鼻内镜下蝶窦外侧壁的应用解剖学研究  

Applied anatomy study on the lateral wall of sphenoid sinus under transnasal endoscope

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

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

出　　处：《临床耳鼻咽喉头颈外科杂志》2007年第5期194-196,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：四川省卫生厅科研计划项目(No:040126);四川省自然科学基金资助项目(No:05JY029-011)

摘　　要：目的:通过经鼻内镜行蝶窦外侧壁尸头解剖,为临床鼻内镜下蝶窦外侧壁相关手术提供解剖学参考。方法:选取经10%甲醛防腐处理的国人成人湿性尸头10具(20侧),鼻内镜下经鼻-蝶窦手术入路,暴露蝶窦腔,在0°和30°鼻内镜下确认蝶窦外侧壁骨性隆起,观察视神经和颈内动脉与毗邻结构的关系,以直尺、量角器等测量工具分别测量视神经管和颈内动脉骨性隆起与鼻小柱、鞍底中线的距离和角度。结果:鼻内镜下可见蝶窦外侧壁上视神经管与颈内动脉骨性隆起呈“八”字形关系,向蝶窦腔凸入的程度及两者间距离因人而异,沿颈内动脉追踪可暴露海绵窦外侧壁;测得视神经管眶口内壁中点、颈内动脉骨性隆起前端到鼻小柱的平均距离分别为(75.33±5.59)mm和(81.02±5.29)mm,到鞍底中线的平均距离分别为(5.81±1.52)mm和(5.53±1.47)mm;视神经管眶口内壁中点到鼻小柱连线与鼻底的夹角平均为(53.4±4.1)°。结论:以鼻小柱及鞍底中线为参考点,在鼻内镜下经鼻-蝶窦手术径路进行的蝶窦外侧壁解剖学形态观察和相关测量数据可为临床医生提供相应指导。Objective：To provide transsphenoidal endoscopic surgery with the anatomic reference through anatomic study on the lateral wall of sphenoid sinus under transnasal endoscope. Method： The dissection of the lateral wall of sphenoid sinus were performed on 10（20 sides） damp cadaveric heads of Chinese adults via transsphenoidal approach. The anatomic relationship of the lateral wall of sphenoid sinus and its adjacent structures were observed. The distance and angle from the bony prominence of optic canal and internal carotid artery to the columella nasi and midline of sellar floor were measured by ruler and protractor respectively. Result：From the study of endoscopic anatomy, the specific structure of optic canal and internal carotid artery were found, and the lateral wall of the cavernous sinus could be exposed by tracing the internal carotid artery. The mean distance from the midpoint of the medial wall of optic canal orbital aperture and the anterior bony prominence of internal carotid artey to the columella nasi were （75.33±5. 59）mm and （81.02± 5.29）mm respectively, to the midline of sellar floor were （5.81± 1.52）mm and （5.53 ± 1.47）mm respectively. The angle from the midpoint of the medial wall of optic canal orbital aperture to columella nasi was （53.4 ±4.1 ）°. Conclusion： Taken the columella nasi and midline of sellar floor as the reference points, the anatomic observation and measurement under endoscope via transsphenoidal ap- proach can provide a guide for surgeons.

关 键 词：内镜检查 蝶窦 解剖学 局部 

分 类 号：R765.04[医药卫生—耳鼻咽喉科]