本文選題：鼻內(nèi)鏡 + 鼻腔　； 參考：《山西醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的：通過尸頭解剖觀測(cè),明確鼻內(nèi)鏡下鼻眼相關(guān)區(qū)域手術(shù)的重要解剖關(guān)系,為臨床醫(yī)師實(shí)施該區(qū)域手術(shù)提供解剖學(xué)依據(jù)。同時(shí)在尸頭標(biāo)本上模擬手術(shù)入路的解剖操作,為臨床手術(shù)提供參考。 方法：選取經(jīng)10%甲醛溶液固定的成人尸頭60例。按既定研究方法對(duì)尸頭進(jìn)行精細(xì)解剖研究,對(duì)鼻眼相關(guān)區(qū)域的重要解剖結(jié)構(gòu)進(jìn)行觀測(cè),并用專業(yè)設(shè)備對(duì)鼻腔相關(guān)結(jié)構(gòu)進(jìn)行多方位拍攝。 結(jié)果：1)視神經(jīng)管的四壁中內(nèi)側(cè)壁最長(男10.58±1.03 mm,女9.24±0.96mm)且最薄(男0.56±0.16mm,女0.48±0.31mm)；2)眼動(dòng)脈發(fā)出后,行于視神經(jīng)硬膜鞘下壁內(nèi),一般沿視神經(jīng)管的內(nèi)下方向前外下方走形；3)視神經(jīng)管內(nèi)側(cè)壁與篩竇、蝶竇毗鄰關(guān)系復(fù)雜(可分為全部毗鄰蝶竇、全部毗鄰篩竇、與篩竇蝶竇同時(shí)相鄰等三型),特別是最后組篩房、蝶上篩房的關(guān)系直接影響到手術(shù)的操作方式。4)淚囊長度(男15.47-2.13mm,女15.13-2.87mm),寬度(男7.46+0.93mm,女6.82-0.73mm),淚骨菲薄,其中段厚度男性只有1.26-0.35mm,女性只有1.10+0.22mm。而上頜骨額突后緣處的厚度男性為3.71-0.28mm,女性為2.93-0.15mm。5)鼻丘氣房依氣化范圍分為1度(24.17%),2度(58.33%),3度(17.5%),通過此分度可明確鼻丘氣房與淚囊窩的位置關(guān)系,有利于淚囊鼻腔造口術(shù)的手術(shù)定位。6)在明確重要解剖結(jié)構(gòu)的基礎(chǔ)上對(duì)三類鼻眼相關(guān)手術(shù)進(jìn)行尸頭模擬操作,為臨床手術(shù)提供解剖參考。 結(jié)論：由于邊際學(xué)科的學(xué)科交叉性較大,手術(shù)解剖較為復(fù)雜,經(jīng)鼻內(nèi)鏡鼻眼相關(guān)手術(shù)對(duì)眼科和耳鼻咽喉科醫(yī)師來講具有一定的挑戰(zhàn)性。手術(shù)的成功與否與手術(shù)相關(guān)區(qū)域解剖標(biāo)志的認(rèn)識(shí)和掌握程度密切相關(guān)。因此在手術(shù)開展之前對(duì)手術(shù)醫(yī)師進(jìn)行針對(duì)性的尸頭解剖培訓(xùn)至關(guān)重要。
[Abstract]:Objective: to determine the important anatomical relationship of nasal and ophthalmic surgery under nasal endoscope, and to provide anatomical basis for clinicians to perform this region operation. At the same time, anatomic operation of surgical approach was simulated on cadaveric specimen, which provided reference for clinical operation. Methods: 60 adult cadaveric heads fixed with 10% formaldehyde solution were selected. According to the established research method, the anatomical structure of the head of cadaver was studied, the important anatomical structure of the related region of nose and eye was observed, and the related structure of nasal cavity was photographed in various directions with professional equipment. Results the medial wall of the optic canal was the longest (male 10.58 鹵1.03 mm, female 9.24 鹵0.96 mm) and thinnest (0.56 鹵0.16 mm for male, 0.48 鹵0.31 mm for female 0.48 鹵0.31 mm). The medial wall of the optic canal and ethmoid sinus are generally along the inner and lower part of the optic canal. The relationship between the sphenoid sinus and the sphenoid sinus is complex (all adjacent to the sphenoid sinus, all adjacent to the ethmoid sinus). The relationship between the sphenoid sinus and the ethmoid sinus, especially the ethmoidal chamber and the suprasphenoidal chamber in the last group, had a direct influence on the operation mode. 4) the length of the lacrimal sac (male 15.47-2.13mm, female 15.13-2.87mm), width (male 7.460.93mm, female 6.82-0.73mm), lacrimal bone thinning, lacrimal sac length (male 15.47-2.13mm, female 15.13-2.87mm, female 6.82-0.73mm). The segment thickness was only 1.26-0.35 mm for men and 1.10 0.22 mm for women. The thickness of the posterior margin of the maxillary frontal process was 3.71-0.28mm for males and 2.93-0.15mm.5 for females.) the nasal colliculus gas chamber was divided into 1 degree (24.17%) and 2 degrees (58.3333) and 3 degrees (17.5%) according to the range of gasification. The relationship between the nasal colliculus gas chamber and the lacrimal sac fossa could be determined by this classification. On the basis of defining the important anatomical structure, the anatomic operation of three kinds of naso-eye related surgery is simulated, which provides anatomic reference for clinical operation. Conclusion: due to the large interdisciplinary nature of marginal disciplines and complicated surgical anatomy, transnasal endoscopic naso-ophthalmic surgery is challenging for ophthalmologists and otolaryngologists. The success of the operation is closely related to the understanding and mastery of the anatomical markers in the surgical area. Therefore, it is very important to train the surgeon on autopsy of cadaveric head before the operation.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R765.9

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本文編號(hào)：1800528