本文選題：咽旁間隙　切入點(diǎn)：經(jīng)口入路　出處：《局解手術(shù)學(xué)雜志》2016年06期

【摘要】：目的觀察內(nèi)鏡下經(jīng)口入路咽旁間隙手術(shù)的解剖恒定標(biāo)志,為處理咽旁間隙病變、提高手術(shù)成功率提供依據(jù)。方法對(duì)2015年1月至2015年9月獲得的10具新鮮尸頭進(jìn)行CT多平面重建及三維重建,觀察咽旁間隙等咽旁結(jié)構(gòu),然后應(yīng)用內(nèi)窺鏡,于口內(nèi)行內(nèi)鏡輔助咽旁間隙解剖。結(jié)果 CT圖像上,極低密度的鼻咽向后外側(cè)延伸形成咽隱窩,咽旁間隙位于咽隱窩的外側(cè),呈前窄后寬的低密度三角形陰影,翼內(nèi)肌、翼外肌、咬肌、顳肌位于咽旁間隙的外側(cè),呈中密度陰影,莖突位于咽旁間隙的前部陰影,咽旁間隙后部頸內(nèi)動(dòng)脈呈中密度陰影。咽旁間隙內(nèi)血管、神經(jīng)顯影不清晰。莖突位于顱底顳骨鼓部下,長(zhǎng)(24.98±2.01)mm,咽旁間隙內(nèi)結(jié)構(gòu)均位于莖突及其周?chē)罴∶?如莖突外側(cè)有頸外動(dòng)脈、面神經(jīng)及乳突,莖突根部的內(nèi)側(cè)有頸靜脈孔及舌下神經(jīng)管外口,前內(nèi)方有頸動(dòng)脈管外口、棘孔和卵圓孔,后方有莖乳孔。左右側(cè)莖突根部到周?chē)徑M織結(jié)構(gòu)的距離比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。除莖突根部至莖乳孔外,男性莖突根部到周?chē)徑M織結(jié)構(gòu)的距離均大于女性,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論內(nèi)鏡輔助下經(jīng)口入路咽旁間隙手術(shù)以莖突等作為解剖學(xué)標(biāo)志,以莖突到毗鄰解剖結(jié)構(gòu)的距離為參考,有助于咽旁間隙周?chē)窠?jīng)、血管等的尋找和辨認(rèn)。
[Abstract]:Objective to observe the anatomical constant marks of endoscopic parapharyngeal space operation through oral approach, and to provide the basis for the treatment of parapharyngeal space disease and the improvement of surgical success rate.Methods CT multiplanar reconstruction and 3D reconstruction were performed on 10 fresh cadaveric heads from January 2015 to September 2015. The parapharyngeal space and other parapharyngeal structures were observed. Then endoscopic anatomy of the parapharyngeal space was performed by endoscope.Results on CT images, the extremely low density nasopharynx extended to the posterolateral side to form a pharyngeal recess, and the parapharyngeal space was located on the lateral side of the pharyngeal recess, with a low density triangle shadow of anterior narrow posterior width, medial pterygoid muscle, lateral pterygoid muscle and masseter muscle.The temporal muscle was located on the lateral side of the parapharyngeal space with medium density shadow, the styloid process in the anterior part of the parapharyngeal space and the posterior internal carotid artery in the parapharyngeal space.The vessels and nerves in the parapharyngeal space were not clear.The styloid process is located under the tympanic part of the skull base and 24.98 鹵2.01mm. the structure of the parapharyngeal space is located in the styloid process and its surrounding deep muscle surface, such as the external carotid artery, facial nerve and mastoid outside the styloid process, the medial foramen jugular vein and the external orifice of the sublingual nerve duct in the root of the styloid process.There are external orifice of carotid artery, foramen spinosus and foramen ovale in anterior and inner side, and caulomastoid foramen in the rear.There was no significant difference in the distance between the right and left stem process root and adjacent tissue structure (P 0.05).Except for the stem process root to the stem mammary foramen, the distance from the stem process root to the adjacent tissue structure of the male was larger than that of the female, and the difference was statistically significant (P 0.05).Conclusion Endoscope-assisted parapharyngeal space surgery with styloid process as anatomic marker and the distance from styloid process to adjacent anatomical structure as reference is helpful for the search and identification of peripheral nerves and blood vessels in parapharyngeal space.
【作者單位】： 深圳市龍華新區(qū)中心醫(yī)院耳鼻咽喉科;
【基金】：深圳市科技計(jì)劃項(xiàng)目(GCYG20150402140827355)
【分類(lèi)號(hào)】：R762;R322

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