鼻内镜下扩大经鼻蝶入路海绵窦内侧壁的应用解剖学  

Applied anatomy of the medial wall of the cavernous sinus via extended endoscopic endonasal transsphenoidal approach

作　　者：冯珊珊 杨有雄 廖建春[2] 党瑞山[3] 王红力 李阳 张肖特 

机构地区：[1]宁波市鄞州第二医院耳鼻咽喉-头颈外科,宁波315100 [2]第二军医大学长征医院耳鼻咽喉-头颈外科,上海200003 [3]第二军医大学解剖学教研室,上海200433

出　　处：《解剖学杂志》2015年第4期453-453,共4页Chinese Journal of Anatomy

基　　金：宁波市自然科学基金(2012A610221)

摘　　要：目的:研究扩大经鼻蝶入路海绵窦内侧壁的形态结构特征,为术中处理侵及海绵窦内侧壁的病变,提供解剖学资料.方法:成人福尔马林固定尸头标本15例,模拟扩大经鼻蝶手术入路,由浅入深地解剖观测了海绵窦内侧壁及其毗邻关系.结果:双侧颈内动脉前曲段、床突段和下水平段内侧缘之间的最小间距分别为(21.60±3.83) mm、(11.07±2.05) mm和(11.93±3.469) mm,垂体上下径、左右径分别为(7.57±1.11) mm和(12.43±2.12) mm,垂体与颈内动脉下水平段之间的关系有压迹型、紧邻型和分离型3种,分别占40％、30％和30％.结论:鼻内镜下扩大经鼻蝶入路是处理海绵窦内侧壁病变的良好手术方式,术者需熟悉扩大经鼻蝶入路海绵窦内侧壁在内镜下的解剖特点.Objective:To investigate the anatomic characteristics of the cavernous sinus medial wall via extended endoscopic endonasal transsphenoidal approach,and provide anatomic data for treating the lesions invading the medial wall of the cavernous sinus in intraoperatively.Methods:Fifteen randomly selected adult formalin-processed cadaver heads were dissected to simulate an extended endoscopic endonasal transsphenoidal approach.The morphological characteristics and adjacent anatomic structures of the cavernous sinus medial wall were demonstrated step by step.Results:It was found that the maximum distance between the anterior vertical segments,the minimum distance between the clinoidal segments and inferior horizontal segments of the bilateral internal carotid artery were 21.60 ± 3.83 millimeters,11.07 ± 2.05 millimeters and11.93±3.469 millimeters respectively.The size of the pituitary gland was 7.567 ± 1.11 millimeters vertically and 12.43±2.12 millimeters horizontal.The position relation between the pituitary gland and the inferior horizontal segments of the internal carotid artery included three types:impressio,creber and separation,accounting for 40%,30%and 30%,respectively.Conclusion:Extended endoscopic endonasal transsphenoidal approach is an optimal surgical approach for the lesions invading the medial wall of the cavernous sinus,and operators should be familiar with the anatomic characteristics of the medial wall of the cavernous sinus via extended endoscopic endonasal transsphenoidal approach.

关 键 词：鼻内镜 海绵窦 颈内动脉 解剖学 鼻蝶入路 

分 类 号：R651[医药卫生—外科学] R322.8[医药卫生—临床医学]