眶上切迹指引下内镜经眶径路额窦手术的解剖学研究  

Endoscopic transorbital frontal sinus surgery guided by supraorbital notch:An anatomical study

作　　者：王奎吉[1,2] 赵国强 王平 王成硕 张罗[1,2,3,4] WANG Kuiji;ZHAO Guoqiang;WANG Ping;WANG Chengshuo;ZHANG Luo(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China;Beijing Laboratory of Allergic Diseases,Beijing Key Laboratory of Nasal Diseases,ResearchUnit of Diagnosis and Treatmentof Chronic Nasal Diseases,Chinese Academy of Medical Sciences,Bejing,100005,China;Beijing Institute of Otolaryngology,Bejing,100005,China;Department of Allergy,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China)

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,北京100730 [2]过敏性疾病北京实验室,鼻病研究北京市重点实验室,中国医学科学院慢性鼻病诊疗策略研究创新单元,北京100005 [3]北京市耳鼻咽喉科研究所,北京100005 [4]首都医科大学附属北京同仁医院鼻过敏科,北京100730

出　　处：《中国耳鼻咽喉头颈外科》2022年第8期516-520,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家杰出青年科学基金项目计划(82025010);教育部长江学者创新团队(IRT13082);中国医学科学院医学与健康科技创新工程项目资助(2019-I2M-5-022);北京市科技计划首都健康保障培育研究项目(Z181100001618002)。

摘　　要：目的 探讨眶上切迹(孔)引导下内镜经眶径路额窦手术的解剖学径路。方法 50例干颅骨标本,观察眶上切迹(孔)的形态,测量其距面中线的距离;解剖5例(10侧)额窦发育良好的尸头标本,定位眶上切迹(孔)后行眶上缘皮肤切口,分离并保护眶上神经血管束,磨除部分眶顶壁骨质(额窦底壁)进入额窦,观察额窦暴露范围。结果 50例(100侧)颅骨标本中,表现为单个眶上切迹48侧(48%),单个眶上孔25侧(25%),表现为切迹与孔混合形式27侧(27%)。眶上切迹(孔)至面中线距离为(2.66±0.22)cm(95%CI:2.61~2.70 cm),右侧眶上切迹(孔)距面中线距离为(2.65±0.25)cm,左侧眶上切迹(孔)距面中线距离为(2.66±0.19)cm,双侧比较无统计学差异(t=0.17,P=0.86)。所有尸头标本均可准确定位眶上切迹(孔),眶上神经血管束保护良好,内镜下经眶磨除部分额窦底壁可顺利进入额窦,暴露范围向内侧达额窦中隔,向外侧达额窦外侧隐窝。结论 对于气化良好的额窦,以眶上切迹(孔)为指引的内镜经眶径路可以安全进入额窦,充分显露额窦腔。OBJECTIVE Aimed to explore endoscopic transorbital frontal sinus approach using supraorbital notch(foramen) as anatomical landmarks.METHODS The topographical anatomy of supraorbital notch(foramen) in 50 dry skulls was studied and the distance from supraorbital notch(foramen) to the facial midline was measured.Five cadaveric head specimens(10 sides) were dissected.The supraorbital notch(foramen) was located and then an incision was performed medial to the supraorbital notch(foramen) in supraorbital margin.The supraorbital neurovascular bundle was identified and preserved.Part of the orbital roof(frontal sinus floor) was removed using diamond burr for providing adequate visualization and access of the frontal sinus.RESULTS Of the 50 skull specimens(100 sides),48 sides(48%) were present as a single supraorbital notch,25 sides(25%) as a single supraorbital foramen,and 27 sides(27%) showed a mixed form of notch and foramen.The average distance from the supraorbital notch(foramen) to the facial midline was (2.66±0.22)cm (95%CI:2.61-2.70 cm) with no statistical difference between the two sides(t=0.17,P=0.86).The supraorbital notch(foramen) could be accurately located in all cadaver head specimens.Endoscopic removing of part of the frontal sinus floor leaded to access into the frontal sinus and the supraorbital neurovascular bundle was preserved.The exposed area reached the medial septum and the lateral recess of the frontal sinus.CONCLUSIONEndoscopic transorbital approach guided by supraorbital notch(foraman) provides excellent and safe access to frontal sinus for accessing the frontal sinus boundary.

关 键 词：内窥镜检查 额窦 眼眶 解剖学 

分 类 号：R762[医药卫生—耳鼻咽喉科]