發(fā)布時間：2019-01-17 20:22

【摘要】： 目的翼腭窩藏于頜面深部,是前顱區(qū)與側(cè)顱區(qū)的交界,交通廣泛,發(fā)生于此的腫瘤、類腫瘤不易發(fā)現(xiàn),手術(shù)不易充分暴露和徹底切除。隨著醫(yī)學(xué)的發(fā)展和進步,國內(nèi)外學(xué)者對此從宏觀到影像學(xué)進行大量報道,但用連續(xù)薄切片技術(shù)研究尚不多見。鑒此,我們用改進火棉膠包埋薄切片(0.25mm)的技術(shù)及應(yīng)用解剖學(xué)方法,對翼腭窩進行斷層與應(yīng)用解剖學(xué)研究,為翼腭窩手術(shù)入路提供形態(tài)學(xué)與臨床應(yīng)用解剖學(xué)依據(jù)。 方法取固定成尸頭標本30例,取前顱底。標本經(jīng)20%HCl脫鈣,梯度脫水(將組織塊按照順序浸泡在濃度依次為70%、80%、95%、無水乙醇和乙醚乙醇的液體中),梯度浸膠(將組織塊按順序依次放入濃度為5%、8%和15%的火棉膠中浸泡),包埋,焊塊,用德國制造JUNGAG型大腦切片機,在水平面、矢狀面和冠狀面切成0.25mm薄切片(三維),對翼腭窩的形態(tài)、毗鄰、窩內(nèi)主要結(jié)構(gòu)的位置走行及周圍結(jié)構(gòu)進行觀測。并用80側(cè)干燥顱骨對翼腭窩區(qū)進行測量,并獲取一些數(shù)據(jù)。 結(jié)果對水平面、矢狀面及冠狀面的不同層面進行描述,翼腭窩形態(tài)多樣,左右形態(tài)和位置均可不對稱。翼腭窩骨壁輪廓清晰完整,同一平面左右翼腭窩至中鼻道的距離為1.0-5.0mm。在水平面上,經(jīng)視神經(jīng)管層面,翼腭窩的形狀呈小三角形或弧形,可呈“)(”形。在不同標本,除有小三角形、弧形外,還有橫置“S”形、楔形、、正“L”形、啞鈴形、短棒狀或斜向外上的窄長條形。翼腭窩在經(jīng)中鼻甲根部層面呈橫置的四邊形,行向外上,腔最寬闊,窩內(nèi)左右側(cè)動脈的位置不對稱,而且可發(fā)現(xiàn)翼腭動脈的走行也不對稱,可發(fā)現(xiàn)動脈的斷端,由此可看出動脈的走形應(yīng)為波浪狀。在矢狀面上,經(jīng)上頜尖牙層面,神經(jīng)和動脈趨于前壁并向中線靠攏,并且可清晰發(fā)現(xiàn)動脈的主干和分支。在冠狀面上,經(jīng)視神經(jīng)孔層面,翼腭窩為上寬下窄的倒置楔形,神經(jīng)位于動脈內(nèi)側(cè)。 結(jié)論將水平斷層、冠狀斷層及矢狀斷層有效地結(jié)合,對診斷翼腭窩疾病和指導(dǎo)手術(shù)更加有效。中鼻道是鼻內(nèi)窺鏡經(jīng)鼻腔進入翼腭窩手術(shù)入路的門戶,據(jù)斷層解剖學(xué)本研究設(shè)計了一條新型入路,即經(jīng)鼻腔中鼻道從鼻腔外側(cè)壁直接穿入翼腭窩。新型手術(shù)入路不經(jīng)過上頜竇,運用器械從中鼻道深入至翼腭窩的內(nèi)側(cè)壁深度,打開薄骨板,直接進入翼腭窩,由此處入路手術(shù)創(chuàng)傷小、出血少,安全系數(shù)高、術(shù)后并發(fā)癥少。在術(shù)前對翼腭窩進行的影像學(xué)檢測,以提高手術(shù)的成功率。
[Abstract]:Objective the pterygopalatine is located in the deep part of the maxillofacial region, which is the junction between the anterior cranial region and the lateral cranial area. With the development and progress of medicine, scholars at home and abroad have carried out a lot of reports from macroscopic to imaging, but the use of continuous thin slice technology is still rare. In view of this, we studied the pterygopalatine fossa sectional and applied anatomy by using the improved technique and applied anatomy method of 0.25mm, and provided the morphological and clinical applied anatomical basis for the operation approach of pterygopalatine fossa (pterygopalatine fossa). Methods 30 cases of fixed cadaveric head were collected and the anterior skull base was taken. The specimens were decalcified by 20%HCl, then dehydrated by gradient (the tissue mass was immersed in the liquid with concentration in order of 70, 80 and 95, anhydrous ethanol and ethyl ether ethanol), and the gradient soaking glue (putting the tissue mass into the concentration of 5 in order), Immersing in 8% and 15% of the colloid), embedding, soldering, JUNGAG type brain slicer made in Germany, cut into 0.25mm thin sections (3 D) in horizontal plane, sagittal plane and coronal plane, adjacent to pterygopalatine fossa, and the shape of the pterygopalatine fossa, adjacent to the pterygopalatine fossa. The location of the main structures in the nest and the surrounding structures were observed. The pterygopalatine fossa was measured with 80 dry skulls and some data were obtained. Results the horizontal plane the sagittal plane and the coronal plane were described. The pterygopalatine fossa was varied in shape and asymmetrical in left and right shape and position. The bone wall of pterygopalatine fossa was clear and complete, and the distance between left and right pterygopalatine fossa and middle nasal canal was 1.0-5.0 mm. On the horizontal plane, the pterygopalatine fossa is shaped in a small triangle or arc through the optic canal. In addition to small triangles, arcs, transverse "S"-shaped, wedge-shaped, positive "L"-shaped, dumbbell-shaped, short rod-shaped or oblique-outward narrow strip. The pterygopalatine fossa is transverse quadrilateral through the root of the middle turbinate, with the widest cavities, the asymmetry of the left and right arteries in the fossa, and the asymmetry of the path of the pterygopalatine artery, and the broken end of the artery. From this we can see that the shape of the artery should be wavy. On the sagittal plane, the nerve and artery tend to the anterior wall and close to the midline through the maxillary canine, and the trunk and branches of the artery can be clearly found. On the coronal plane, the pterygopalatine fossa is an inverted wedge across the optic foramen, and the nerve is located in the medial artery. Conclusion the combination of horizontal fault, coronal fault and sagittal fault is more effective in diagnosing pterygopalatine fossa disease and guiding operation. The middle nasal canal is the portal of the endoscopic approach to enter the pterygopalatine fossa through the nasal cavity. According to the sectional anatomy, a new approach was designed, namely, the medial nasal canal entered the pterygopalatine fossa directly from the lateral wall of the nasal cavity. The new surgical approach does not pass through maxillary sinus. The new approach uses instruments to penetrate deep into the medial wall of pterygopalatine fossa, open thin bone plate and enter pterygopalatine fossa directly. From this approach, the surgical trauma is small, the bleeding is less, the safety factor is high, and the postoperative complications are less. Imaging examination of pterygopalatine fossa was performed before operation to improve the success rate.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R322-3

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