筛泡前径路额窦开放术的鼻内镜解剖  

Endoscopic anatomy of tristar of grooves

作　　者：季俊峰[1] 王秋萍[2] 李泽卿[2] 江满杰[2] 石宇江[3] 

机构地区：[1]第二军医大学南京临床医学院耳鼻咽喉-头颈外科,江苏南京210002 [2]南京军区南京总医院耳鼻咽喉-头颈外科,江苏南京210002 [3]江苏省江阴市人民医院耳鼻咽喉科,江苏江阴214400

出　　处：《中国耳鼻咽喉颅底外科杂志》2006年第2期106-110,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的研究鼻内镜下额窦开口及周围解剖结构,为筛泡前径路额窦开放术式提供应用解剖依据。方法鼻内镜下按照筛泡前径路额窦开放的手术步骤,解剖12例24侧外观无异常,经10%福尔马林固定的成人尸头(男8例,女4例)标本,观察额窦开口的解剖特征以及与周围结构的关系。结果①星状裂及其周围结构是识别额窦开口的重要解剖标记。②星状裂由筛泡、钩突和中鼻甲的顶端共同汇合形成。③额窦开口始终位于星状裂的中心,钩突基板的后方,后鼻道气房或筛泡基板的前方,周围有后鼻道气房和前鼻道气房围绕。④筛泡及伸出的前、后角是星状裂的后界限。⑤筛泡前入路开放额窦可以避开筛前动脉和筛顶。结论通过鼻内镜对额窦开口及周围解剖结构的观察,认为星状裂作为恒定的解剖标志是识别额窦开口的关键区域。筛泡前径路是鼻内镜下额窦开放的安全入路,能避免其他径路存在的某些风险。Objective To explore the characteristic and disciplinarian of the ostiurn of frontal sinus and its surrounding structures under endoscope, and to provide the anatomical foundation for the endoscopic frontal sinusotomy via an approach anterior to ethmoid buUa. Methods The endoscopic anatomy of frontal sinus and surrounding structures were observed according to the endoscopic surgical approaches of frontal sinus in the route anterior to ethmoid bulla, in 12 （8 males, 4 females） adult cadavefic heads which were split axially on midline, with the nasal septurn removed. Results ① The tfistar of grooves and its surrounding structures were important lankmarks in identifying the ostium of frontal sinus. ② The tfistar of grooves consisted of beak of the ethmoidal bulla and its prolonging processes, apex of the uncinate process and anterior peak of the middle turbinate. ③The ostium of frontal sinus lied in the centre of the tfistar of grooves, located behind the basal lamellaes of the undnate process and in front of the posterior meatal cells or the ethmoid bulla, surrounded by posterior and anterior meatal cells. ④Ethemoid bulla and its prolonging anterior comu, posterior comu formed the posterior edge of the tristar. ⑤Performation of surgical procedures anterior to ethmoid bulla could avoid damage of anterior ethmoid artery and ethmoidal roof. Conclusion As a constant landmark, the tristar of grooves is a key area for endoscopic frontal sinusotomy. Performation of surgical procedures anterior to ethmoid bulla can avoid risks of the other models, therefore, endoscopic frontal sinusotomy in the route anterior to ethmoid bulla is a safe model.

关 键 词：鼻内镜术 额窦/解剖学和组织学 星状裂/解剖学和组织学 筛泡前径路 

分 类 号：R322.31[医药卫生—人体解剖和组织胚胎学] R730.49[医药卫生—基础医学]