【摘要】： 目的:通過對成年國人濕性頭顱標本的顯微解剖和數(shù)據(jù)測量,了解前縱裂、胼胝體、透明隔、穹窿、第三腦室等與經(jīng)胼胝體-透明隔間腔-穹窿間手術入路有關的顯微解剖結構,量化各項數(shù)據(jù),為經(jīng)胼胝體-透明隔間腔-穹窿間入路切除第三腦室及第三腦室后部腫瘤提供顯微解剖學數(shù)據(jù),以利于術中保護重要組織結構,增加手術的安全性,提高手術成功率,減少術后并發(fā)癥。 方法:對6例成年國人尸頭標本,分別用紅色及藍色乳膠灌注動脈及靜脈,在5～25倍手術顯微鏡下模仿經(jīng)胼胝體-透明隔間腔-穹窿間入路的手術操作并進行解剖,觀察并詳細記錄逐層暴露第三腦室區(qū)顯微結構的步驟。術畢后將頭顱標本均沿正中矢狀面鋸開,觀察并測量眉間到冠矢點的距離、冠矢點到中央溝的距離、冠矢點之前第一根引流靜脈到冠矢點的距離(右側)、冠矢點之后第一根引流靜脈到冠矢點的距離(右側)、在冠矢點到室間孔的連線上冠矢點到胼胝體的距離、胼胝體在冠矢點到室間孔連線上的厚度、在冠矢點到室間孔的連線上冠矢點到第三腦室底的距離、前聯(lián)合后緣到室間孔后緣的距離、中間塊前后徑、前聯(lián)合到后聯(lián)合的距離、室間孔后緣到中腦水管前緣的距離。最后,對數(shù)據(jù)進行統(tǒng)計學分析,得出統(tǒng)計學結論。各結果以均數(shù)±標準差(x±s)表示。 結果:從眉間中點到冠矢點的距離相對恒定,本組實驗測得眉間到冠矢點的距離為:130.8±3.5(126.0～135.0)mm;從正中矢狀面測得冠矢點到中央溝的距離為:46.2±4.7(40.0～52.0)mm;冠矢點之前第一根引流靜脈到冠矢點的距離(右側)最近的為17.0mm,最遠的為84.0mm,其中83.0%(5例)位于冠狀縫之前50.0mm以外;冠矢點之后第一根引流靜脈到冠矢點的距離(右側)最近的為4.0mm,最遠的為22.0mm,其中83.0%(5例)位于冠狀縫之后20.0mm以內;在冠矢點到室間孔的連線上冠矢點到胼胝體的距離為48.7±3.6(42.0～52.0)mm;胼胝體在冠矢點到室間孔連線上的厚度為5.9±0.8(5.0～7.0)mm;在冠矢點到室間孔的連線上冠矢點到第三腦室底的距離為90.0±3.2(85.0～94.0) mm;前聯(lián)合后緣到室間孔后緣的距離為10.3±0.5(9.5～11.0)mm;中間塊前后徑為4.9±0.4(4.5～5.5)mm;前聯(lián)合到后聯(lián)合的距離為22.0±2.2(20.0～24.0)mm;室間孔后緣到中腦水管前緣的距離為19.8±1.2(18.0～21.0) mm。 結論:經(jīng)胼胝體-透明隔間腔-穹窿間入路在技術上是相對安全的,按照腦胚胎發(fā)育間隙沿中線結構逐層進入,不損傷大腦皮質,到達第三腦室最近,對側腦室血管的損傷明顯減少,無需過度牽拉,即可看到雙側重要結構,通過調整顯微鏡角度,可觀察到第三腦室前、中、及部分第三腦室后部的解剖結構。此入路要對以下關鍵解剖結構加以重視并進行保護:引流到上矢狀竇的粗大引流靜脈、胼周動脈、胼胝體、穹窿聯(lián)合、大腦內靜脈及其屬支、前聯(lián)合。此入路的可操作空間相對狹小,需不斷調整顯微鏡的角度以增加對病變的暴露。對第三腦室前、中部病變的顯露較好,到達第三腦室后部的距離相對較遠,但對于第三腦室后部以及松果體區(qū)病變向第三腦室前部突出者,此入路無疑也是可以優(yōu)先考慮的。第三腦室解剖結構復雜,嚴謹?shù)膶嶒炇绎@微外科練習對提高手術安全性、預防術后并發(fā)癥是至關重要的。
[Abstract]:Objective: To study the micro-anatomical structure and quantify the data of the anterior longitudinal fissure, the papillary body, the transparent septum, the hole, the third ventricle and the like, which are related to the surgical approach to the cavity of the transseptal body-transparent compartment, through the microdissection and data measurement of the wet head specimen of the adult Chinese. in ord to provide that micro-anatomical data for the tumor of the third ventricle and the third ventricle through the through-hole in-hole and the hole-to-hole approach, the invention can protect the important tissue structure in the operation, increase the safety of the operation, improve the success rate of the operation and reduce the postoperative complications. Methods: Six adult cadaveric specimens were perfused with red and blue latex, and the operation was simulated by a 5-25-fold operation microscope. The anatomy, observation, and detailed recording of the microstructure of the third ventricular zone exposed to layer by layer The method comprises the following steps of: sawing a head specimen along a median sagittal plane after the operation is completed, observing and measuring the distance between the eyebrow and the crest point, the distance between the coronal point and the central groove, and the distance of the first drainage vein to the sagittal point before the coronal point; right), the distance (right side) of the first drainage vein to the coronal point after the crown point, the distance between the crown vector point and the intercell hole, the distance between the crown vector point and the crown vector body, the thickness of the crown body at the connecting line of the crown vector point to the inter-chamber hole, the crown vector point to the third ventricle bottom at the connecting line of the crown vector point to the inter-chamber hole, the distance from the leading and trailing edge to the rear edge of the inter-chamber aperture, the distance between the anterior and posterior diameters of the intermediate block, the distance from the anterior joint to the posterior joint, the posterior edge of the inter-chamber orifice to the leading edge of the midbrain water tube, The distance. Finally, the data is statistically analyzed and the statistics are obtained. study conclusion. The results are standard deviation (x% s) Results: The distance from the middle point to the crown point of the eyebrow is relatively constant. The distance between the eyebrow and the crest point is 130. 8-3.5 (126. 0-135. 0) mm. The distance from the sagittal plane to the central groove is: 46. 2-4.7 (40. 0 ~ 52. 0) mm; the distance (right) of the first drainage vein to the coronal point before the crown point was 170.0mm, the most distal was 80.0mm, of which 83.0% (5) was located 50. 0mm prior to the coronal suture; the distance (right side) of the first drainage vein to the coronal point after the crown point was nearest 4.0mm, the most distal Of the 22. 0mm, 83.0% (5 cases) were located within 20. 0mm after the coronal suture; the distance from the crown point to the intercell hole was 48. 7 to 3.6 (42. 0-52. 0) mm on the line of the crown point to the inter-chamber hole, and the thickness of the hammer body on the connection line between the crown point and the chamber was 50.9 to 0.8 (5.0) (5.0. 0). The distance from the crown point to the bottom of the third ventricle was 90. 0. 3. 2 (85. 0-94. 0) mm. The distance between the leading and trailing edge to the rear edge of the chamber was 10. 3 to 0. 5 (9.5 to 11. 0) mm, and the anterior and posterior diameter of the intermediate block was 4. 9 to 0.4 (4.5 to 5. 5) mm, and the distance of the anterior joint to the posterior joint was 22. 0 to 2.2 (20. 0 ~ (24. 0) mm; the distance between the posterior edge of the intercell hole and the leading edge of the midbrain water tube was 19.8-1.2 (18. 0 ~ 21. 0) mm. Conclusion: It is relatively safe to enter the through-hole in the cavity of the transparent compartment-transparent compartment. According to the development gap of the brain, it enters in layer by layer along the midline structure, does not damage the cerebral cortex, and reaches the most recent of the third ventricle, and the damage to the lateral ventricle's blood vessels It is obviously reduced, without excessive pulling, the important structure of the double side can be seen, and by adjusting the angle of the microscope, the front, middle and the part of the third ventricle can be observed. The anatomy of the posterior part of the third ventricle. The approach is to attach importance to and protect the following key anatomical structures: the gross drainage vein, the peripheral artery, the papillary body, the hole, the hole, the brain, The inner vein and its branches and anterior joint. The operation space of the inlet is relatively small, and it is necessary to adjust the microscope continuously. The angle is to increase exposure to the lesion. The exposure of the central lesion to the third ventricle is relatively good, the distance to the posterior of the third ventricle is relatively far, but for the third ventricle posterior and the pineal region lesion to the front of the third ventricle, this entry There is no doubt that the third ventricle is complex in anatomy and rigorous laboratory microsurgery to improve the safety of the operation and to prevent
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R322.8

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