中鼻道上颌窦内窥镜开窗术相关的断层解剖研究及临床.docVIP

　　中鼻道上颌窦内窥镜开窗术相关的断层解剖研究及临床 【摘要】 目的 为上颌窦内窥镜开窗术提供相关断层解剖学参数。方法 对30个（60侧）成人干性颅骨标本进行切片,10个行矢状面切片，10个行水平面切片,10个行冠状面切片。观察上颌窦口的形态，测量上颌窦口及其毗邻结构的相关数据,并对所得结果进行统计学分析。结果 ①矢状面上，上颌窦口位于上颌窦的内侧壁，为不规则的四边形。上颌窦口最高点高于或平行于通过眶底最低处的水平面；在矢状位上，80％（16/20）上颌窦口与眶底板同处一垂面。钩突位于鼻泪管后内侧，其游离缘中上部距鼻泪管后壁较近，平均值为3.3 mm左右；②水平面上，骨性上颌窦口的前后径为18.24±2.28 mm；其前界与鼻泪管后壁的距离为2.96±0.87 mm，鼻泪管后壁的厚度为0.24±0.13 mm。③冠状面上,上颌窦口的上下径为10.64±2.48 mm，上颌窦口上界至眶下壁与上颌窦内壁交界处的距离为3.12±0.63 mm，眶下壁的厚度为2.12±0.83 mm.结论 骨性上颌窦口与眶底和骨性鼻泪管后壁关系密切，内窥镜下中鼻道行上颌窦开窗，扩大窦口的安全方向为向下和向后，向前向上咬除至骨质时应当停止，避免损伤眶底和鼻泪管等并发症的发生。 【关键词】 上颌窦 上颌窦口 断层解剖 内窥镜开窗术 Abstract：Objective To provide sectional anatomy mutuality parameter for maxillary sinus endoscopic fenestration.Methods 30 dry skull species(60 sides) of maxillary sinus.ostium of maxillary sinus and its adjacent structures easured,the results of the test of maxillary sinus like irregular quadrilaterals edial axillary sinus.The highest point of the ostium of maxillary sinus of maxillary sinus and orbital lamina situated at the same level edial of the nasolacrimal duct.The average distance from the upper part of the margin of the Uncinate Process to the posterior al duct m;②On horizontal plane,anteroposterior diameter of bony ostium of maxillary sinus m,the distance from its anterior boundary to posterior al duct m,the thickness of the posterior al duct m.③On coronal plane,the vertical height of the ostium of maxillary sinus m，the distance of the superior boundary of the ostium of maxillary sinus to the junction of the orbital floor edialaxillary sinus m，the thiess of the orbital floor m.Conclusion There are intimate relationships among the bony ostium of maxillary sinus,the orbital floor and nasolacrimal duct,Fenestration Operation of maxillary sinus Under Endoscopein Middle Meatus,the safty direction of ostium enlarge al duct. Key axillary sinus;ostium of maxillary sinus;sectional anatomy;endoscopic fenestration 随着鼻窦内窥镜手术的广泛开展，经中鼻道上颌窦开窗，重建上颌窦的通气和引流，已经成为治疗上颌窦炎的主要措施［1,2］。有资料报道该手术易引起眶底及鼻泪管损伤，造成眼眶内出血、眼压增高及泪液渗漏等并发