和鼻中隔粘膜的鼻腔面未見(jiàn)嗅神經(jīng)分布。鼻甲側(cè)嗅神經(jīng)數(shù)為(10.33±1.81)條,嗅神經(jīng)根部直徑為(0.90±0.22)mm。鼻中隔側(cè)嗅神經(jīng)數(shù)為(6.28±1.04)條,嗅神經(jīng)根部直徑為(1.17±0.24)mm。嗅粘膜鼻中隔側(cè)嗅神經(jīng)長(zhǎng)度為(5.91±1.95)mm,醫(yī)學(xué)參考值范圍(95%)上限為9.73 mm;嗅粘膜鼻甲側(cè)嗅神經(jīng)長(zhǎng)度為(10.22±2.20)mm,醫(yī)學(xué)參考值范圍(95%)上限為14.53 mm。干性標(biāo)本觀察發(fā)現(xiàn)每側(cè)篩孔分布呈兩列,分別與嗅神經(jīng)的鼻甲側(cè)和鼻中隔側(cè)相對(duì)應(yīng)。每側(cè)篩孔數(shù)為(16.33±2.79)個(gè),篩孔最大徑為(1.09±0.52)mm。②HE染色和VG染色可見(jiàn)嗅區(qū)粘膜表面的嗅上皮為假?gòu)?fù)層柱狀上皮,固有層多為結(jié)締組織,嗅神經(jīng)內(nèi)膜、束膜和外膜清晰可見(jiàn),神經(jīng)外膜外可見(jiàn)由一層致密的結(jié)締組織圍成的嗅鞘結(jié)構(gòu)。③X片可見(jiàn)嗅鞘內(nèi)可以透過(guò)造影劑。2、篩孔靜脈的形態(tài)觀察:①顯微解剖發(fā)現(xiàn),篩孔靜脈走行于嗅鞘內(nèi),與嗅神經(jīng)伴行,通過(guò)篩孔向顱內(nèi)引流,與顱內(nèi)的嗅靜脈、額葉皮質(zhì)靜脈或硬膜靜脈相交通。②HE染色可見(jiàn)篩孔靜脈位于嗅鞘內(nèi),管壁較薄。VG染色未見(jiàn)篩孔靜脈中膜含有平滑肌細(xì)胞。③DSA發(fā)現(xiàn)68.6%的成人存在篩孔靜脈使面部靜脈與顱內(nèi)靜脈直接交通,篩孔靜脈入顱后與額葉皮質(zhì)靜脈或額下靜脈吻合。 結(jié)論①深入系統(tǒng)的觀察嗅神經(jīng)及其伴行靜脈,豐富了解剖學(xué)和影像學(xué)資料;②熟悉嗅神經(jīng)的形態(tài)特征,有助于神經(jīng)外科手術(shù)入路的選擇和手術(shù)過(guò)程中更好地保護(hù)嗅神經(jīng),避免術(shù)后并發(fā)癥的發(fā)生;③嗅粘膜鼻中隔側(cè)距篩板下10 mm,鼻甲側(cè)距篩板下15 mm以外極少存在嗅神經(jīng),在此范圍手術(shù)操作較為安全;④人的面部靜脈與顱內(nèi)靜脈之間存在經(jīng)篩孔靜脈直接交通的途徑,這一途徑可能是顱內(nèi)外感染更為直接的通路;⑤嗅鞘結(jié)構(gòu)和篩孔靜脈的存在,為經(jīng)鼻給藥治療中樞神經(jīng)系統(tǒng)疾病提供了可能的形態(tài)學(xué)依據(jù)。
[Abstract]:Objective To observe the morphological features of the olfactory nerve and its accompanying veins on the microanatomy, histology and image images, improve the morphological data of the olfactory nerve and explore the significance of the sieving vein in the intracranial and external infection, and provide the clinical anatomical data for the protection of the patients' olfactory function in the top of the nasal cavity and the anterior cranial fossa. The morphological basis of central nervous system disease is provided.
Methods: (1) 30 cases (60 sides) of adult head wet specimens were selected to observe the shape and distribution of the olfactory nerve after perfusion of gelatin pigment, and observe the walk and distribution of the base of the cranial fossa and the facial veins. Another 5 cases (10 sides) of adult head wet specimens were perfused with ink and contrast agent, and the olfactory mucosa was removed after microdissection. 30 cases (60 sides) of dry specimens were observed by microanatomy. (3) 3 cases (6 sides) were randomly selected, and 2 tissues were taken from the upper nasal turbinate and nasal septum mucous membrane in each sample. 12 blocks were collected from the nasal septum and nasal septum. HE staining and VG staining were performed to observe the histological characteristics of the olfactory God meridian and its accompanying vein. (4) 51 cases (97 sides) were collected. The venous phase of the whole brain digital subtraction angiography (DSA) series without facial vein abnormalities was confirmed, and the distribution and distribution of the anterior cranial fossa and facial veins were observed.
Results 1, morphological observation of the olfactory nerve: (1) the olfactory nerve (Xiu Si) was found to be wrapped by the olfactory sheath formed by the dura and a latent cavity in the olfactory sheath. The olfactory nerve was located on the olfactory mucosa, distributed in the horseshoe type, divided into the turbinate side and the nasal septum. The turbinate olfactory nerve was distributed in the ethmoid surface of the upper nasal turbinate and the vertical mucous membrane of the middle turbinate. The olfactory nerve was distributed on the ethmoid surface of the nasal septum mucosa. The olfactory nerve was not distributed in the nasal surface of the nasal septum and nasal septum. The number of olfactory nerves in the turbinate side was (10.33 + 1.81), the diameter of the olfactory nerve root was (0.90 + 0.22) and the number of olfactory nerves in the nasal septum was (6.28 + 1.04), and the diameter of the olfactory nerve was (1.17 + 0.24) mm. in the nasal septum. The length of (5.91 + 1.95) mm, the range of medical reference value (95%) was 9.73 mm, the length of olfactory turbinate nasal turbinate was (10.22 + 2.20) mm, and the range of medical reference range (95%) was 14.53 mm. dry specimen, and the distribution of each sieved hole was two in each side. The number of sieve holes at each side was (16.33 +), respectively. 2.79) the maximum diameter of the sieve hole was (1.09 + 0.52) mm. (1.09 + 0.52) and VG staining showed that the olfactory epithelium on the mucosal surface of the olfactory area was a pseudo complex columnar epithelium. The lamina propria was mostly connective tissue, the olfactory nerve intima, the fascicular membrane and the outer membrane were clearly visible, and the outer membrane was visible from a dense layer of connective tissue. (3) the olfactory sheath can be seen in the X film. The morphology of the sieved vein was observed through the contrast agent.2: (1) the microdissection showed that the sieved vein walked in the olfactory sheath, accompanied by the olfactory nerve, through the sieved hole to the intracranial drainage, the cranial vein, the frontal cortex vein or the dural vein. (2) the HE staining showed that the sieved vein was located in the olfactory sheath, and the wall of the tube was thinner and.VG staining was not found in the sieved vein. The membrane contains smooth muscle cells. (3) DSA found that 68.6% of adults present the sieved vein to direct the facial vein and the intracranial vein, and the sieving vein is anastomosed to the frontal cortex and the inferior vena cava after the sieving vein enters the cranium.
Conclusions (1) the observation of the olfactory nerve and its accompanying veins in a deep and systematic way enriches the anatomical and imaging data. 2. To be familiar with the morphological features of the olfactory nerve, it is helpful for the selection of the surgical approach in the Department of neurosurgery and the operation process to protect the olfactory nerve better and avoid the occurrence of postoperative complications; (3) the nasal septum lateral distance to the nasal septum of the olfactory mucosa is 10 mm and the lateral nasal distance of the nasal turbinate. The olfactory nerve is rarely found outside the 15 mm of the sieve plate, and the operation is safer in this area. (4) there is a direct traffic route between the facial veins and the intracranial veins. This pathway may be a more direct pathway for the infection of the craniofacial infection. 5. The presence of the olfactory sheath and the sieve pore veins for the treatment of the central nervous system by nasal administration. The disease provides a possible morphological basis.
【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)】：R323.1
本文編號(hào)：2130234
[Abstract]:Objective To observe the morphological features of the olfactory nerve and its accompanying veins on the microanatomy, histology and image images, improve the morphological data of the olfactory nerve and explore the significance of the sieving vein in the intracranial and external infection, and provide the clinical anatomical data for the protection of the patients' olfactory function in the top of the nasal cavity and the anterior cranial fossa. The morphological basis of central nervous system disease is provided.
Methods: (1) 30 cases (60 sides) of adult head wet specimens were selected to observe the shape and distribution of the olfactory nerve after perfusion of gelatin pigment, and observe the walk and distribution of the base of the cranial fossa and the facial veins. Another 5 cases (10 sides) of adult head wet specimens were perfused with ink and contrast agent, and the olfactory mucosa was removed after microdissection. 30 cases (60 sides) of dry specimens were observed by microanatomy. (3) 3 cases (6 sides) were randomly selected, and 2 tissues were taken from the upper nasal turbinate and nasal septum mucous membrane in each sample. 12 blocks were collected from the nasal septum and nasal septum. HE staining and VG staining were performed to observe the histological characteristics of the olfactory God meridian and its accompanying vein. (4) 51 cases (97 sides) were collected. The venous phase of the whole brain digital subtraction angiography (DSA) series without facial vein abnormalities was confirmed, and the distribution and distribution of the anterior cranial fossa and facial veins were observed.
Results 1, morphological observation of the olfactory nerve: (1) the olfactory nerve (Xiu Si) was found to be wrapped by the olfactory sheath formed by the dura and a latent cavity in the olfactory sheath. The olfactory nerve was located on the olfactory mucosa, distributed in the horseshoe type, divided into the turbinate side and the nasal septum. The turbinate olfactory nerve was distributed in the ethmoid surface of the upper nasal turbinate and the vertical mucous membrane of the middle turbinate. The olfactory nerve was distributed on the ethmoid surface of the nasal septum mucosa. The olfactory nerve was not distributed in the nasal surface of the nasal septum and nasal septum. The number of olfactory nerves in the turbinate side was (10.33 + 1.81), the diameter of the olfactory nerve root was (0.90 + 0.22) and the number of olfactory nerves in the nasal septum was (6.28 + 1.04), and the diameter of the olfactory nerve was (1.17 + 0.24) mm. in the nasal septum. The length of (5.91 + 1.95) mm, the range of medical reference value (95%) was 9.73 mm, the length of olfactory turbinate nasal turbinate was (10.22 + 2.20) mm, and the range of medical reference range (95%) was 14.53 mm. dry specimen, and the distribution of each sieved hole was two in each side. The number of sieve holes at each side was (16.33 +), respectively. 2.79) the maximum diameter of the sieve hole was (1.09 + 0.52) mm. (1.09 + 0.52) and VG staining showed that the olfactory epithelium on the mucosal surface of the olfactory area was a pseudo complex columnar epithelium. The lamina propria was mostly connective tissue, the olfactory nerve intima, the fascicular membrane and the outer membrane were clearly visible, and the outer membrane was visible from a dense layer of connective tissue. (3) the olfactory sheath can be seen in the X film. The morphology of the sieved vein was observed through the contrast agent.2: (1) the microdissection showed that the sieved vein walked in the olfactory sheath, accompanied by the olfactory nerve, through the sieved hole to the intracranial drainage, the cranial vein, the frontal cortex vein or the dural vein. (2) the HE staining showed that the sieved vein was located in the olfactory sheath, and the wall of the tube was thinner and.VG staining was not found in the sieved vein. The membrane contains smooth muscle cells. (3) DSA found that 68.6% of adults present the sieved vein to direct the facial vein and the intracranial vein, and the sieving vein is anastomosed to the frontal cortex and the inferior vena cava after the sieving vein enters the cranium.
Conclusions (1) the observation of the olfactory nerve and its accompanying veins in a deep and systematic way enriches the anatomical and imaging data. 2. To be familiar with the morphological features of the olfactory nerve, it is helpful for the selection of the surgical approach in the Department of neurosurgery and the operation process to protect the olfactory nerve better and avoid the occurrence of postoperative complications; (3) the nasal septum lateral distance to the nasal septum of the olfactory mucosa is 10 mm and the lateral nasal distance of the nasal turbinate. The olfactory nerve is rarely found outside the 15 mm of the sieve plate, and the operation is safer in this area. (4) there is a direct traffic route between the facial veins and the intracranial veins. This pathway may be a more direct pathway for the infection of the craniofacial infection. 5. The presence of the olfactory sheath and the sieve pore veins for the treatment of the central nervous system by nasal administration. The disease provides a possible morphological basis.
【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)】：R323.1
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