经唇下—鼻中隔—蝶窦入路鞍区手术的非X线定位探讨  

NON -X - RAY COMPREHENSIVE MEASUREMENT FOR ACCURATE LOCALIZATION IN SELLA TURCIACA OPERATION THROUGH THE SUBLABIO - SEPTO-SPHENOIDAL APPROACH

作　　者：顾建文[1] 章翔[1] 费舟[1] 易声禹[1] 李安民[1] 

机构地区：[1]第四军医大学西京医院神经外科,西安710032

出　　处：《中国现代手术学杂志》1998年第4期283-285,共3页Chinese Journal of Modern Operative Surgery

摘　　要：应用非X线综合测量定位法对经唇下—鼻中隔—蝶窦入路鞍区手术(Sublabio-septo-sphenoidal approach, SSSA)进行精确定位,以缩短时间、减少出血、提高手术成功率。对122例鞍区肿瘤患者在术中综合采用非X线定位法包括眉弓中点、前鼻棘—蝶鞍、前鼻棘夹角定位法,上切牙尖、前鼻棘—蝶鞍、前鼻棘夹角定位法,解剖学标志定位法(鼻中隔及犁状骨确定中线,蝶窦开口与掣状骨体为蝶窦前壁的标志,找寻蝶窦中隔矫正鞍底,鞍底的形态提供鞍底中点的标志,鞍区骨质破坏位置提示入路方向),并采用X线片定位法矫正其精确度,结果为40例患者应用非X线综合测量定位鞍底位置及深度后,再以X线片佐证,提示测量准确,手术时间平均在2.2h。82例患者直接采用非X线片定位法综合测量鞍底,手术顺利,手术时间平均在1.5h、平均输血量为200ml。无死亡及严重并发症。故非X线综合測量定位法可直接应用于经唇下—鼻中隔—蝶窦入路鞍区手术的精确定位。Objective: To apply non-X-ray comprehensive measurement for accurate localization in sella turcica operation by the sublabio - septo- sphenoidal approach with the purpose of shortening operating duration, decreasing hemorrhage and increasing the success rate of operation. Material and methods; 122 patients suffering tumors in the sella turcica region underwent the operation, non - X - ray localizations including localization by the angle formed by the middle point of arcus superciliaris, nasospinale and na-sospinale- sella turcica, localization by the angle formed by the upper incisors nasospinale and nasospinale -sella turcica, and localization by anatomical markers( determining midline by nasoseptum and vomer, determining the front wall of sinus sphenoidalis by sinus sphenoidalis opening and vomer body; correcting the saddle base by septum of sinus spheroidalis; locating of the saddles center by shape of the saddle base and determining direction of approach by the damaged area in the sella turcica region) were comprehensively employed. Additional X-ray localization was used to correct its accuracy in 40 cases. The operation duration was averaging 2. 2h in these 40 cases. To 82 patients non - X - ray localization was directly applied for comprehensively measuring the saddle base, the operaton duration was averaging 1. 5h. No death and severe complication resulted. Conclusion: Non - X - ray measurement can be directly applied for localizing the saddle base.

关 键 词：经唇下-鼻中隔-蝶窦入路 鞍区手术 定位 脑肿瘤 手术径路 

分 类 号：R739.41[医药卫生—肿瘤] R730.56[医药卫生—临床医学]