鼻內(nèi)鏡下鼻咽癌挽救手術(shù)及相關(guān)顱底的應(yīng)用解剖學(xué)研究
發(fā)布時(shí)間：2018-09-05 19:49
【摘要】：目的對(duì)鼻咽癌鼻內(nèi)鏡下挽救手術(shù)所涉及的鼻咽旁間隙及相關(guān)的顱底區(qū)域進(jìn)行解剖學(xué)研究,了解經(jīng)鼻內(nèi)鏡下鼻咽癌挽救手術(shù)中相關(guān)顱底區(qū)域重要解剖結(jié)構(gòu)在內(nèi)鏡下的空間相互關(guān)系,尋找合適的解剖標(biāo)志,指導(dǎo)臨床手術(shù)。 方法選擇8具(16側(cè))用10%福爾馬林防腐固定的生長(zhǎng)發(fā)育正常成年人的尸頭標(biāo)本,分別用紅、藍(lán)兩種染色的乳膠灌注動(dòng)、靜脈系統(tǒng),在行螺旋CT掃描后開(kāi)放全組鼻竇,分別模擬以下三種手術(shù):經(jīng)中鼻道或經(jīng)上頜竇后壁進(jìn)入翼腭窩、顳下窩;經(jīng)翼突(或翼腭窩)進(jìn)路行內(nèi)鏡下鼻顱底手術(shù);經(jīng)鼻內(nèi)鏡鼻咽癌切除術(shù),并對(duì)鼻咽部、咽旁間隙及相應(yīng)區(qū)域的顱底進(jìn)行解剖,辨認(rèn)重要的解剖結(jié)構(gòu)及相互的空間關(guān)系。在尸頭上并分別測(cè)量鼻小柱距翼管神經(jīng)與頸內(nèi)動(dòng)脈膝部交界處、距咽鼓管峽部的距離、距頸內(nèi)動(dòng)脈的距離;咽鼓管峽距頸內(nèi)動(dòng)脈管外口的距離,在CT上測(cè)量翼管的長(zhǎng)度,通過(guò)翼管后口的矢狀線到頸動(dòng)脈管口內(nèi)緣的距離,咽鼓管峽到頸內(nèi)動(dòng)脈管的最短距離,翼管后口到咽鼓管峽的距離,翼管后口到頸動(dòng)脈管口的距離。 結(jié)果○1翼管在蝶竇內(nèi)的出現(xiàn)率受蝶竇氣化程度影響,但翼管總是很恒定的指向破裂孔,追蹤其包繞的翼管神經(jīng)可定位頸內(nèi)動(dòng)脈膝部,在翼管神經(jīng)下方操作可以磨除破裂孔的纖維軟骨而不會(huì)傷及頸內(nèi)動(dòng)脈;圓孔與翼管的位置關(guān)系在翼腭窩內(nèi)恒定不變,經(jīng)翼突(或翼腭窩)進(jìn)路行內(nèi)鏡下鼻顱底手術(shù)時(shí)通過(guò)追蹤上頜神經(jīng),翼管神經(jīng)可以定位頸內(nèi)動(dòng)脈的水平段、海綿竇前緣及美克爾腔;在鼻內(nèi)鏡下鼻咽癌挽救手術(shù)中咽鼓管的峽部位于卵圓孔的后外側(cè),咽鼓管的軟骨部在內(nèi)鏡下全切困難,以通過(guò)卵圓孔的下頜神經(jīng)為標(biāo)志能最大化切除咽鼓管的軟骨部;咽旁間隙的頸內(nèi)動(dòng)脈位于頭長(zhǎng)肌的外側(cè),莖突咽筋膜的后方和咽鼓管峽部后下方約0.5cm,而頸內(nèi)動(dòng)脈內(nèi)側(cè)緣距離翼管后口外側(cè)約1cm的矢狀面上;○2尸頭測(cè)量結(jié)果:鼻小柱距翼管與頸內(nèi)動(dòng)脈膝部交界處為84.97±4.27mm、距離咽鼓管峽部96.33±2.07mm、距離頸內(nèi)動(dòng)脈的分別為101.56±2.56mm;○3 CT上測(cè)量結(jié)果:翼管的長(zhǎng)度16.31±2.16mm,通過(guò)翼管后口的矢狀線到頸動(dòng)脈管口內(nèi)緣的距離9.98±2.22mm,咽鼓管峽到頸內(nèi)動(dòng)脈管口的最短距離4.46±0.96mm,翼管后口到頸動(dòng)脈管外口的距離為20.08±2.70mm,到咽鼓管峽的距離為17.74±1.17mm。 結(jié)論對(duì)部分放療后復(fù)發(fā)或殘留鼻咽癌行鼻內(nèi)鏡下挽救手術(shù)是可行的,翼管、卵圓孔、頭長(zhǎng)肌、咽鼓管峽、莖突咽筋膜是鼻咽癌內(nèi)鏡手術(shù)中的重要標(biāo)志;在鼻內(nèi)鏡下鼻咽癌挽救手術(shù)中咽鼓管的軟骨部在內(nèi)鏡下全切困難,以翼管及卵圓孔為標(biāo)志可擴(kuò)大手術(shù)切緣;翼管及圓孔是鼻內(nèi)鏡經(jīng)翼突(翼腭窩)進(jìn)路顱底手術(shù)中的重要解剖標(biāo)志。
[Abstract]:Objective to study the anatomy of the parapharyngeal space and the associated skull base area involved in nasoscopic salvage surgery for nasopharyngeal carcinoma (NPC). To understand the spatial relationship of the important anatomical structures in the skull base region in nasopharyngeal carcinoma salvage surgery under nasal endoscope, to find the appropriate anatomical markers to guide the clinical operation. Methods A total of 8 cadaveric heads (16 sides) with 10% formalin as anticorrosive fixation were selected and perfused with red and blue latex respectively. After spiral CT scanning, the nasal sinuses were opened. The following three operations were simulated: through the middle nasal canal or through the posterior wall of the maxillary sinus into the pterygopalatine fossa, into the infratemporal fossa; through the pterygoid process (or pterygopalatine fossa) to perform endoscopic nasal skull base surgery; The parapharyngeal space and the skull base of the corresponding region were dissected to identify the important anatomical structure and spatial relationship. The length of the pterygoid canal on CT was measured on the head of the cadaver, the distance between the nasal column and the genu of the pterygoid canal and the genu of the medial carotid artery, the distance from the isthmus of the eustachian tube to the internal carotid artery, the distance between the isthmus of the eustachian duct and the external orifice of the internal carotid artery, and the length of the pterygoid canal on CT. The distance from the sagittal line of the posterior orifice of the pterygoid canal to the inner edge of the orifice of the carotid artery, the shortest distance from the gorge of the eustachian tube to the internal carotid artery, the distance from the posterior orifice of the pterygoid canal to the isthmus of the eustachian tube, and the distance from the posterior orifice of the p@@ Results the occurrences of pterygoid canal in sphenoid sinus were affected by the degree of sphenoid sinus vaporization. However, the pterygoid canal always pointed to the ruptured hole, and the nerve around the pterygoid canal could locate the knee of the internal carotid artery. Under the pterygoid canal nerve, the fibrous cartilage of the ruptured foramen can be removed without harming the internal carotid artery; the relationship between the foramen circle and the pterygoid canal is constant in the pterygopalatine fossa. By tracking the maxillary nerve, the pterygoid canal nerve can locate the horizontal segment of the internal carotid artery, the anterior edge of the cavernous sinus and the Meckel's cavity by endoscopic naso-skull base operation via the pterygoid process (or pterygopalatine fossa). The isthmus of the eustachian tube is located on the lateral side of the foramen ovale during the nasoscopical salvage operation of nasopharyngeal carcinoma. The cartilage of the eustachian tube is difficult to be totally cut under endoscope. The mandibular nerve passing through the foramen ovale can maximize the excision of the cartilage of the eustachian tube. The internal carotid artery in the parapharyngeal space was located on the lateral side of the longus, the posterior fascia of the styloid pharyngeal fascia and the posterior inferior part of the eustachian duct isthmus about 0.5 cm, while the medial margin of the internal carotid artery was about the sagittal face of 1cm from the lateral side of the posterior orifice of the pterygoid canal. The length of the pterygoid canal was 16.31 鹵2.16mm, the length of the pterygoid canal was 16.31 鹵2.16mm, the length of the pterygoid canal was 16.31 鹵2.16mm, the distance from the eustachian canal isthmus was 96.33 鹵2.07mm, and the distance from the internal carotid artery was 101.56 鹵2.56mm. The distance from the line to the inner edge of the carotid canal was 9.98 鹵2.22 mm, the shortest distance from the eustachian duct isthmus to the internal carotid artery was 4.46 鹵0.96 mm, the distance from the posterior orifice of the pterygoid canal to the external orifice of the carotid artery was 20.08 鹵2.70 mm, and the distance to the isthmus of the eustachian tube was 17.74 鹵1.17 mm. Conclusion it is feasible to perform endoscopic salvage surgery for recurrent or residual nasopharyngeal carcinoma after partial radiotherapy. Pterygoid canal, foramen ovale, longus capitis, isthmus of eustachian tube and fascia of styloid pharynx are important markers in endoscopic surgery for nasopharyngeal carcinoma. The cartilage of the eustachian tube was difficult to be removed under endoscope in nasopharyngeal carcinoma salvage operation, and the surgical margin could be enlarged by using pterygoid canal and foramen ovale as marks. The pterygoid canal and foramen are important anatomic markers in the skull base operation via the pterygopalatine fossa under nasal endoscope.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R739.63
本文編號(hào)：2225289
[Abstract]:Objective to study the anatomy of the parapharyngeal space and the associated skull base area involved in nasoscopic salvage surgery for nasopharyngeal carcinoma (NPC). To understand the spatial relationship of the important anatomical structures in the skull base region in nasopharyngeal carcinoma salvage surgery under nasal endoscope, to find the appropriate anatomical markers to guide the clinical operation. Methods A total of 8 cadaveric heads (16 sides) with 10% formalin as anticorrosive fixation were selected and perfused with red and blue latex respectively. After spiral CT scanning, the nasal sinuses were opened. The following three operations were simulated: through the middle nasal canal or through the posterior wall of the maxillary sinus into the pterygopalatine fossa, into the infratemporal fossa; through the pterygoid process (or pterygopalatine fossa) to perform endoscopic nasal skull base surgery; The parapharyngeal space and the skull base of the corresponding region were dissected to identify the important anatomical structure and spatial relationship. The length of the pterygoid canal on CT was measured on the head of the cadaver, the distance between the nasal column and the genu of the pterygoid canal and the genu of the medial carotid artery, the distance from the isthmus of the eustachian tube to the internal carotid artery, the distance between the isthmus of the eustachian duct and the external orifice of the internal carotid artery, and the length of the pterygoid canal on CT. The distance from the sagittal line of the posterior orifice of the pterygoid canal to the inner edge of the orifice of the carotid artery, the shortest distance from the gorge of the eustachian tube to the internal carotid artery, the distance from the posterior orifice of the pterygoid canal to the isthmus of the eustachian tube, and the distance from the posterior orifice of the p@@ Results the occurrences of pterygoid canal in sphenoid sinus were affected by the degree of sphenoid sinus vaporization. However, the pterygoid canal always pointed to the ruptured hole, and the nerve around the pterygoid canal could locate the knee of the internal carotid artery. Under the pterygoid canal nerve, the fibrous cartilage of the ruptured foramen can be removed without harming the internal carotid artery; the relationship between the foramen circle and the pterygoid canal is constant in the pterygopalatine fossa. By tracking the maxillary nerve, the pterygoid canal nerve can locate the horizontal segment of the internal carotid artery, the anterior edge of the cavernous sinus and the Meckel's cavity by endoscopic naso-skull base operation via the pterygoid process (or pterygopalatine fossa). The isthmus of the eustachian tube is located on the lateral side of the foramen ovale during the nasoscopical salvage operation of nasopharyngeal carcinoma. The cartilage of the eustachian tube is difficult to be totally cut under endoscope. The mandibular nerve passing through the foramen ovale can maximize the excision of the cartilage of the eustachian tube. The internal carotid artery in the parapharyngeal space was located on the lateral side of the longus, the posterior fascia of the styloid pharyngeal fascia and the posterior inferior part of the eustachian duct isthmus about 0.5 cm, while the medial margin of the internal carotid artery was about the sagittal face of 1cm from the lateral side of the posterior orifice of the pterygoid canal. The length of the pterygoid canal was 16.31 鹵2.16mm, the length of the pterygoid canal was 16.31 鹵2.16mm, the length of the pterygoid canal was 16.31 鹵2.16mm, the distance from the eustachian canal isthmus was 96.33 鹵2.07mm, and the distance from the internal carotid artery was 101.56 鹵2.56mm. The distance from the line to the inner edge of the carotid canal was 9.98 鹵2.22 mm, the shortest distance from the eustachian duct isthmus to the internal carotid artery was 4.46 鹵0.96 mm, the distance from the posterior orifice of the pterygoid canal to the external orifice of the carotid artery was 20.08 鹵2.70 mm, and the distance to the isthmus of the eustachian tube was 17.74 鹵1.17 mm. Conclusion it is feasible to perform endoscopic salvage surgery for recurrent or residual nasopharyngeal carcinoma after partial radiotherapy. Pterygoid canal, foramen ovale, longus capitis, isthmus of eustachian tube and fascia of styloid pharynx are important markers in endoscopic surgery for nasopharyngeal carcinoma. The cartilage of the eustachian tube was difficult to be removed under endoscope in nasopharyngeal carcinoma salvage operation, and the surgical margin could be enlarged by using pterygoid canal and foramen ovale as marks. The pterygoid canal and foramen are important anatomic markers in the skull base operation via the pterygopalatine fossa under nasal endoscope.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R739.63
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