脑干下段—颈脊髓上段腹侧手术入路的应用解剖  

An Applied Anatomy on the Operational Ventral Entrance for Inferior Segment of Brain Stem and Superior segment of Cervical Spinal Cord

作　　者：代生富[1] 杨先东 吴宇华 丁明甫 靳升荣 陶远孝[2,3] 

机构地区：[1]华西医科大学人体解剖学教研室,成都610041 [2]广元职工医学院人体解剖教研室 [3]四川省肿瘤医院头颈外科

出　　处：《四川解剖学杂志》1999年第3期157-161,共5页Sichuan Journal of Anatomy

基　　金：四川省卫生厅基金项目资助

摘　　要：为脑干下段及颈脊髓上段腹侧病变的切除提供解剖学资料。方法：①成人完整颅骨１００个，测量枕骨基底部的长、宽和厚度；②在１０ 具成人尸体水平切开的颅腔内，观察硬脑膜、各脑神经和血管在颅后窝内的位置毗邻关系；③１５ 具成人尸体正中矢状断面，观察经咽部进入颅腔和椎管的层次结构；④对５ 具尸头逐层解剖经咽至脑干下段和颈髓上段的层次结构，并观察两侧椎动脉、基底动脉、静脉及两侧和各脑神经根。结果：①枕骨基底部平均长２７９±２．４ｍ ｍ ，平均宽２０．３±２．６ｍ ｍ ，平均厚度０．８±０．５ｍ ｍ ，此数据为枕骨开窗范围提供了参考；②详述了手术入路的各层次结构；③从口腔经咽的腹侧入路适合于骨开窗区一定范围的肿瘤或其它病变的切除，暴露直接，并发症少，恢复快；④软腭切开造成腭咽闭合不良及枢椎齿突与寰枢椎部分切除后，需石膏托颈部固定或植骨等特点的克服。The data is applied for operational ventral entrance to tumour or lesion on inferior segment of brainstem and superior segment of cervical spinal cord. Methods and results: 1. The occipital basilar part was measured in 100 skulls. It was 27.9±2.4mm in length, 20.3±2.6mm in width and 0.8±0.5mm in thickness. 2.The location and relation of the roots of cranial nerves in the posterior cranial fossa were observed in 10 cadaver′s cranial cavities. 3.On sagittal plane of 15 corpses,the layers from oral nasopharyngeal side to the inferior segment of brainstem and superior segment of cervical spinal cord were observed. 4.The vertebral arteries, the basilar artery, the roots of the first cervical spinal nerve and the Ⅻ-Ⅴ cranial nerves were dissected and observed on 5 cadavers. Conclusion: Our data shows that this operation entrance is suitable for tumor or lesions limited in this area and the tumor may be exposed better,direct, with less of complication and recovered quickly. After the section of soft palate, the function of the palate pharyngeal muscles will be injured and the closure will not well, so the patient pronunciation may be not clear. The head must be drew and fixed by plaster stone for 6-8 weeks,after partial excision of the atlas and the axis.The author will study further to overcome the defects described above.

关 键 词：经口手术入路 脑干下段 颈脊髓上段 应用解剖 

分 类 号：R602[医药卫生—外科学] R323.1[医药卫生—临床医学]