经岩骨迷路后乙状窦前入路的评价  

Evaluation of Tanspetrosal Postlabyrithine Presigmoid Approach

作　　者：彭翔[1] 夏勤学[1] 蔡润[1] 周勇[1] 朱炎昌[2] 

机构地区：[1]东风公司总医院神经外科,十堰442008 [2]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《华中科技大学学报（医学版）》2003年第3期303-305,308,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的　对到达小脑桥脑角区及岩斜区的一种手术入路方式 ,即经岩骨迷路后乙状窦前入路进行评价。方法用正常成人尸体头颅标本按照经岩骨迷路后乙状窦前入路途径手术操作步骤进行解剖学研究 ,借助内窥镜技术对操作过程各层次中的组织解剖结构进行细微观察 ,并与枕下入路及经岩骨迷路后乙状窦后入路进行了比较分析。结果　经岩骨迷路后乙状窦前入路到达内耳孔的最近距离为 (19 18± 0 6 5 )mm ,小脑被牵离岩骨面的最大距离为 (13 96±1 0 4 )mm ,操作角度为 (11 4 1± 0 6 2 )°,经岩骨迷路后乙状窦后入路途径的相应指标为 (37 74± 1 11)mm、 (2 5 91±0 95 )mm、 (16 72± 0 75 )°,常规枕下入路途径的相应指标为 (49 95± 2 5 3)mm、 (34 94± 0 5 9)mm、 (2 3 0 9±0 5 7)°。与后 2种手术入路相比 ,前者操作距离明显缩短 (P <0 0 5 ) ,小脑被牵离的程度明显减小 (P <0 0 5 ) ,术者对小脑桥脑角区的血管、神经及脑干前外侧面的结构能直接清晰观察 ,静脉窦损伤可能性小。结论　经岩骨迷路后乙状窦前入路与传统入路比较具有优势 。Objective To evaluate the operative approach of transpetrosal postlabyrinthine presigmoid to cerebellopontine angle. Methods The anatomy of transpetrosapostlabyrinthine presimoid approach in the adult cadaveric head specimen was studied and the anatomical structure of different layers was observed with the aid of endoscopy and compared with that of suboccipital approach and postlabyrinthine postsigmoid approach. Results The shortest distance to inner ear hole on transpetrosal postlabyrinthine presigmoid approach was (19.18±0.65) mm, the longest distance the cerebellum could be raised was (13.96±1.04) mm and the operation angle was (11.41±0.62)°, but correspondingly they were (37.74±1.11) mm, (25.91±0.95) mm, (16.72±0.75)° on postlabyrinthine postsigmoid approach and (49.95±2.53) mm, (34.94±0.59) mm, (23.09±0.57)° on suboccipital approach, respectively. Compared with the latter two approaches, transpetrosal postlabyrinthine presimoid approach could shorten the operative distance (P<0.05) and decrease the extent of the cerebellum being pulled (P<0.05) and the possibility of injuring venous sinus obviously. The neurosurgeon could see the blood vessel, nerve of the cerebellopontine angle and anterior-lateral structure of brain stem distinctively. Conclusion The transpetrosal postlabyrinthine presigmoid approach is superior to the traditional approaches and is worthy of trying and studying further.

关 键 词：小脑桥脑角区 手术入路 经岩骨迷路后乙状窦前入路 解剖学 

分 类 号：R651[医药卫生—外科学]