滑车上动脉和眶上动脉定位在内外联合径路额窦内镜手术中的应用  

Application of locating supratrochlear artery and supraorbital artery in combined transfrontal and intranasal endoscopic approaches

作　　者：陈志鹏 吴喜福[2] 郑博文[3] 陈其龙 袁田 郑瑞[2] 陈靖媛 孔维封 吴硕 康庄[3] 任杰[4] 杨钦泰[2] Chen Zhipeng;Wu Xifu;Zheng Bowen;Chen Qilong;Yuan Tian;Zheng Rui;Chen Jingyuan;Kong Weifeng;Wu Shuo;Kang Zhuang;Ren Jie;Yang Qintai(Department of Ophthalmology and Otorhinolaryngology,the Second People′s Hospital of Longgang District,Shenzhen 518112,China;Department of Otorhinolaryngology Head and Neck Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Ultrasonography,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Radiology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]深圳市龙岗区第二人民医院眼耳鼻喉科,深圳518112 [2]中山大学附属第三医院耳鼻咽喉头颈外科,广州510630 [3]中山大学附属第三医院超声科,广州510630 [4]中山大学附属第三医院放射科,广州510630

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第8期931-936,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(U20A20399,81870704);广东省重点领域研发计划(2020B0101130015);中山大学临床医学研究5010计划(2019006)。

摘　　要：目的探讨滑车上动脉(supratrochlear artery,STA)和眶上动脉(supraorbital artery,SOA)的定位方法,及通过血管定位伴行神经在额窦内外联合径路手术中的应用价值。方法选取2019年6月至2021年5月在中山大学附属第三医院耳鼻喉头颈外科住院接受内外联合径路额窦手术的14例患者,其中男11例,女3例,年龄18~69岁。术前分别通过彩色多普勒血流成像(color doppler flow imaging,CDFI)、CT血管成像(CTA)、对比增强磁共振血管成像(contrast enhanced magnetic resonance angiography,CE-MRA)3种方法进行STA和SOA定位,同时测量28侧别眉毛处STA、SOA与面正中线的距离。根据术前定位的STA和SOA确定外切口位置,并记录3种方法的检查用时、费用等指标和术后并发症。手术验证14侧别定位的准确性。使用GraphPad Prism 8.3软件进行统计学分析。结果CDFI、CTA、CE-MRA均可定位STA和SOA,3种方法测量的眉毛处STA、SOA与面正中线的距离差异无统计学意义(P值均>0.05)。可根据定位结果确定外径路切口位置以保护相应血管及伴行神经,患者术后均无前额皮肤麻木等并发症。CDFI、CTA和CE-MRA检查用时分别为22.50(15.75,30.00)、30.00(28.00,34.25)和48.00(44.00,52.75)min[M(Q_(1),Q_(3))],组间差异有统计学意义(P值均<0.05)。CDFI费用最低,用时最短。结论CDFI是高效、经济的STA和SOA定位方法。该定位有利于外径路切口位置的精确选择,可保护伴行神经,减少手术并发症。Objective To investigate the localization methods of supratrochlear artery(STA)and supraorbital artery(SOA),and to explore the clinical benefit of locating nerve via accompanying vascular localization in combined transfrontal and intranasal endoscopic approaches.Methods From June 2019 to May 2021,14 patients,including 11 males and 3 females,aging from 18 to 69 years old,were underwent frontal sinus surgery through the combined transfrontal and intranasal endoscopic approaches in the Department of Otorhinolaryngology Head and Neck Surgery of the Third Affiliated Hospital of Sun Yat-sen University.Before the surgery,localization of STA and SOA was determined by color doppler flow imaging(CDFI),computerized topographic angiography(CTA)and contrast enhanced magnetic resonance angiography(CE-MRA)respectively,and the distances between STA and SOA from facial midline were measured on 28 eyebrows.The position of external incision was determined according to the preoperative localization of STA and SOA.The examination time,cost and postoperative complications of the three methods were recorded.The accuracy of localization at 14 sides was verified by the surgery.GraphPad Prism 8.3 software was used for statistical analysis.Results STA and SOA could be located by CDFI,CTA and CE-MRA.There was no significant difference in the measurement of the distance between STA and SOA from the facial midline among 3 methods(all P>0.05).Determining the position of external incision according to the localization of STA and SOA could protect both the blood vessels and accompanying nerves.No postoperative complications such as numbness of the forehead skin occurred.The measurement time of CDFI,CTA and CE-MRA was 22.50(15.75,30.00),30.00(28.00,34.25)and 48.00(44.00,52.75)min(M(Q_(1),Q_(3))),respectively(all P<0.05).CDFI incurred the lowest costs and took the shortest time.Conclusions CDFI is an efficient and economic localization method.The localization of STA and SOA facilitates the precise selection of the position of external incision,pro

关 键 词：额窦 内镜 耳鼻喉外科手术 并发症 滑车上动脉 眶上动脉 

分 类 号：R762[医药卫生—耳鼻咽喉科]