鼻内镜下经鼻径路翼腭窝区临床解剖特点分析及意义.docVIP

鼻内镜下经鼻径路翼腭窝区临床解剖特点分析及意义 　　[摘要] 目的 分析探讨在翼腭窝区解剖中使用鼻内镜下经鼻径路的临床特点，为临床手术做出参考。 方法 随机选取50例该院附属医院的成人尸头标本，并将其用乳胶灌注，使用零度的鼻内镜经两种手术径路（上颌窦后壁径路和蝶腭孔径路）将翼腭窝显露，进一步将蝶窦开放，使蝶窦外侧壁、颈内动脉、视神经等充分暴露，对各结构之间的立体关系进行观察。 结果 不同的手术路径对翼腭窝的显露程度不同，蝶腭孔径路可以对蝶窦与翼腭窝的结构解剖关系进行观察，上颌窦后壁径路可以使翼腭窝内的结构最大限度的得以显露。 结论 在临床手术的过程中，要根据患者的具体情况，选择鼻内镜下的不同入路对翼腭窝区的疾病进行治疗。 　　[关键词] 鼻内镜；鼻径路；翼腭窝区；解剖特点 　　[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2016）02（b）-0081-02 　　[Abstract] Objective To analyze and discuss the clinical characteristics of the application of nasal approach under nasal endoscope in the anatomy of pterygopalatine fossa region and provide reference for clinical operation. Methods 50 cases of adult cadaver specimens in the affiliated hospital of our hospital were selected and perfused with emulsion， the pterygopalatine fossa was exposed by the application of two surgical approaches（maxillary sinus paries posterior approach and foramen sphenopalatinum approach ）under nasal endoscope at zero degree， the sphenoid sinus was further opened in order to make ostium of sphenoid sinus， internal carotid optic nerve fully exposed， the stereoscopic relation between each structure was observed. Results The exposure degree of pterygopalatine fossa was different by different surgical approaches， the anatomic relationship between sphenoid sinus and pterygopalatine fossa structure could be observed by foramen sphenopalatinum approach， structures in the pterygopalatine fossa could be exposed extremely by maxillary sinus paries posterior approach. Conclusion We should select different approaches under nasal endoscope in treatment of diseases in the pterygopalatine fossa region according to the patient’s specific condition during clinical operation. 　　[Key words] Nasal endoscope； Nasal approach； Pterygopalatine fossa region； Anatomical features 　　翼腭窝区位于颌面的深部，是眶尖后下方的一个狭小的骨性间隙，呈现倒置椎体型[1-2]。它的外壁是翼突上颌裂，内壁是腭骨垂直板，上壁为蝶骨体的下面，后壁为蝶骨翼突的根部，前壁为上颌窦的后壁。翼腭窝的前上方经眶下裂与眶内相互交通，向后经过翼管及圆孔与颅中窝相互交通，内侧经过蝶腭孔与鼻腔相互交通，外侧经过翼突上颌裂与鼻腔相互沟通，向下经过腭小孔及腭大孔与口腔相互交通。在临床对翼腭窝区