發(fā)布時(shí)間：2018-03-07 12:13

  本文選題：鼻內(nèi)鏡　切入點(diǎn)：上頜竇　出處：《青島大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的：通過對(duì)鼻腔和上頜竇相關(guān)解剖結(jié)構(gòu)的觀測(cè),尋找影響鼻內(nèi)鏡下經(jīng)下鼻甲前入路的上頜竇手術(shù)視野的解剖學(xué)因素,以期求解決方法,為獲得滿意的手術(shù)視野提供指導(dǎo)。 方法：取30例(60側(cè))外觀無異常的經(jīng)10%福爾馬林固定的成人尸頭(男21例,女9例),依鼻內(nèi)鏡下經(jīng)中鼻道上頜竇手術(shù)的路徑,完成在尸頭標(biāo)本上的0°、30°鼻內(nèi)鏡下上頜竇觀察,確定視野盲區(qū)的存在；通過對(duì)尸頭標(biāo)本的解剖學(xué)觀測(cè),結(jié)合幾何光學(xué)理論,輔以CT掃描影像學(xué)研究,尋找影響手術(shù)視野的因素,從而確定獲得滿意手術(shù)視野的方法。按照該方法進(jìn)行尸頭標(biāo)本的鼻內(nèi)鏡上頜竇觀察,對(duì)其的可行性加以論證。 結(jié)果：①0°及30°鼻內(nèi)鏡下經(jīng)中鼻道徑路觀察上頜竇各解剖結(jié)構(gòu),部分結(jié)構(gòu)不能窺及,前者主要以前壁、底壁、內(nèi)側(cè)壁、頂壁前以及后外側(cè)壁前、下為主,后者主要以前壁、底壁、內(nèi)側(cè)壁為主。②螺旋CT解剖學(xué)測(cè)量：30例(60側(cè))標(biāo)本鼻淚管前界上端、中端、下端到上頜竇前壁與內(nèi)側(cè)壁交界的水平距離分別為0.00、2.17±1.02、3.33±1.03,鼻淚管前下到下鼻甲前緣的水平距離為4.91±0.53,到鼻底的垂直距離為17.01±0.63,左右側(cè)測(cè)量數(shù)據(jù)差別無統(tǒng)計(jì)學(xué)意義(p0.05)。③在尸頭標(biāo)本上對(duì)以上徑線進(jìn)行測(cè)量：鼻淚管前界上端、中端、下端到上頜竇前壁與內(nèi)側(cè)壁交界的水平距離分別為0.00、1.90±1.03、3.29±1.04；鼻淚管前下到下鼻甲前緣的水平距離為5.13±0.62,到鼻底的垂直距離為16.83±0.97,左右側(cè)測(cè)量數(shù)據(jù)差別無統(tǒng)計(jì)學(xué)意義(p0.05),應(yīng)用解剖學(xué)測(cè)量數(shù)據(jù)與影像學(xué)測(cè)量數(shù)據(jù)差別無統(tǒng)計(jì)學(xué)意義(p0.05)；④1000例(2000側(cè))正常成人上頜竇CT分析：根據(jù)上頜竇底部氣化程度分為3型,Ⅰ型662例,占66.20%,Ⅱ型265例占26.50%,Ⅲ型73例,占7.30%。30例(60側(cè))標(biāo)本中Ⅰ型23例,Ⅱ型6例,Ⅲ型1例。⑤0°和30°鼻內(nèi)鏡下鼻甲前入路行上頜竇手術(shù)可以獲得滿意的手術(shù)視野,其結(jié)果與中鼻道入路差別有統(tǒng)計(jì)學(xué)意義(p0.05)。去除的骨質(zhì)范圍：下鼻甲附著緣以上部分上下徑為9.43±1.27,前后徑由上往下分別為9.76±0.83、11.39±0.50、12.85±0.66,下鼻甲附著緣以下部分上下徑為13.52±0.83,前后徑由上往下分別為19.89±1.37、16.59±0.77、12.48±0.91。但有1例Ⅲ型上頜竇標(biāo)本其底壁不能完全觀察到。 結(jié)論：鼻內(nèi)鏡下下鼻甲前徑路行上頜竇手術(shù)視野較中鼻道徑路明顯擴(kuò)大,但有的個(gè)體仍有視野盲區(qū)存在,這與上頜竇氣化程度有關(guān),影像學(xué)檢查為手術(shù)擴(kuò)大視野提供方向。
[Abstract]:Objective: through the nasal cavity and maxillary sinus related anatomy and anatomy to find the factors that affect the endoscopic maxillary sinus surgery under the anterior turbinate, to seek solutions, to provide guidance for the surgical field was satisfactory.
Methods: 30 cases (60 sides) no abnormal appearance after 10% formalin fixed adult cadaveric heads (male 21 cases, female 9 cases), according to the endoscopic maxillary sinus surgery in the nasal route, completed in cadaveric head on 0 degrees, 30 degrees to observe the maxillary sinus under nasal endoscope. Determine the blind vision; through anatomic observation of cadaveric head specimens, combined with geometrical optics theory, the study combined with CT scan, find the influence factors of the operative field, so as to determine satisfactory surgical field. Observation of cadaveric head according to the method of endoscopic maxillary sinus, to demonstrate its feasibility.
Results: 0 degrees and 30 degrees in the endoscopic nasal meatus approach to observe the anatomical structure of the maxillary sinus, and the former part of the structure could not see, before the main wall, the bottom wall, medial wall and lateral wall of the top wall before and after, mainly, the latter mainly before the wall, the bottom wall, the inner wall. II. Spiral CT anatomical measurement: 30 cases (60 sides) were nasolacrimal duct before the top, in the end, end to the maxillary sinus and medial wall at the junction of the horizontal distance were 0.00,2.17 + 1.02,3.33 + 1.03, down to the nasolacrimal duct before the inferior turbinate front horizontal distance was 4.91 + 0.53, to the bottom of the vertical nose the straight distance is 17.01 + 0.63, left and right side measurements had no significant difference (P0.05). The measurement of the above line in cadaveric head: nasolacrimal duct before the upper circles, in the end, the lower end of the maxillary sinus and medial wall at the junction of the horizontal distance were 0.00,1.90 + 1.03,3.29 + 1.04; anterior nasolacrimal duct next to Inferior turbinate front horizontal distance was 5.13 + 0.62, the vertical distance to the nasal floor is 16.83 + 0.97, left and right side measurements had no significant difference (P0.05), and the measurement data of image measurement data applied anatomy of the difference was not statistically significant (P0.05); 1000 cases (2000 sides) of normal adult maxillary sinus CT according to the bottom of maxillary sinus pneumatization is divided into 3 types, type I 662 cases, accounting for 66.20%, 265 cases of type II accounted for 26.50%, 73 cases of type III and 7.30%.30 cases (60 sides) type were 23 cases, 6 cases of type II, 1 cases of type III. The surgical field 0 degrees and 30 degrees the inferior turbinate of anterior maxillary sinus surgery can achieve satisfactory results, and the middle meatus approach had significant difference (P0.05). The removal of bone: the inferior turbinate attachment margin above superoinferior diameter was 9.43 + 1.27, and the diameter from top to bottom were 9.76 + 0.83,11.39 + 0.50,12.85 + 0.66, inferior margin of attachment The upper and lower diameters of the following parts were 13.52 + 0.83, and the anteroposterior diameters were 19.89 + 1.37,16.59 + 0.77,12.48 + 0.91. from top to bottom respectively, but 1 cases of type III maxillary sinus specimens could not be observed completely.
Conclusion: endoscopic sinus surgery is significantly wider than the middle nasal approach for anterior maxillary sinus surgery. However, some individuals still have blind area. This is related to the degree of gasification of the maxillary sinus. Imaging examination provides direction for surgery to expand the field of vision.

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R765.4

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