经单鼻孔入路显微镜结合神经内窥镜对颅底中线结构肿瘤活体观察测量研究  

Research on the measuring scope of skull base midline structure tumors in the mothod of single-nostril microscopy combined with neural endoscopy

作　　者：陈胜利[1] 乔志刚[2] 张汉伟[1] 张子屏[1] 胡涛[1] 王春红[1] 郭建忠[1] 吉宏明[1] 

机构地区：[1]山西省人民医院神经外科,太原030012 [2]山西省肿瘤医院神经外科

出　　处：《肿瘤研究与临床》2012年第3期169-171,174,共4页Cancer Research and Clinic

基　　金：山西省卫生厅科技攻关项目（200620）

摘　　要：目的观察扩大经蝶入路涉及的各种标志结构、活体形态并测量相关数据，为扩大经蝶入路提供直观的形态学基础、详尽的解剖学参数。方法选择80例临床患者，术前测量患者的鼻孔大小、鼻小柱的高度、鼻梁与双眼内眦和鼻小柱三点平面的夹角、鼻梁的长度；术中测量鼻小柱到蝶窦口的距离，观察蝶窦口的形状，测量蝶窦口最长、短间距，观察蝶窦分隔的形态、三个隆起的形态及三者间的关系以及肿瘤的质地及色泽，测量蝶窦壁、筛房、鞍底、斜坡切除范围以及操作空间大小，并对颅底重建材料选择和修补方法进行观察研究。结果鼻外形按鼻柱的高低分为鞍鼻、正常鼻、鹰鼻和肢端肥大鼻。鼻孔的形状呈“肾形”、“球形”、“雪人形”、“三角形”。蝶鞍底最大开凿距离：海绵窦间为（18．9±2．51）mm，鞍结节、斜坡间为（19．2±2．67）mm。切除肿瘤后空间观察，经蝶入路前可达前组筛窦，后可达下斜坡。结论测量数据有利于术前选择窥器的型号、放置窥器深度、体位的仰角、鞍底开窗范围，避免损伤颈内动脉、海绵间窦、颅神经等使手术安全、微创、有效。Objective By combined application of endoscopic and microscopic vivisection-pronged approach, forms a three-dimensional morphological observation through focusing on an observation of structure of various signs, imaging features, morphology and measuring in vivo data, which are concerned with expansion of transsphenoidal approach. This will provide expansion of transsphenoidal approach with an intuitive morphological imagines, detailed anatomical parameters, accurate imaging data, viviperception and data measurement. Methods 80 patients were recruited for investigation, preoperative measurement of the size of the patient＇s nose, height of nasal corrnella, the plane angle among bridge of nose, inner canthal of eyes and nose columella, and the length of bridge of nose. in the operation, measure the distance from nasal columella to aperture of sphenoidal sinus; observe the shape of aperture of sphenoidal sinus; measure the longest and the shortest distance between aperture of sphenoidal sinus; observe the shape of septum of sphenoidal sinus, three uplift and the relationship among them, as well as the color and texture of the tumor. Measure sphenoid sinus wall, screening room, sellar floor, extent of slope resection, operating space, as well as observation ＆ study of selection and repairing of skull base reconstruction materials. Results The shape according to the discretion of the column is divided into butterfly saddle nose, normal nose, eagle nose and acromegaly hypertrophy nose. The nostrils shape is ＂kidney form＂, ＂ball form＂ , ＂snow humanoid form＂and＂ triangle form＂. The butterfly saddle biggest digging distance： between the cavernous sinus is（ 18.9±2.51 ） ram, from saddle nodules to slope is（19.2 ±2.67） mm. After tumor resection, the transsphenoidal observation space is forward to former group of ethmoid sinus, back to the slope. Conclusion The measurement data might be benefit for selecting of speculum, evalution of placing depth on speculum and operation position and sellar f

关 键 词：显微镜检查 颅底 神经内窥镜 肿瘤 

分 类 号：R739.4[医药卫生—肿瘤]