内镜下颅底修复的带蒂鼻中隔瓣的解剖测量  

Endoscopic reconstruction skull base using pedicled nasoseptal flap and its anatomy measurement

作　　者：程付伟[1,2] 殷善开[1] Djamaldine Mohamed Sambi 张维天[1] 

机构地区：[1]上海交通大学附属第六人民医院耳鼻咽喉科上海交通大学耳鼻咽喉科研究所,上海200233 [2]苏州大学医学院研究生院,江苏苏州215123

出　　处：《临床耳鼻咽喉头颈外科杂志》2013年第14期741-744,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:我们在尸头标本上实践获取和转移鼻中隔黏骨膜瓣技术,另外采用放射解剖学方法测量内镜经中线颅底手术入路可能造成的颅底缺损的尺寸,根据缺损的测量结果,对鼻中隔黏骨膜瓣进行设计。期望结果有助于改进亚裔人群鼻中隔黏骨膜瓣的设计,提高修复成功率。方法:首先在尸头标本上进行鼻中隔黏骨膜瓣的获取和转移,接着在20例成人鼻窦颅底区域的CT扫描图像上,利用工作站进行测量。从准备采用鼻中隔黏骨膜瓣修复颅底缺损的角度出发,测量中线颅底的3个区域[两眶之间的前颅底区(经筛板入路);蝶骨平台区(鞍区);斜坡区]缺损的最大面积以及相关长度与宽度,再以这些数据指导鼻中隔黏骨膜瓣的设计并预测组织瓣是否能够对缺损提供充足的覆盖。应用鼻中隔黏骨膜瓣修复时,需要将蝶腭孔的投射点到相关颅底区域的距离与相关颅底区域的前后长度相加,以获得所需要的鼻中隔黏骨膜瓣的长度数据。结果:使用鼻中隔黏骨膜瓣修复中线颅底缺损时,由蝶腭孔的投射点到前颅底、蝶骨平台区/鞍区及斜坡尾端的平均长度分别为49.56、57.47、67.19 mm;上述3个颅底区域分别完全切除后的缺损面积分别为16.13、14.03、13.12 cm2。鼻中隔黏骨膜瓣可以提供的瓣长度为64.71～65.93 mm,宽度为28.57～30.59 mm,平均面积为22.95 cm2。结论:一侧完全的鼻中隔黏骨膜瓣可以分别为颅底中线的前颅底和蝶骨平台区/鞍区提供足够的覆盖面积;而其由于长度的限制,对于斜坡区缺损不能完全覆盖,术前要特别予以重视。Objective：The harvesting procedures on cadaver heads and a radioanatomic study of measuring dimensions of skull base by endoscopic endonasal approach were performed.The measurements could do help to design the nasoseptal mucoperiosteum and improve the rate of repair success.Method：The surgical procedures were demonstrated on cadaver heads specimens.Then 20 adult CT scans of sinus and skull base were calculated by workstations.The dimensions of three different skull base（the defect of anterior skull base/cribriform plate approach,sellar region/planum sphenoidale region and clivus region） of maximum areas,length and width,were measured.And with these data the nasoseptal flap were designed for providing enough area to cover the defect.The distance from the projection of sphenopalatine foramen to related area of skull base were plused for obtaining desired the length of nasoseptal flap.Result：The mean length from the projection of sphenopalatine to the anterior skull base,planum /sella area and clivus were 49.56 mm,57.47 and 67.19 mm,respectively.The means of areas of anterior dural defect,transsellar defect and panclivectomy were 16.13 cm2,14.03 cm2 and 13.12 cm2,respectively.The average length of the nasoseptal flap ranged between 64.71-65.93 mm,the width ranged between 28.57-30.95 mm with an average area of 22.95 cm2.Conclusion：One side of nasal septal flap can provide enough area to reconstruct the anterior skull base and planum/sella area.In some cases,the flap can not completely cover the area of clivus region because of the limitation of its length.

关 键 词：鼻中隔黏骨膜瓣 带血管蒂组织瓣 内镜颅底手术 颅底重建 放射解剖测量 

分 类 号：R736.4[医药卫生—肿瘤]