鼻内镜下颌内动脉翼腭段应用解剖及其意义  

Applied anatomy and clinical significance of the pterygopalatine segment of internal maxillary artery via transnasal endoscopic approach

作　　者：敖勇[1] 张华[2] 郭全民[3] 

机构地区：[1]新疆阿克苏地区第一人民医院耳鼻咽喉科,新疆阿克苏843000 [2]新疆医科大学第一附属医院耳鼻咽喉科,新疆乌鲁木齐830054 [3]新疆医科大学口腔系,新疆乌鲁木齐830054

出　　处：《中国耳鼻咽喉颅底外科杂志》2013年第1期32-37,共6页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的通过鼻内镜经鼻腔入路对颌内动脉翼腭段及其周围区域的解剖学研究,为临床鼻内镜下颌内动脉翼腭段区域手术提供解剖学基础。方法对10具(20侧)新鲜尸头经鼻内镜下鼻腔外侧壁入路对侧颅底翼腭窝区域进行解剖学观测,正中矢状锯开标本观测内镜下解剖标志及颌内动脉翼腭段分支变异及邻近血管神经结构。结果①颌内动脉翼腭窝段变异较大,颌内动脉翼腭段按顺序发出分支占25%(5/20),眶下动脉和上牙槽后动脉共干发出占50%(10/20),分别由颌内动脉发出占40%(8/20);颌内动脉同时发出眶下动脉、腭降动脉、蝶腭动脉占10%(2/20);眶下动脉和腭降动脉共干发出占10%(2/20);翼管动脉和圆孔动脉分别由颌内动脉发出及共干发出各占50%(10/20);②鼻内镜下能够较好的控制颌内动脉及其分支,对周围结构触动少。结论掌握颌内动脉翼腭段及其周围区域的解剖可降低鼻内镜下该区域手术的并发症,对于翼腭窝手术及治疗顽固性鼻出血有重要意义。Objective To provide detailed anatomical data for endoscopic surgery by studying the related anatomy of the pterygopalatine segment of internal maxillary artery （PSIMA） and its surrounding area through transnasal endoscopic approach. Methods In 10 fresh cadaveric heads （20 sides）, the pterygopalatine fossa （PPF） was observed via transnasal endoscopic approach. After the heads were split, the important bony symbols of PPF, the neurovascular structure and their relations with the surrounding structures were observed via median sagittal approach. Results ① The branch patterns of the PSIMA varied prodigiously. Of all the sides, the PSIMA was emitted sequentially in 5 （ 25 % ） , originated from the common stake of inferior ophthalmic artery （ IOA ） and posterior superior alveolar artery in 10 （50%） , and emitted respectively from internal maxillary artery （IMA） in 8 （40%）. The ratio of simultaneous emittenee of IOA, descending palatine artery （DPA）, sphenopalatine artery （SPA） from IMA was 10% （2 /20）. IOA and DPA were emitted in a common stake in 10% （2/20）. The ratios of emittenee of pterygoid canal artery and foramen rotundum artery from IMA separately and with a common stake were 50% （10/20） respectively. ② Transnasal endoscopic approach could preferably manage IMA and its branches with little disturbance to the surrounding structures. Conclusion Being familiar with the anatomy of PSIMA and its surrounding regions can reduce complications of intranasal endoscopic surgery, therefore has important significance in the treatment of intractable epistaxia and transnasal endoscopic surgery of maxillary peterygopalatine fossa.

关 键 词：颌内动脉翼腭段 翼腭窝 鼻内镜 应用解剖 

分 类 号：R730.49[医药卫生—肿瘤] R323.1[医药卫生—临床医学]