以腭骨蝶突为标志的翼管神经切断术  

A vidian neurectomy approach with the sphenoid process of the palatine bone as a landmark

作　　者：赵可庆 蒋晓文 朱佳毅 孙希才 刘全 薛凯 余洪猛 ZHAO Keqing;JIANG Xiaowen;ZHU Jiayi;SUN Xicai;LIU Quan;XUE Kai;YU Hongmeng(Department of Otolaryngology,Eye&ENT Hospital,Fudan University,Shanghai,200031,China;Department of Otolaryngology,Huazhong University of Science and Technology Union Shenzhen Hospital;Department of Nursing,Eye&ENT Hospital,Fudan University,Shanghai;Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor,Chinese Academy of Medical Sciences)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科,上海200031 [2]华中科技大学协和深圳医院耳鼻咽喉科 [3]复旦大学附属眼耳鼻喉科医院护理部 [4]中国医学科学院内镜下鼻颅底肿瘤外科治疗技术创新单元

出　　处：《临床耳鼻咽喉头颈外科杂志》2022年第8期604-607,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：上海市“科技创新行动计划”自然科学基金项目(No:20ZR1410000);中国医学科学院医学与健康科技创新工程项目(No:2019-I2M-5-003);国家自然科学基金面上项目(No:81970856);上海市科学技术委员会科技创新行动计划临床医学项目(No:19411950600);上海市科学技术委员会科技创新行动计划基础研究项目(No:21JC1401100);复旦大学附属眼耳鼻喉科医院“双优”临床实验资助计划(No:SYB202009)。

摘　　要：目的探索一种以腭骨蝶突为标志,能够安全有效定位翼管神经并将其切断的手术方式。方法通过尸头解剖确认可有效定位翼管外口的手术标志,并验证利用确定的解剖标志在术中定位翼管神经的可行性。结果通过对5例(10侧)尸头解剖研究确定腭鞘管前口、腭鞘管后口、腭鞘管及翼突根部延续至鼻咽顶的骨嵴几个解剖标志可作为定位翼管神经的重要标志。应用以上解剖标志在10例难治性变应性鼻炎及血管运动性鼻炎患者中成功定位翼管神经并将其切断,1例患者术后出现短期单侧硬腭麻木的不良反应。结论腭鞘管前口、腭鞘管后口、腭鞘管及翼突根部延续至鼻咽顶的骨嵴可作为以腭骨蝶突为标志的翼管神经切断术的手术标志。Objective To explore a safe and effective surgical approach to locate and cut the vidian nerves with the sphenoid process of the palatine bone as a landmark.Methods The landmarks of locating the external opening of the vidian canal were confirmed by the dissection of the cadaveric heads,and the feasibility of locating the vidian nerves with the determined landmarks was verified during operation.Results The anatomical landmarks,which are the anterior opening of palatovaginal canal,the posterior opening of palatovaginal canal,palatovaginal canal and the nasal pharyngeal crest of the root of the pterygoid process can be used as the important landmarks of locating vidian nerve.In the cases of 10 patients with refractory allergic rhinitis and vasomotor rhinitis,the vidian nerves were successfully located and sectioned,and one patient was complicated with short-term unilateral palatal numbness after surgery.Conclusion The anterior opening of palatovaginal canal,the posterior opening of palatovaginal canal,palatovaginal canal and the nasal pharyngeal crest of the root of the pterygoid process can be used as surgical markers for vidian neurectomy with the sphenoid process of the palatine bone as landmarks.

关 键 词：翼管神经 腭骨蝶突 腭鞘管 鼻炎 变应性 血管运动型鼻炎 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]