迷路后桥脑小脑三角区内镜手术的应用解剖研究  

Anatomic Study on Post-labyrinthine Approach of Cerebellopontine Angle Via Endoscope

作　　者：朱杭军[1] 王光辉[1] 杜云翔[2] 王益龙[3] 李前文[2] 高莉莉[1] 

机构地区：[1]中国人民解放军第八二医院耳鼻咽喉科,江苏淮安223001 [2]中国人民解放军第八二医院肿瘤科,江苏淮安223001 [3]中国人民解放军第八二医院神经外科,江苏淮安223001

出　　处：《解剖与临床》2008年第1期17-19,共3页Anatomy and Clinics

基　　金：南京军区卫生专业人才培养"122工程"资助项目

摘　　要：目的:评价内镜在桥脑小脑三角区手术中的应用价值。方法:对5例10侧成人尸头进行大体解剖,熟悉桥脑小脑三角区诸结构解剖关系;在10例20侧成人尸头上模拟迷路后径路内镜手术,将镜下结构按解剖位置分为面神经、三叉神经、舌咽神经三个区域,重点观察各区域各组颅神经之间、神经和血管之间关系;在15例标本上,于颞骨岩部后骨板平面测量内耳门外缘距后半规管外缘、颞骨表面距离,内耳门下缘距舌咽神经距离。结果:10例标本通过内压小脑均能成功导入内镜进行模拟手术;内耳门及第7、8颅神经可作为内镜手术的解剖标志。内耳门外缘距颞骨表面距离为(33.82±2.80)mm,距后半规管后缘距离为(13.24±2.55)mm,下缘距舌咽神经距离为(6.26±1.05)mm。结论:迷路后径路桥小脑角区内镜手术完全可行,较显微镜手术而言具有微创、能多角度观察病变区域、更清晰分辨血管神经关系等优点,更适合耳科医生采用,但需熟悉和掌握有关解剖知识以及内镜操作技巧。Objective： To evaluate the applied values of endoscope in the operations performed in cerebellopontine angle area. Methods： 15 adult cadaveric heads fixed with formaldehyde were used in this study. Gross anatomy was carried out on 5 cases, and sham operations were performed on other 10 cases. Under endoscope, the cerebellopontine angle area included three subregions, namely, area facialis, trigeminal area and glossopharyngeal area. We paid close attention to the relationships between cranial nerves and between nerves and blood vessels. To measure the distance from the exterior margin of internal acoustic pore to the outer margin of posterior semicircular canal and to the surface of temporal bone, and distance from the inferior border of internal acoustic pore to glossopharyngeal nerve, on the 15 adult cadavers. Results：All sham operations were performed on 10 cadavers successfully by importing an endoscope. The internal auditory foramen, seventh and eighth cranial nerves could be anatomic landmarks for endoscopic surgery. The distance from the exterior margin of internal acoustic pore to the surface of temporal bone and to the outer margin of posterior semicircular canal were （ 33.82 ±2.80 ） mm and （ 13.24 ± 2.55 ） mm, respectively. The distance from the inferior border of internal acoustic pore to glossopharyngeal nerve was （ 6.26 ± 1.05 ） mm. Conclusions ： Endoscopic surgery via postlabyrinthine approach is feasible, which has advantages of micro-wound, observing the diseased region from various angles, discernmenting vascular nerve clearly. It more suits for otology, but need the operator understand the relative anatomic knowledge and be familiar with endoscopic technique.

关 键 词：迷路后径路 内镜 颅神经 

分 类 号：R322.81[医药卫生—人体解剖和组织胚胎学] R730.49[医药卫生—基础医学]