中耳内窥镜解剖  

Endoscopic anatomy of the middle ear

作　　者：江红群[1] 张剑[1] 文三立[1] 

机构地区：[1]江西医学院第一附属医院耳鼻咽喉科,南昌330006

出　　处：《临床耳鼻咽喉科杂志》2002年第1期17-18,I001,共3页Journal of Clinical Otorhinolaryngology

摘　　要：目的 :探讨经不同途径的中耳内窥镜解剖所见。方法 :采用 0°,30°,90°的硬质内窥镜 ,对 17个颞骨标本进行了观察 (其中干标本 6个 ,湿标本 11个 ) ,内窥镜插入途径有 :外耳道 ;耳后切口 (包括乳突腔 鼓窦和乳突腔 后鼓室两条亚途径 ) ;中颅窝。结果 :外耳道途径 :采用 0°,30° ,90°的硬质内窥镜 ,所有鼓室结构都可看见 ,包括鼓室窦、面隐窝、上鼓室前隐窝等隐蔽处 ;乳突腔 鼓窦途径 :可以看见乳突腔、鼓窦、上中鼓室等结构 ;乳突腔 后鼓室途径 :可观察到乳突及中下鼓室结构 ;中颅窝途径 :可以观察到上鼓室、鼓窦、乳突腔及鼓室外侧壁的结构 ,中鼓室的大部分结构亦可观察到。结论 :经不同的途径行内窥镜术能清楚地观察到中耳各个结构 ,因此能减少胆脂瘤的复发率及评价术后中耳腔的状态 ,其中 30°的内窥镜提供的视野较好 ;但如经外耳道途径观察后上鼓室及经乳突腔 鼓窦途径观察后鼓室 ,则Objective:To provide a detailed anatomic description of middle ear endoscopy via different approaches.Method:Using 0,30 and 90 degree rigid endoscopes,6 dry tymporal bones and 11 tymporal bone blocks were examined to define the average range of view obtained by three approaches:①via the external ear canal approach;②via a retroauricular incision: including two subdivided routes,the mastoid tympanic antrum route and mastoid retrotympanum route;③via the middle ear cranial fossa. Each region of the middle ear was chosen for inspection. Result:①via the external ear canal approach,all sites of the tympanic cavity structures were seen with 0,30 and 90 degree rigid otoendoscopes,including the hidden areas such as the tympanic sinus,facial recess,anterior epitympanic recess,orifice of eustachian tube et al.②via the mastoid tympanic antrum route,the structures of the mastiod cavity,tympanic antrum ,epi mesotympanum were clearly defined;via the mastiod retrotympanum route,the structures of the mastoid cavity and meso hypotympanum were also observed;③via the middle cranial fossa approach ,the structures of the epitympanum,tympanic antrum,mastoid cavity and lateral wall were inspected ,most mesotympanic structures were evaluated.Conclusion:Middle ear endoscopy through the different approaches provides the otosurgeons a clear view field of the middle ear structures,can therefore decrease the incidence of cholesteatoma recurrence and evaluate the state of the postoperative middle ear cavity. The 30 degree otoendoscope can provide a better visualization of the middle ear structures,via the three approaches,the 90 degree otoendoscope is suited for the inspection of the posterior epitympanum via the transmeatal approach and retrotympanum via mastoid cavity tympanic antrum route.

关 键 词：内窥镜术 中耳 解剖 

分 类 号：R322.922[医药卫生—人体解剖和组织胚胎学]