本文關(guān)鍵詞： 內(nèi)窺鏡檢查 上頜竇 視野 手術(shù)入路 中鼻道 下鼻道 解剖　出處：《中國醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的 鼻內(nèi)窺鏡的出現(xiàn)和廣泛應(yīng)用,使在處理上頜竇疾病時更加方便,手術(shù)方式更多樣化。出現(xiàn)了很多經(jīng)典的微創(chuàng)手術(shù)入路包括鼻腔內(nèi)的或鼻內(nèi)鏡聯(lián)合鼻外入路。但內(nèi)窺鏡下術(shù)野的可控范圍,常受到手術(shù)入路狹小的限制及竇腔特殊解剖結(jié)構(gòu)的不利影響。鼻內(nèi)窺鏡上頜竇手術(shù)不同入路下術(shù)野的可控范圍直接影響著該術(shù)式處理疾病的有效范圍。為探討鼻內(nèi)鏡上頜竇手術(shù)四種不同入路視野的差異與互補程度,我們在尸頭標本上經(jīng)四種不同手術(shù)入路,使用鼻內(nèi)鏡對上頜竇腔進行了檢查。 方法 將選取的4側(cè)上頜竇腔解剖,模擬手術(shù)入路,在每側(cè)竇腔上依次行上頜竇前壁開窗入路,中鼻道開窗入路,下鼻道開窗入路,鼻腔外側(cè)壁切開入路。在每一入路開窗后,依次使用三種角度鼻內(nèi)鏡經(jīng)該開窗口對上頜竇腔進行檢查,調(diào)整鼻內(nèi)鏡方向和位置,測出最大視野,應(yīng)用鼻內(nèi)鏡攝錄系統(tǒng),將鏡下的觀測過程保存記錄。由三位耳鼻喉科醫(yī)師共同確認在各上頜竇上各手術(shù)入路鼻內(nèi)鏡下視野。進而研究鼻內(nèi)鏡上頜竇手術(shù)四種入路視野的差異及互補程度。 結(jié)果 4側(cè)上頜竇腔,0°、30°、70°三種角度鼻內(nèi)鏡聯(lián)合應(yīng)用,經(jīng)上頜竇前壁開窗口及經(jīng)鼻腔外側(cè)壁切開入路均可窺清上頜竇腔各壁；經(jīng)中鼻道開窗入路可檢查部位：竇腔頂壁后半部,開窗口向后至頂后壁的小部分內(nèi)壁,后壁上1／2,后外壁及底壁典型者可擴展至外壁上2／3部分；經(jīng)下鼻道開窗入路可檢查部位：竇腔后外壁,頂壁,前壁下2／3部分,竇底,內(nèi)壁的后部1／2及開窗口以下的內(nèi)壁,各竇壁典型者可擴展至前壁。 使用0°鼻內(nèi)鏡經(jīng)前壁開窗口檢查上頜竇腔時,氣化良好的上頜竇的開窗口向上及向外的前壁不易窺及,尤其是開窗口上部的前壁,包括淚前隱窩。氣化良好較深竇底不利于經(jīng)下鼻道開窗入路使用0°及30°鼻內(nèi)鏡對竇底的檢查。竇底及后外壁典型竇腔有利于30°鼻內(nèi)鏡經(jīng)下鼻道開窗口對前壁外側(cè)的檢查,有利于70°鼻內(nèi)鏡經(jīng)中鼻道開窗口對竇腔外壁的檢查。竇腔的氣化程度對三種角度鼻內(nèi)鏡經(jīng)鼻腔外側(cè)壁切開入路下的最大視野影響輕微。 結(jié)論 上頜竇手術(shù)4種入路鼻內(nèi)鏡下視野范圍不完全相同,在3種角度鼻內(nèi)鏡聯(lián)合應(yīng)用時,經(jīng)上頜竇前壁開窗口及經(jīng)鼻腔外側(cè)壁切開入路對上頜竇腔的檢查較好,無解剖死角；經(jīng)中鼻道開窗及下鼻道開窗入路對竇壁的視野都是不完全的,都存在不能窺及的部位；在中鼻道開窗基礎(chǔ)上聯(lián)合下鼻道開窗入路,對竇壁的視野范圍有所增加,但仍不能窺及內(nèi)壁前半部,前內(nèi)壁交角處,如淚前隱窩較深者,則更難窺及。竇腔的氣化程度及形態(tài)特征對上頜竇手術(shù)不同入路鼻內(nèi)鏡下視野有著不同的影響。
[Abstract]:objective
The nasal endoscope and the wide application of mirror, make more convenient in the treatment of maxillary sinus disease, surgery more diversified. The minimally invasive surgical approach includes many classic combined nasal nasal or nasal endoscopic approach. But endoscopic controllable surgical field under microscope, the adverse effects are always limited the surgical approach and sinus cavity narrow special anatomic structure. Endoscopic maxillary sinus surgery in different controllable surgical field road directly affects the effective range of the surgical treatment of the disease. To investigate endoscopic maxillary sinus surgery four different approaches view the difference and complementarity, we in the cadaveric head specimens with four different surgical approaches, the use of endoscopic maxillary sinus were examined.
Method
The 4 side of maxillary sinus were dissected, simulate the surgical approach, followed by maxillary sinus anterior wall fenestration approach in each side of the sinus cavity, middle meatus fenestration approach, inferior nasal meatus fenestration approach, lateral nasal wall incision approach. After fenestration of each approach, followed by the use of three through the open window view of endoscopic examination of maxillary sinus, nasal endoscope to adjust the orientation and position of measured maximum vision, endoscopic camera system, the microscopic observation records. By three in the Department of ENT physicians to confirm the maxillary sinus surgical approach under nasal endoscope. The difference of vision endoscopic maxillary sinus surgery in visual field of four kinds and the degree of complementarity.
Result
The 4 side of maxillary sinus, 0 degrees, 30 degrees, 70 degrees angle of three kinds of combined application of nasal endoscopy, the anterior wall of maxillary sinus open window and nasal lateral incision approach can peep clear maxillary sinus wall; middle nasal meatus fenestration approach can check the site: the top wall of sinus cavity after half. The inner wall of a small portion of the top wall of the rear window, a rear wall 1 / 2, after the outer wall and the bottom wall can be extended to the outer wall of the typical 2 / 3 part; inferior nasal meatus fenestration approach can check the site: the sinus cavity after the outer wall, a top wall, the anterior wall of the lower 2 / 3 parts, sinus 1 / 2, the inner wall of the rear wall and window below, the sinus wall typically can be extended to the front wall.
The use of 0 degrees of nasal endoscopic examination window on the front wall of maxillary sinus, open the window to the gasification good maxillary sinus anterior wall and outward and is not easy to see, especially on the front wall of the upper part of the window, including the anterior lacrimal fossa. Good deep sinus gasification is not conducive to the examination of windowing of inferior nasal meatus approach 0 degrees and 30 degrees of nasal endoscopic sinus. Sinus after sinus wall and typical for 30 degrees of nasal endoscopic nasal tract open window on the front wall outside the examination to 70 degrees of nasal endoscopic nasal sinus open window on the wall. Check the sinus pneumatization cavity of three angles of nasal endoscopic nasal lateral incision into the largest field road under the influence of minor.
conclusion
The range of vision of maxillary sinus surgery 4 approach under nasal endoscope is not exactly the same, in view of the combination of the 3 kinds of nasal endoscopy, the anterior wall of maxillary sinus and open the window by nasal lateral incision approach of maxillary sinus anatomy examination is good, no dead; through the middle meatus and inferior nasal meatus fenestration in the window the road of sinus wall view is not complete, there are parts of the endoscope and; in the middle meatus fenestration combined with inferior nasal meatus fenestration approach, the sinus wall view range increased, but still can not see the front wall and the front wall, such as the angle at the anterior lacrimal fossa is deep who is more difficult to see. And pneumatization and morphological characteristics of sinus cavity of maxillary sinus endoscope via different approaches have different effects.

【學(xué)位授予單位】：中國醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R765.9

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