扩大经鼻蝶海绵窦下壁手术入路的显微外科解剖  

Microsurgical anatomy of the extended transnasal transsphenoidal approach to the inferior wall of cavernous sinus

作　　者：范翔[1] 江广理[2] 王海军[3] 初国良[4] 蔡赣桥[1] 樊韵平[1] 

机构地区：[1]中山大学附属第五医院神经外科,广东珠海519000 [2]中山大学附属第一医院耳鼻喉科 [3]中山大学附属第一医院神经外科 [4]中山大学中山医学院解剖学教研室,广州510080

出　　处：《中国临床解剖学杂志》2008年第6期601-603,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的：为经鼻蝶海绵窦下壁手术入路提供解剖基础。方法：对10例成人头颅湿标本，采用扩大经鼻蝶手术入路，在手术显微镜下观测相关解剖结构。结果：（1）通过扩大入路可建立直视海绵窦下壁的通路。（2）可视的海绵窦下壁范围为不规则四边形，前界长（11．95±2．01）mm（8．66-15．15mm），内侧界长（14．02±1．68）mm（11．47～17．66mm）。（3）可完整显示海绵窦的前下腔和内侧腔及外侧腔和海绵窦外侧壁的大部。结论：切除中、上鼻甲及后组筛窦的扩大手术入路，可以较好的显露海绵窦的下壁，具有直视、微创的优点。Objective： To provide anatomic references for the extended transnasal transsphenoidal approach to the inferior wall of cavernous sinus. Methods： Simulating surgeries of the extended transnasal transsphenoidal approach were performed under microscope in 10 formalin fixed cadaveric heads, and correlated anatomic structures were observed and measured. Results： （1） The direct working pathway to expose the inferior wall of cavernous sinus could be established through the extended transnasal transsphenoidal approach. （2） The visible field of the inferior wall of cavernous sinus was the irregular shape of quadrangle, with the length of anterior and medial edge of （11.95±2.01 ）ram （8.66-15.15 mm）,and （ 14.02±1.68）mm （ 11.47-17.66 mm）respectively. （3） The whole antero-inferior and medial compartments of cavernous sinus, as well most parts of lateral compartment and lateral wall could be observed. Conclusions： The extended transnasal transsphenoidal approach to expose the inferior wall of cavemous sinus could be established by removing upper and middle nasal concha and posterior ethmoid sinus. The advantages of this approach include direct visualization and minimal invasion.

关 键 词：扩大经鼻蝶入路 筛窦 海绵窦 视神经-颈内动脉陷窝 显微外科解剖 

分 类 号：R651[医药卫生—外科学] R323.1[医药卫生—临床医学]