三种扩大经蝶至斜坡手术入路的螺旋CT评价实验研究  

Three Methods of Expanding Operative Access through Sphenoidal Sinus to Clivus:An Experimental Study with Spiral CT Evaluation

作　　者：周胜利[1] 顾艳[1] 徐伦[2] 李爱民[3] 

机构地区：[1]连云港市第一人民医院放射科,222002 [2]连云港市中医院神经外科 [3]连云港市第一人民医院神经外科,222002

出　　处：《临床放射学杂志》2014年第7期1088-1092,共5页Journal of Clinical Radiology

摘　　要：目的利用CT三维重组测量模拟的3种扩大经蝶至斜坡入路斜坡暴露范围,为临床手术提供参考和依据。方法选取10%甲醛溶液固定的尸颅20例,在安全显露范围内,在同一尸颅上先后模拟3种扩大经蝶-斜坡的手术入路,即直接鼻内入路(ENA)、经唇下-鼻中隔入路(SLSA)和经唇下-上颌窦入路(SLMSA)。分别使用16排螺旋CT行尸颅薄层扫描,后行斜坡的三维重组,分别测量3种扩大经蝶-斜坡入路获得的纵径和横径,并对结果进行统计学分析。结果测得两侧破裂孔外口内侧缘、颈内静脉孔外口内侧缘、颈内动脉管外口内侧缘、舌下神经管外口内侧缘之间距离及Dorello管处、颈静脉孔处、舌下神经管处斜坡的厚度分别为(23.2±3.4)mm、(44.2±4.0)mm、(54.2±4.2)mm、(39.6±4.4)mm和(16.5±3.1)mm、(11.2±2.7)mm、(6.5±1.7)mm;测得斜坡的暴露范围,ENA、SLSA、SLMSA的纵径及横径分别为(31.8±1.4)mm、(37.1±1.6)mm、(37.2±1.4)mm和(29.0±1.4)mm、(29.5±1.2)mm、(36.8±1.20mm,SLSA较ENA斜坡暴露范围中纵径增加明显(q=11.39,P<0.05),横径增加不明显(q=1.08,P>0.05)。SLMSA较ENA斜坡暴露范围的纵径、横径增大均明显(q值分别为11.64和17.93,P均<0.05)。SLMSA与SLSA相比,暴露范围中的横径差别有统计学意义(q=16.84,P<0.05),而纵径没有明显差异(q=0.26,P>0.05)。结论多排螺旋CT三维重组技术为扩大经蝶-斜坡入路提供解剖学依据,有利于入路手术方案的确定,有利于减少手术风险。Objective To study three methods of expanding operative access （through sphenoidal sinus to clivus） and enlarging operation field in order to provide useful references and anatomic basis for clinical operation. Methods Twenty formalin-fixed cadaveric heads were used for this study. Three surgical approaches were simulated on each head： endonasal approach （ENA） , sublabial septum approach （SLSA） and sublabial maxillary sinus approach （SLMSA）. Thin-slice scanning with a 16-slice spiral CT scaner was performed and 3-D reconstruction of clivus was conducted. Both the longitudinal and transverse diameters from sphenoidal sinus to clivus were measured, and the results were statistically analyzed. Results The bilateral distances of inner border of outer entrance of lacerated foramen, inner border of outer entrance of jugular vein hole, inner border of outer entrance of carotid artery hole and inner border of outer entrance of hypoglossal canal were as follows （23.2 ± 3.4） mm, （44.2 ± 4.00） mm, （54.2 ± 4.2） mm, （39.6± 4.4） mm respectively. The thicknesses of ciivus next to the Dorello canal, jugular vein hole and hypoglossal canal were （ 16.5 ± 3.1 ） mm, （ 11.2 ±-2.70） mm and （6.5 ± 1.7 ） mm respectively. The exposed diameters of average anteroposterior and transverse distance were （31.8±1.4） mm, （37.1±1.6） mm, （37.2±1.4） mmand （29.0±1.4） mm, （29.5±1.2） mm, （36.8±1.2） mm respectively. The difference in anteroposterior diameters between sublabial septum approach and endonasal approach was statistically significant （ q = 11.39, P 〈 0.05 ）. However, the difference in the transverse diameters between the two approches was not statistically significant （ q = 1.28, P 〉 0.05 ）. The differences in both anteroposterior diameters and transverse diameters between sublabial maxillary sinus approach and endonasal approach were statistically significant, （q =11.64 and q = 17.93, P 〈 0.05）. Besides, the differences in transverse diamete

关 键 词：斜坡 体层摄影术 X线计算机 扩大经蝶入路 经唇下-鼻中隔入路 经唇下-上颌窦入路 直接鼻内入路 

分 类 号：R651.1[医药卫生—外科学] R816.1[医药卫生—临床医学]