發(fā)布時(shí)間：2018-01-15 09:03

  本文關(guān)鍵詞：迷路下入路內(nèi)聽(tīng)道及巖尖區(qū)手術(shù)的顯微解剖學(xué)研究　出處：《昆明醫(yī)學(xué)院》2009年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 迷路下進(jìn)路 顯微解剖學(xué) 內(nèi)聽(tīng)道 頸靜脈孔 高分辨率CT(HRCT)

【摘要】： 【目的】本研究通過(guò)在尸頭上模擬耳后經(jīng)迷路下徑路暴露內(nèi)聽(tīng)道、巖尖區(qū)各結(jié)構(gòu),提供解剖學(xué)依據(jù),并結(jié)合影像學(xué)檢查結(jié)果,通過(guò)二者的對(duì)比定量研究此區(qū)各重要結(jié)構(gòu)的形態(tài)特征,總結(jié)此區(qū)重要血管神經(jīng)的走行規(guī)律及變異,并探討該術(shù)式及改良術(shù)式的優(yōu)越性和安全性,為臨床手術(shù)提供參考依據(jù)。 【方法】對(duì)20例成人頭顱標(biāo)本行高分辨率CT雙側(cè)顳骨薄層掃描并測(cè)量相關(guān)數(shù)據(jù),觀察乳突氣房的氣化程度、范圍以及頸靜脈球窩、乙狀竇的情況等。全部數(shù)據(jù)均攝片留存。然后在顯微鏡下模擬迷路下徑路及改良徑路暴露內(nèi)聽(tīng)道、巖尖區(qū)、頸靜脈球及頸靜脈孔區(qū),完成該區(qū)內(nèi)各重要解剖結(jié)構(gòu)的測(cè)量和拍攝。 【結(jié)果】1.影像測(cè)量與實(shí)際解剖測(cè)量結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 2.①迷路下入路骨質(zhì)磨除范圍的形態(tài)和面積個(gè)體差異較大,6側(cè)由于頸靜脈球頂緊貼甚至高于后半規(guī)管下弓峰,不能完成迷路下入路手術(shù)。②迷路下手術(shù)入路與水平半規(guī)管呈28.42°±2.64°(25.78°～31.06°),經(jīng)迷路下徑路開(kāi)放內(nèi)聽(tīng)道的可能性為85%(34/40)。③能經(jīng)迷路下入路暴露內(nèi)聽(tīng)道的標(biāo)本乳突氣化都較良好,且大多存在迷路下氣房。④迷路下入路骨質(zhì)磨除范圍以面神經(jīng)垂直段至乙狀竇中段距離為橫徑,距離平均為6.84 mm;以后半規(guī)管至頸靜脈球頂距離為縱徑,距離平均為4.56mm,它是迷路下手術(shù)入路的決定性參數(shù)。⑤改良后的迷路下徑路使開(kāi)放內(nèi)聽(tīng)道的可能性變?yōu)?0%(36/40),而且術(shù)野更加寬敞。 【結(jié)論】1.CT掃描測(cè)量與實(shí)際解剖測(cè)量結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),所以術(shù)前顳骨CT薄層掃描可以指導(dǎo)術(shù)中安全有效地磨除巖骨。 2.經(jīng)迷路下入路手術(shù)及改良術(shù)式切除內(nèi)聽(tīng)道、巖尖病變能夠保護(hù)半規(guī)管、迷路不受損傷,保存聽(tīng)力和前庭功能,是一個(gè)具有臨床應(yīng)用意義的手術(shù)途徑。采用切除后半規(guī)管弓的改良術(shù)式,使術(shù)野上方的操作空間相對(duì)擴(kuò)大,從而盡量避開(kāi)對(duì)頸靜脈球的損傷,使迷路下進(jìn)路的適應(yīng)證進(jìn)一步擴(kuò)大。 3.經(jīng)迷路下入路手術(shù)易受乙狀竇前置、高位頸靜脈球、迷路下氣化不良等的影響,常會(huì)導(dǎo)致手術(shù)視野狹小、操作困難。因此,我們應(yīng)全面掌握各結(jié)構(gòu)間的各種關(guān)系,結(jié)合手術(shù)前詳盡的影像學(xué)檢查,以制定合理的手術(shù)入路。
[Abstract]:[objective] to provide anatomical basis by simulating the structure of internal auditory canal and petrous apical region through the sublabyrinthine approach on the cadaveric head, and combined with the results of imaging examination. The morphological characteristics of each important structure in this area were studied quantitatively by comparing the two methods, and the rule and variation of the important vessels and nerves in this area were summarized, and the superiority and safety of the operation and the modified operation were discussed. To provide reference for clinical operation. [methods] Twenty adult head specimens were scanned with high resolution CT on bilateral temporal bone and relevant data were measured to observe the degree of vaporization of mastoid gas chamber and its scope and jugular fossa. The sigmoid sinus and so on. All the data were taken. Then the inferior labyrinthine pathway and the modified pathway were simulated under the microscope to expose the internal auditory canal, petrous apical region, jugular bulb and jugular foramen area. The important anatomical structures in the area were measured and photographed. [results] 1. There was no significant difference between image measurement and actual anatomical measurement (P 0.05). 2.1 individual differences in the shape and area of bone removal area in the sublabyrinthine approach were significant in 6 sides because the top of the bulb of jugular vein was close to or even higher than the peak of the arch under posterior semicircular canal. 2 Sublabyrinthine approach and horizontal semicircular canal were 28.42 擄鹵2.64 擄(25.78 擄鹵31.06 擄). The possibility of opening the internal auditory canal via the sublabyrinthine pathway is that 85 / 34 / 40.3 of the specimens exposed to the internal auditory canal via the sublabyrinthine approach have better mastoid gasification. In most cases, the distance from vertical segment of facial nerve to middle part of sigmoid sinus was transverse diameter, and the average distance was 6.84 mm. The distance from the posterior semicircular canal to the apex of jugular vein was longitudinal diameter, and the average distance was 4.56 mm. It is the decisive parameter of the sublabyrinthine approach. 5 the modified sublabyrinthine approach makes the possibility of opening the internal auditory canal 90 / 36 / 40, and the surgical field is more spacious. [conclusion] 1. There is no significant difference between CT scanning and actual anatomical measurement. Therefore, thin slice CT scanning of temporal bone before operation can be used to guide the removal of petrosal bone safely and effectively. 2. 2.Translabyrinthine approach and modified resection of the internal auditory canal showed that the lesion of the petrous apex could protect the semicircular canal, prevent the labyrinth from being damaged, and preserve the hearing and vestibular function. It is a clinical application of the surgical approach. The posterior semicircular canal arch resection of the modified operation, so that the operation space above the field is relatively expanded, so as to avoid the injury to the jugular bulb as far as possible. The indications of the sublabyrinthine approach are further expanded. 3.Translabyrinthine approach is easy to be affected by sigmoid sinus anterior position, high jugular bulb and poor sublabyrinthine vaporization, which often leads to narrow visual field and difficult operation. We should master all kinds of relationships between different structures and make reasonable operative approach with detailed imaging examination before operation.
【學(xué)位授予單位】：昆明醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類號(hào)】：R322

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