内镜下经鼻至岩尖区的临床应用解剖学研究  

Nose to Petrous Apex: Practical Anatomy for Endonasal Endoscopic Approach

作　　者：曾宪海 徐敏 李娟娟 赵海亮 邱书奇 ZENG Xianhai;XU Min;LI Juanjuan;ZHAO Hailiang;QIU Shuqi(Department of Otolaryngology,Longgang E.N.T hospital,Shenzhen Key Laboratory of Otolaryngology,Institute of Otolaryngology,Shenzhen,518172,China;Zunyi Medical University Zhuhai,Zhuhai,519041,China)

机构地区：[1]深圳市龙岗区耳鼻咽喉医院耳鼻咽喉科、深圳市耳鼻咽喉研究所 [2]遵义医科大学珠海校区

出　　处：《中华耳科学杂志》2019年第4期541-545,共5页Chinese Journal of Otology

摘　　要：目的通过对岩尖区及其周围结构的解剖学研究,为临床内镜下经鼻至岩尖区的手术提供解剖学依据。方法:选取5例新鲜成人灌注尸头标本和10例干性成人颅骨标本,分别进行内镜解剖研究和骨性颅底解剖结构测量。(1)在5例(10侧)新鲜成人灌注尸头标本上行内镜下经鼻至岩尖区的解剖暴露观察;(2)在10例(20侧)干性成人尸头标本上进行颅底岩尖区周围解剖标志的辨认,并从颅底外面观分别测量两侧卵圆孔內缘、棘孔內缘、破裂孔內缘、破裂孔外缘、咽鼓管口、颈动脉管前界及后界的內缘至正中线的距离,进行左右侧对比及男性与女性之间的对比;测量前鼻棘至破裂孔前界、颈动脉管前界的距离。结果(1)通过对岩尖区进行内镜下及显微镜下解剖操作,辨认出岩尖区及其邻近重要结构、了解颈内动脉在岩尖区的走行,为临床内镜下经鼻至岩尖区的手术提供参考依据;(2)左右两侧卵圆孔內缘至正中线的距离分别为22.85±0.39mm、22.86±0.26mm,男性头颅与女性头颅的测量距离分别为23.01±0.24mm、22.70±0.33mm;左右两侧棘孔內缘至正中线的距离分别为30.79±0.32mm、30.69±0.71mm,男性头颅与女性头颅的测量距离分别为30.98±0.47mm、30.50±0.37mm;左右两侧破裂孔內缘至正中线的距离为11.88±0.20、11.80±0.36mm,男性头颅与女性头颅的测量距离分别为11.97±0.17mm、11.70±0.26mm;左右两侧破裂孔外缘至正中线的距离为19.59±1.03mm、19.52±1.15mm,男性头颅与女性头颅的测量距离分别为20.12±1.03mm、18.99±0.87mm;左右两侧咽鼓管口至正中线的距离为32.14±0.72mm、32.04±0.90mm,男性头颅与女性头颅的测量距离分别为32.54±0.61mm、31.64±0.76mm;左右两侧颈动脉管前界的內缘至正中线的距离为26.82±0.76mm、26.78±0.72mm,男性头颅与女性头颅的测量距离分别为27.22±0.56mm、26.38±0.64mm;左右两侧颈动脉管后界的內缘至正中线的距离为3Objective To study anatomy of the petrous apex and its surrounding structures to provide anatomical parameters for endonasal endoscopic approach to the petrous apex region.Method Five fresh adult cadaveric heads with color silicone injected vessels were used for endoscopic anatomy study and 10 dry skulls for measuring key ana-tomical landmarks of the petrous apex region.Endoscopic transnasal approach to the petrous apex region was simulated on the 5 fresh cadaveric heads(10 sides)and the 10 dry skulls(20 sides)were used for identification of important land-marks around the petrous apex and measurement of the distances from their medial border to the mid line including the foramen ovale,foramen spinosum,foramen lacerum,orifice of eustachian tube,carotid foramen.Measurements were compared between the two sides and between male and female specimens.Distance from the anterior nasal spine to the anterior border of the foramen lacerum and carotid foramen were also measured.Result(1)Important anatomical land-marks,including the course of internal carotid artery near the petrous apex,were successfully identified during endo-scopic and microscopic surgical simulations toward and around the petrous apex region.(2)In male and female speci-mens,the distance from the medial border to the mid line was 23.01±0.24 mm and 22.70±0.33 mm for foramen ovale(22.85±0.39 mm on left and 22.86±0.26 mm on right),30.98±0.47 mm and 30.50±0.37 mm for foramen spinosum(30.79±0.32 mm on left and 30.69±0.71 mm on right),and 11.88±0.20 mm and 11.80±0.36 mm for foramen lacerum(11.97±0.17 mm on left and 11.70±0.26 mm on right).In male and female specimens,the distance to mid line was 20.12±1.03 mm and 18.99±0.87 mm from the lateral border of foramen lacerum(19.59±1.03 mm on left and 19.52±1.15 mm on right),32.54±0.61 mm and 31.64±0.76 mm from the orifice of eustachian tube(32.14±0.72 mm on left and 32.04±0.90 mm on right),27.22±0.56mm and 26.38±0.64mm from the anteromedial border of carotid foramen(26.82±0.76 mm on left and 26

关 键 词：内镜 经鼻入路 岩尖区 解剖 

分 类 号：R764[医药卫生—耳鼻咽喉科]