内镜下经口翼下颌皱襞内侧入路颈静脉孔区解剖学研究  

Endoscopic transoral⁃medial pterygomandibular fold approach anatomic study for jugular foramen

作　　者：李静[1] 张焕康 刘全 顾晔 薛凯 孙希才 余洪猛 LI Jing;ZHANG Huan-kang;LIU Quan;GU Ye;XUE Kai;SUN Xi-cai;YU Hong-meng(Department of Otolaryngology,Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310006,Zhejiang,China;Department of Otolaryngology,Eye&ENT Hospital of Fudan University,Shanghai 200126,China;Department of Neurosurgery,Eye&ENT Hospital of Fudan University,Shanghai 200126,China;Department of Otolaryngology,People's Hospital of Shigatse,Shigatse 857012,Xizang,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院耳鼻咽喉科,310006 [2]复旦大学附属眼耳鼻喉科医院耳鼻喉科,上海200126 [3]复旦大学附属眼耳鼻喉科医院神经外科,上海200126 [4]西藏自治区日喀则市人民医院耳鼻喉科,857012

出　　处：《中国现代神经疾病杂志》2023年第7期591-598,共8页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨内镜下经口翼下颌皱襞内侧入路进入颈静脉孔区的解剖步骤,分析其临床施行之可行性。方法与结果于复旦大学附属眼耳鼻喉科医院鼻颅底肿瘤外科治疗技术创新单元解剖实验室以5具(10侧)尸头标本作为研究对象,模拟经口翼下颌皱襞内侧入路进入颈静脉孔区及其相邻结构的解剖步骤,观察并描述重要解剖标志。(1)颈静脉孔区解剖步骤:首先通过翼下颌皱襞内侧切口切开软腭黏膜、咽上缩肌进入咽旁前间隙,剔除间隙内脂肪组织,显露茎突咽筋膜和茎突肌群,切除茎突咽筋膜后进入咽旁后间隙,进一步显露颈内动脉并进入颈静脉孔区。(2)颈静脉孔及其毗邻解剖结构:颈静脉孔上界为颈静脉球窝,前方为颈内动脉,前外侧为茎突前外侧,后方为头外侧直肌、寰椎横突,内侧为舌下神经和枕髁内侧,外侧为乳突、二腹肌和面神经。结论经口翼下颌皱襞内侧入路进入颈静脉孔区视野良好,显露范围广泛,路径更短。Objective To investigate the endoscopic transoral⁃medial pterygomandibular fold approach anatomic procedures for jugular foramen,and to analyze the clinical feasibility of this approach.Methods and Results In the anatomical laboratory of the Surgical Treatment Technology Innovation Unit of Nasal Skull Base Tumor in Eye&ENT Hospital of Fudan University,a total of 5 specimens of necroheads(10 sides)were taken as research objects to simulate the anatomical steps of entering the jugular foramina and its adjacent structures through the oral pterygomandibular fold medial approach,and observe and describe important anatomical markers.1)Anatomical procedures of the jugular foramen:firstly,the soft palate mucosa and suprapharyngeal retractive muscle were cut through the medial incision of pterygomandibular fold to enter anterior parapharyngeal space,the adipose tissue in the space was removed,and the stylopharyngeal fascia and stylopharyngeal muscle group were exposed.After the stylopharyngeal fascia was removed,the internal carotid artery(ICA)was further exposed and the jugular foramen was exposed.2)The jugular foramen and its adjacent anatomical structures:the upper boundary of the jugular foramen was jugular bulbous fossa,the anterior was ICA,the anterolateral lateral was styloid process,the posterolateral boundary was the lateral rectus of head and transverse process of atlas,the medial boundary was the hypoglossal nerve and medial of occipital condyle,and the lateral boundary was the mastoid,digastric and facial nerves.Conclusions Endoscopic transoral⁃medial pterygomandibular fold approach for jugular foramen has better visual field,wider exposure range and shorter path.

关 键 词：颈静脉孔 咽旁间隙 内窥镜检查 尸体解剖 

分 类 号：R323[医药卫生—人体解剖和组织胚胎学]