鼻内镜下额隐窝区域手术的应用解剖  

Applied anatomy of the operation in frontal recess region under the nasal endoscope

作　　者：邹剑[1] 张勤修[1] 刘世喜[1] 王光辉[2] 安会明[1] 梁传余[1] 

机构地区：[1]四川大学华西医院耳鼻咽喉科 [2]四川省肿瘤医院颅脑颅底外科,成都610041

出　　处：《中国临床解剖学杂志》2006年第6期623-626,共4页Chinese Journal of Clinical Anatomy

基　　金：四川省卫生厅科研计划(040126);四川省自然科学基金(05JY029-011)

摘　　要：目的:为鼻内镜下额隐窝区域手术提供相应的解剖基础。方法:(1)成人干颅骨5例(10侧),从正中矢状位锯开,观察额窦、额隐窝及毗邻骨性解剖结构;(2)成人湿性尸头5例(10侧),从正中矢状位锯开,观察额窦引流部位,以量角器、直尺等测量工具测量相关解剖数据;(3)另选成人湿性尸头标本5例(10侧),模拟经鼻内镜鼻丘径路额窦开放术,鼻内镜下观察额隐窝及毗邻结构解剖特征。结果:(1)额隐窝作为额窦引流通道,具有复杂的三维空间结构;(2)鼻内镜下经鼻丘径路额窦开放手术可充分暴露额隐窝范围,鼻丘、钩突和毗邻结构的解剖关系决定了具体的手术方式;(3)筛前动脉距鼻小柱与鼻翼交点(58.0±2.9)mm,与鼻底夹角(51.0±3.9)°,是辨认额窦口及前颅底的重要标志。结论:鼻丘、钩突及筛前动脉为鼻内镜下额隐窝区域手术的重要解剖标志,准确辨认额隐窝及毗邻结构的解剖关系,有助于提高手术的彻底性及避免严重的手术并发症。Objective： To provide anatomic data for the operation in the frontal recess region under the nasal endoscope. Methods： （1） Bony structures around the frontal recess were observed on 5 （10 sides） cranial skeletons. （2） The drainage passage of the frontal sinus was observed on 5 （10 sides） cadaveric heads of Chinese adults which were cut sagittally along the midlines and some data were measured by ruler and protractor. （3） Simulating endoscopic frontal sinus surgery with agger nasi approach on 5 （10 sides） cadaveric heads was performed and anatomic characteristics around frontal recess were observed. Results： （1） As the drainage passage of frontal sinus, frontal recess was a complex 3-dimensional structure. （2） The range of frontal recess can be exposed completely by endoscopic frontal sinus surgery with agger nasi approach and the anatomic relationship among agger nasi, uncinate process and adjacent structures determined the approach of surgery. （3） The median distance between anterior ethmoid artery, which was the important mark to recognize frontal ostium and skull base, and the junction of columella nasi and alae nasi was about （58.0±2.9）mm and the median angle with nasal bottom was （51.0±3.9）°. Conclusions： Agger nasi, uncinate process and anterior ethmoidal artery are the important anatomic landmarks in nasal endoscopic surgery around frontal recess. Accurately recognizing the anatomic relationship of frontal recess and its adjacent structures helps to improve the efficiency of surgery and avoid serious complications.

关 键 词：额隐窝 鼻丘 鼻内镜 解剖 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]