改良部分迷路切除岩骨尖入路的显微解剖  

Modified partial labyrinthectomy petrous apicectomy approach: an microanatomic study

作　　者：赵兵[1] 李长元[1] 冯春国[1] 韩卉[2] 万经海[1] 

机构地区：[1]安徽医科大学第一附属医院神经外科,合肥市230022 [2]安徽医科大学解剖学教研室

出　　处：《中华显微外科杂志》2006年第1期45-47,i0004,共4页Chinese Journal of Microsurgery

基　　金：安徽省卫生厅第五批科研基金资助项目(2002A010);安徽省教育厅自然科学研究项目(2005KJ248)

摘　　要：目的应用锁孔理念,对部分迷路切除岩骨尖入路进行改良,并对改良后的入路进行显微解剖学研究。方法对15例30侧成人尸头采用改良部分迷路切除岩骨尖入路暴露岩斜区,测量磨除部分迷路和岩骨尖后增加的手术视野和视角,观察岩斜区解剖结构的暴露情况。结果在4cm×3cm大小的骨窗范围内可以完成所有的手术操作。磨除部分迷路和岩骨尖后,手术水平视野平均增加14·2mm,垂直视野平均增加12·5mm,手术水平视角平均增加58°,垂直视角平均增加46°,该入路可充分暴露岩斜区各解剖结构,与原入路相比无明显差别。结论改良部分迷路切除岩骨尖入路暴露充分,较原入路创伤小,脑牵拉轻,不容易损伤颈静脉球和面神经颅外段等重要结构,是一种良好的处理岩斜区病变的手术入路。Objective Partial labyrinthectomy petrous apicectomy approach is a relatively new approach to the petroclival region. The keyhole concept is applied to modify this approach for reducing surgeryrelated traumatization in this study. To iavestigate the feasibility and the microsurgical anatomy of modified partial labyrinthectomy petrous apicectomy approach. Methods Bilateral stepwise dissections were performed on 15 formalin-fixed and dye-injected cadaveric heads（30 sides） under × 7 to × 40 magnification, The incision and the craniectomy were minimized, The mastoid tip and the bone overlying the jugular bulb were preserved. The petroclival region was exposed by the modified partial labyrinthectomy petrous apicectomy approach. The amount of dura exposed and the angle of exposure were measured after the partial labyrinthectomy and the petrous apicectomy. The petroclival anatomic structures were observed. Results Each step of operative procedure was accomplished within the 4cm × 3cm craniectomy. On average, there were an increase of 14, 2mm in horizontal exposure and 12. 5mm in perpendicular exposure after the partial labyrinthectomy and the petrous apicectomy. The average angle of vision provided by this approach were 58 degrees horizontally and 46 degrees perpendicularly. This approach provided wide expose to the petroclival region, the posterior cavern- ous sinus and midclival area. There was not an apparent difference between this approach and the partial labyrinthectomy petrous apicectomy approach. Conclusion The modified partial labyrinthectomy petrous apicectomy approach increase the expose markedly without significant brain retraction. The important anatomy structures, such as the jugular bulb, the facial canal and the vein of Labb6, are not easy to be injuried by this approach as compared with the partial labyrinthectomy petrous apicectomy approach, It provide safe and exellent access to the petroclival region, and it may also preserve auditory function.

关 键 词：颅底 岩骨入路 迷路切除术 显微解剖 

分 类 号：R651[医药卫生—外科学] R322[医药卫生—临床医学]