内镜下经单鼻孔蝶窦入路鞍区手术的解剖研究  

Anatomical study of unilateral endoscopic endonasal transsphenoidal approach for sellar operation

作　　者：漆松涛[1] 罗洪海[1] 彭玉平[1] 

机构地区：[1]南方医科大学南方医院神经外科,广州510515

出　　处：《中华神经医学杂志》2009年第4期372-375,379,共5页Chinese Journal of Neuromedicine

基　　金：南方医科大学南方医院新业务新技术科研项目（2004010）

摘　　要：目的研究内镜下经单鼻孔蝶窦入路中各解剖标志的辨认，探讨如何确认和根据不同的鞍区肿瘤生长方式扩大显露蝶窦前壁。方法对甲醛固定的成人尸头标本Oo例1和新鲜成人尸头标本（5例）经颈内动脉灌注红色乳胶、颈内静脉灌注蓝色玻璃胶后，经单侧鼻孔入路导入内镜，再剖开一侧鼻腔进行解剖观察和测量。结果腭咽弓到蝶窦开口下缘距离为（15．13±1．99）mm，中鼻甲后部下缘到鞍底中心距离为（10．20±0．15）mm，去除蝶窦内分隔后蝶窦容量为（8．73±2．90）mL，鞍底厚度为（3．68±1．96）mm；鼻中隔和蝶窦前壁之间在不同平面的夹角差异有统计学意义（P〈0．05）。结论对难以找到蝶窦开口者，可根据蝶窦前壁特有的橄榄状隆起、蝶窦前壁和中鼻甲位置关系及蝶窦开口和腭咽弓距离确定蝶窦前壁；犁骨居中可为鞍底中线的定位标志；扩大入路适用于往鞍区各个不同方向生长的肿瘤手术。Objective To study the identification of the endoscopic anatomical landmarks in the unilateral endoscopic endonasal transsphenoidal approach, and discuss the verification of the anterior wall of the sphenoid sinus and expansion of the bone exposure of the sellar region according to different growth patterns of the sellar tumors. Methods Ten formalin-fixed adult cadaveric heads and 5 fresh cadaveric heads were perfused with red silicone through the internal carotid artery, and blue glass cement was perfused through the internal jugular vein. The endoscope was introduced through the unilateral nasal cavity, and the contralateral nasal cavity was fully exposed by removing the superficial nasofacial structures for observation and measurement. Results The distance from the pharyngopalatine arch to the inferior edge of the sphenoidal ostium was 15.13±1.99 mm, and that from the inferior edge of the posterior middle turbinate to the center of the sellar floor was 10.20±0.15 mm. The content of the sphenoid sinus was 8.73±2.90 mL after removal of the compartment of the sphenoid sinus, with the sellar floor thickness of 3.68±1.96 mm. The angles between the nasal septum and the anterior wall of the sphenoid sinus varied significantly on different planes （P〈0.05）. Conclusion When difficult to locate the sphenoidal ostium, the opening site can be determined by observing the peculiar oval protuberance on the anterior wall of the sphenoid sinus, the relationship between the anterior wall of the sphenoid sinus and the middle turbinate, and the average distance from the superior limit of the pharyngopalatine arch to the sphenoidal ostium. The vomer on the midline position can be used as the landmark of the midline of the sellar floor. When the tumor has an extrasellar portion, as in the planum sphenoidale, the modified enlarged approach can be the choice.

关 键 词：神经内镜 经单鼻孔蝶窦入路 内镜解剖 

分 类 号：R686[医药卫生—骨科学]