经鼻内镜下眼眶肌锥内间隙的解剖入路研究  

Endoscopic endonasal approach to intraconal space:a cadaveric study

作　　者：李立锋[1] 臧洪瑞[1] 韩德民[1] Ricardo L.Carrau LI Lifeng;ZANG Hongrui;HAN Demin;Carrau RL(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing,100730,China;Department of Otolaryngology Head and Neck Surgery,Wexner Medical Center at Ohio State University,Ohio,USA)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]俄亥俄州立大学维克斯纳医学中心耳鼻咽喉头颈外科,美国俄亥俄州

出　　处：《中国耳鼻咽喉头颈外科》2020年第2期63-66,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探索眼眶肌锥内间隙的解剖学关系,并评估经鼻肌锥内间隙手术入路的可行性。方法采用8个动静脉双灌注的新鲜尸头(共16侧)进行解剖学研究。在标本的一侧采用经筛窦入路,分别进行眼眶内上及内下肌锥内间隙的解剖;在另一侧采用经鼻泪前隐窝入路,分别进行内下及外下肌锥内间隙的解剖。比较两种入路对相应肌锥内间隙的暴露程度,以及各自的优缺点。结果经筛窦入路,去除眼眶下内壁的骨嵴,在下直肌与内直肌之间可以暴露眼眶内下肌锥内间隙;向内牵拉内直肌,可暴露内直肌上半部与视神经间的区域。在内直肌与上斜肌之间,可进入眼眶内上肌锥内间隙。经鼻泪前隐窝入路,能在直视下暴露眼眶内下肌锥内间隙,无需牵拉内直肌,且可保留眼眶内下壁骨嵴。向下移位眶下神经,沿着下直肌的外侧缘,可进入眼眶外下肌锥内间隙。结论经筛窦入路可暴露内上及内下肌锥内间隙,经泪前隐窝入路可显露内下及外下肌锥内间隙。本研究可为经鼻内镜下行眼眶肌锥内间隙内的病变切除提供解剖学参考。OBJECTIVE To assess the maximal exposure of intraconal space a via transnasal approach,and to highlight anatomical relationships of neurovascular structures in this space.METHODS Eight cadaveric heads(16 sides)were dissected using a transnasal approach.For each specimen,one side is used for transethmoidal approach,and the other side for prelacrimal approach.Through the transethmoidal approach,the superomedial and inferomedial intraconal spaces were explored;through the prelacrimal approach,the inferomedial and inferolateral intraconal spaces were explored.The advantages and drawbacks for each approach were compared.RESULTS Through transethmoidal approach,the corridor between the inferior and medial recti muscle was used as the avenue for exposure of inferomedial intraconal space;to access the region between the medial rectus muscle and optic nerve,the medial rectus muscle needs to be retracted;through the space between superior oblique and medial rectus muscle,the superomedial intraconal space could be accessed.Through the prelacrimal approach,the inferomedial intraconal space could be directly exposed,and the inferomedial orbital bony wall was preserved and the retraction of medial rectus muscle was avoided;after inferiorly displacement of inferior orbital nerve,the inferolateral intraconal space could be accessed along the lateral border of inferior rectus muscle.CONCLUSION The inferomedial and superomedial intraconal space could be accessed through transethmoidal approach;the inferomedial and inferolateral intraconal space could be exposed via prelacrimal approach.

关 键 词：眼眶 动眼肌 筛窦 解剖 肌锥内间隙 泪前隐窝 内直肌 下直肌 

分 类 号：R779.6[医药卫生—眼科]