不同手术入路对颈静脉孔区显露程度的比较研究及其临床应用价值探讨  

Comparative anatomic study and clinical evaluation of the exposure of the jugular foramen region via different surgical approaches

作　　者：王勇利[1,2] 蒋卫红[1] 章华[1] 柒琳[1] 吴平[1] 肖健云[1] 司勇锋[2] 赵素萍[1] 

机构地区：[1]中南大学湘雅医院耳鼻咽喉头颈外科,湖南长沙410008 [2]广西壮族自治区人民医院耳鼻咽喉科二区,广西南宁530021

出　　处：《中国耳鼻咽喉颅底外科杂志》2010年第1期1-6,共6页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的比较各颈静脉孔区手术入路的显露范围,为选择恰当的手术入路切除不同范围的颈静脉孔区病变提供解剖依据。方法成人头颈标本6具随机分为A、B、C三组,每组2具尸头。其中A组应用颈侧入路、B组分别采取鼓室底入路和改良鼓室底入路、C组分别选择A型颞下窝入路及改良A型颞下窝入路进行颈静脉孔区解剖,比较各手术入路对颈静脉孔区及其周围解剖区域的显露程度。结果颈侧入路对颈静脉孔的颅外部分及咽旁间隙显露良好;鼓室底入路在颈侧入路的基础上进一步显露乳突、乙状窦垂直臂、颈静脉球、颈静脉孔神经部;A型颞下窝入路又在鼓室底入路的基础上扩大显露外耳道深部、中耳腔及岩骨段颈内动脉垂直段;改良鼓室底入路和改良A型颞下窝入路很好地弥补了鼓室底入路和A型颞下窝入路对乙状窦水平臂和颈静脉孔血管部显露不足的缺陷。结论不同颈静脉孔区手术入路对颈静脉孔区的显露程度各不相同。以此为依据,根据颈静脉孔区病变的范围选择手术入路对有效显露和切除病变,减少结构和功能破坏具有现实的指导意义。Objective To provide anatomic evidence for appropriate selection of the surgical approach to resecting the lesions in the jugular foramen region via exposing the jugular foramen region with different surgical approaches.Methods Six adult cadaveric heads（12 sides）were randomly assigned to three groups（Group A,B,and C）.The transcervical-transmandibular（TCM）approach was applied to Group A,the hypotympanic（HT）approach and modified hypotympanic（MHT）approach to Group B,and infratemporal fossa type A approach（ITFT-A）and modified infratemporal fossa type A（MITFT-A）approach were used to Group C.The exposure degree of the jugular foramen region and the surrounding anatomic structure were compared among above-mentioned surgical approaches.Results The TCM approach offered a good view of the extracranial areas of the jugular foramen and the parapharyngeal space.The HT approach not only provided an excellent view of above-mentioned areas as the TCM approach,but also provided a good anatomic view of the mastoidal process,vertical segment of sigmoid sinus,glomus jugular,and pars nervosa of the jugular foramen.The ITFT-A approach could provide clear visualization of the above mentioned anatomic structure.Besides,this approach could provide further exposure of the deep areas of the external auditory canal,middle ear cavity,and vertical part of the petrous segment of the internal carotid artery.The MHT and MITFT-A approaches not only provided a panoramic view of the all above-mentioned anatomic structure,but also offered a better exposure of the areas of the horizontal segment of sigmoid sinus and pars vascularis of the jugular foramen.Conclusion The exposure degree of jugular foramen region varies in different surgical approaches.Therefore,the surgical approach should be selected according to different lesions of the jugular foramen,to optimize the exposure and removal of lesions and to minimize the traumat of the anatomic structure.

关 键 词：显微外科解剖 颈静脉孔 颈静脉球体瘤 手术入路 

分 类 号：R739.4[医药卫生—肿瘤]