本文選題：蝶腭動脈 + 篩前動脈　； 參考：《南華大學》2012年碩士論文

【摘要】：目的： 通過對蝶腭孔的位置和蝶腭動脈分支在鼻腔外側壁的穿出點進行觀測，探討傳統(tǒng)中鼻道入路蝶腭動脈結扎術的不足；通過觀測鼻后外側動脈分支在鼻腔外側壁的分布，探討下鼻甲動脈電凝的可行性；通過對篩動脈的解剖和臨床資料的研究與分析，探尋一種可供選擇的結扎術式。 材料和方法： 1.干性半側顱骨50例。16具頭頸部標本，其中12具防腐標本，4具為新鮮標本。臨床資料（影像，內鏡）。 2.干性半側顱骨標本50例，觀察蝶腭孔的位置，測量蝶腭孔的相關數據，測量篩前孔至鼻前棘的距離及其連線與鼻底的夾角。 3．16具防腐和新鮮頭部標本灌注后，其中10具行正矢中狀切，5具沿中鼻甲后端平面行冠狀切，1具新鮮標本用于制作鑄型。 4.在20側頭部正中矢狀切標本上，對鼻腔外側壁結構進行解剖，測量鼻后外側動脈穿出點至上頜竇自然口、至鼻后孔、至中鼻甲后端的距離；測量鼻后中隔動脈穿出點至中鼻甲后端水平距離和垂直距離、及至中鼻甲附著部的距離。觀察鼻后外側動脈在中鼻道的分支分布，測量下鼻甲動脈起點至中鼻甲附著部、下鼻甲附著部的垂直距離，至中鼻甲后端附著部、下鼻甲后端附著部的水平距離（在下鼻甲附著部的水平測量），至上頜竇自然口的距離。在5具冠狀切的標本，充分顯露蝶竇前壁，測量鼻后中隔動脈上、下支至蝶竇口的垂直距離及其外徑；去除眶頂和篩頂，充分顯示篩前動脈主干走行。 5.觀察鑄型標本中蝶腭動脈分支和篩動脈的主干走行。 6.分析臨床典型內鏡和影像資料。 結果： 1.蝶腭孔的位置：第一類：蝶腭孔位于中鼻道和后鼻道后部的移行區(qū)域，38例占76%，，其前緣的中部與篩嵴后端接觸；第二類：蝶腭孔緊鄰篩嵴且位于其后上，12例占24%。蝶腭孔相關數據測量：篩嵴至鼻前棘的距離：54.15±7.82mm；篩嵴至前鼻棘的連線與鼻底的夾角：(21.4±3.6)°；篩嵴至下鼻甲水平部的距離：13.11±2.12mm；篩嵴至腭骨水平板的距離：18.27±1.13mm。 2.蝶腭動脈分支穿出點的相關數據測量：鼻后外側動脈穿出點至上頜竇自然口的距離：21.60±3.03mm；至鼻后孔的距離：9.41±2.05mm；至中鼻甲后端的距離：8.21±1.74mm。鼻后中隔動脈穿出點至中鼻甲后端水平距離：7.72±2.04mm；至中鼻甲后端的垂直距離：8.11±2.45mm；至中鼻甲附著部的距離：4.31±1.69mm。相對于中鼻甲在鼻腔外側壁的附著部而言，鼻后中隔動脈穿出點均較恒定的位于其后上方。鼻后中隔動脈上、下支至蝶竇口的垂直距離及其外徑：上支距蝶竇口的距離：8.50±0.20mm；下支距蝶竇口的距離：13.22±0.30mm；上支外徑：0.93±0.06mm；下支外徑：1.01±0.21mm。 3.在20側標本中，有19例（95%），其鼻后外側動脈分為中鼻甲動脈和下鼻甲動脈兩個分支，分別供應中鼻甲、下鼻甲，僅有1例標本（5%）的鼻后外側動脈發(fā)出三個分支，即兩支下鼻甲動脈，一支為中鼻甲動脈；鼻后外側動脈在鼻腔外側壁發(fā)出分支的高度也不盡相同，近端分叉和遠端分叉分別占95%(19例)和5%（1例）；在12例（60%）標本中觀測到上頜竇后囟支，其中起源于中鼻甲動脈的為10例，起源于下鼻甲動脈的為2例。在3例（15%）標本中，可見腭降動脈的分支從后面加入到下鼻甲動脈；下鼻甲動脈起點的相關數據測量：下鼻甲動脈起點到中鼻甲附著部的垂直距離：2.50±1.22mm;下鼻甲動脈起點到下鼻甲附著部的垂直距離:9.50±2.10mm;下鼻甲動脈起點到中鼻甲后端附著部的距離:8.21±2.80mm;下鼻甲動脈起點到下鼻甲后端附著部的水平距離:9.20±1.82mm;下鼻甲動脈起點到上頜竇自然口的距離:20.22±3.01mm。 4.篩前動脈主干穿過三個腔：眼眶、篩竇、顱前窩，該血管在篩竇內呈水平位向前內走行，于嗅窩前部穿入鼻腔。篩動脈竇內段部分緊貼篩頂走行，部分離篩頂有一段距離。篩前孔到鼻前棘的距離為58.13±4.01mm,篩前孔至鼻前棘連線與鼻底的夾角為(65.5±4.5)°。 結論： 1．通過兩步法分別結扎蝶腭動脈兩主干是一種可供選擇的方法。 2．下鼻甲手術前為減少術中出血，可在下鼻甲后端前上1cm左右，靠經下鼻甲附著部電凝下鼻甲動脈。 3．沿眶紙板鼻腔側和篩頂的夾角區(qū)域尋找結扎篩動脈是一種可以嘗試的方法。
[Abstract]:Objective:
Through the observation of the location of the sphenopalatine hole and the perforating point of the sphenopalatine artery in the lateral wall of the nasal cavity, the shortcomings of the traditional transsphenoidal ligation of the sphenopalatine artery were discussed. The feasibility of the electrocoagulation of the inferior turbinate artery was explored by observing the distribution of the lateral nasal lateral artery in the lateral wall of the nasal cavity, and the anatomical and clinical data of the sifted artery were analyzed. Research and analysis to explore an alternative way of ligation.
Materials and methods:
1. 50 cases of dry half side skull were.16 with head and neck specimens, 12 of them were anticorrosive specimens, 4 were fresh specimens. Clinical data (imaging, endoscopy).
2. the 50 cases of dry semi cranial bone specimens were used to observe the location of the sphenopalatine foramen and the related data of the sphenopalatine holes. The distance between the anterior sieves and the anterior nasal spines and the angle between the line and the bottom of the nose were measured.
After perfusion of 3.16 anticorrosive and fresh head specimens, 10 of them were cut in the middle of the normal vector, and 5 were cut along the posterior end of the middle turbinate, and 1 fresh specimens were used to make the cast.
4. on 20 sides of the median sagittal section of the head, the structure of the lateral nasal wall was dissected, and the distance from the posterior nasal cavity to the natural mouth of the maxillary sinus, to the posterior nasal hole and to the posterior end of the middle turbinate was measured; the distance from the posterior nasal septum to the posterior nasal turbinate and the distance to the attachment of the middle turbinate was measured. The branches of the posterolateral artery were distributed in the middle nasal canal, measuring the distance between the starting point of the inferior turbinate artery to the attachment of the middle turbinate, the vertical distance of the inferior turbinate attachment, the attachment of the posterior turbinate, the horizontal distance of the posterior inferior turbinate attachment part (level at the inferior turbinate attachment part), the distance from the maxillary sinus natural mouth. The 5 coronoid specimens were fully demonstrated. The anterior wall of the sphenoid sinus is used to measure the vertical distance and the outer diameter of the superior septal artery, the lower branch of the nasal septum to the mouth of the sphenoid sinus, and the removal of the orbital top and the ethmoid top, which fully displays the main artery of the anterior ethmoid artery.
5. to observe the branches of the sphenopalatine artery and the ethmoidal artery in cast specimens.
6. analysis of typical clinical endoscopy and imaging data.
Result錛

本文編號：1984696