颈静脉孔区颅底内镜手术解剖  

Endoscopic anatomy study of jugular foramen region

作　　者：朱杭军[1] 张建东[1] 王玉海[2] 

机构地区：[1]解放军第101医院耳鼻咽喉科,江苏无锡214044 [2]解放军第101医院神经外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第14期1288-1290,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：南京军区医学科研课题资助项目(No:11MA013)

摘　　要：目的：观测颈静脉孔区解剖结构,并模拟、比较相关内镜手术,为颈静脉孔区颅底内镜手术提供解剖资料。方法：对8例（16侧）成人尸头颈静脉孔区进行解剖,模拟实施迷路后和乙状窦后径路内镜手术,观察手术径路上各结构对手术的影响以及相关血管、神经之间解剖关系。去除顶骨、大脑以及部分小脑组织,暴露颈静脉孔、内耳门及其周围结构,测量颈静脉孔上缘距内耳门下缘垂直距离。结果：8例（16侧）标本均顺利完成迷路后径路模拟内镜手术,仅有2例（4侧）在不损伤小脑情况下顺利完成乙状窦后径路模拟手术,小脑为内镜导入的主要障碍。镜下能清晰分辨颈静脉孔区血管神经区域,舌咽和迷走神经之间间距相对较大,迷走和副神经相距较近,部分小脑下后动脉穿行于其间;舌下神经位于上述颅神经内、下方,形成5~8束较细神经纤维平行分布。颈静脉孔上缘距内耳门下缘垂直距离为（8.26±1.05）mm。结论：相较而言,迷路后径路颈静脉孔区内镜手术术野暴露更好且能更好保护小脑,但其操作相对复杂且对术者要求较高;内耳门仍是手术的可靠定位标志。Objective：To observe anatomic structure of jugular foramen region by endoscope,to provide anatomic data for avoiding damnification in the surgery.Method：We performed the retrolabyrinthine and retrosigmoid endoscopic surgery on 8fomalin-fixed adult cadaver specimens and observed the structures of jugular foramen by endoscope and compared the different surgeries at the same time.We excised the calvarium and cereburm and exposured and observed the nerves and vessels.Moreover we measured the the distance from internal accoustic pore to glossopharyngeal and analyse the data by SPSS.Result：All retrolabyrinthine endoscopic surgeries were performed successfully.Only 4postsigmoid endoscopic surgeries were performed without damage of cerebellum which is the major obstacles.The distance from internal accoustic pore to glossopharyngeal was（8.26±1.05）mm.About half of posterior inferior cerebellar arteries located to inboard of nerves.Conclusion：The jugular foramen region endoscopic surgery can be performed successfully by retrolabyrinthine.The ＂lockhole＂ technology by retrosigmoid is more difficult for blocking of cerebella.the internal acoustic porus is a fixed structure of the cerebellopontine angleand a perfect landmark to the surgery.

关 键 词：颈静脉孔区 内耳门 内镜 解剖 

分 类 号：R653[医药卫生—外科学]