【摘要】：研究目的 通過對人體標本鼻咽部及側顱底的連續(xù)橫斷面薄層斷層解剖學圖像的觀測,連續(xù)追蹤觀測咽鼓管及周圍重要毗鄰結構的位置關系,為安全的進行咽鼓管周圍區(qū)域手術提供解剖學資料。 研究方法 篩選無明顯器質性病變的成年男性頭部標本15例(30側),經(jīng)固定、冷凍、包埋,以層厚0.1mm的厚度(機床0.001mm的銑削精度)、以Reid基線為基準行橫斷面銑切,每銑切完一層即通過電腦自帶軟件控制相機拍攝采集圖像,獲取咽鼓管區(qū)域連續(xù)斷層圖像,使用相關軟件測量數(shù)據(jù),與原圖旁邊的刻度尺對照,得實物真實距離,觀察、測量咽鼓管及周圍重要毗鄰結構。 結果 咽鼓管于橫斷面上從首次出現(xiàn)到基本消失,共銑切197-254個斷面,其中63-89個顯示較完整骨部。 1、于咽鼓管咽口水平：咽鼓管兩側枕狀粘膜間經(jīng)測量,咽口寬度為(4.92±2.68)mm。于咽口所在平面,11側未見下鼻甲后端,測量剩余19側標本咽口到下鼻甲后端粘膜距離為(11.65±3.42)mm。 2、于咽鼓管中段可追蹤觀察到咽外側間隙呈一個底大尖小的倒立錐體,顳下窩向上移行形成翼腭間隙的底,其后界與頂為蝶骨。 3、于咽鼓管鼓室口水平：測量咽鼓管骨部與頸動脈管間骨質厚度為(1.28±0.31)mm。 結論及意義 1、對標本行冰凍銑切斷層技術,避免傳統(tǒng)鋸切法造成的標本某些微細結構的變形及損壞,層厚僅為0.1mm,片間損耗極小,可保持標本的相對完整,獲得的圖像較傳統(tǒng)圖像清晰,清楚顯示咽鼓管及周圍有關結構的解剖位置,為該區(qū)域手術治療提供了一定意義上的解剖學資料。 2、對咽鼓管咽口的觀測表明：咽口前后枕粘膜間隙寬度的個體差異較大,形狀多變,此對變應性鼻炎、分泌性中耳炎等多種疾病的診斷及治療密切相關。 3、咽側壁的咽隱窩及咽外側間隙所屬的側顱底結構復雜,此區(qū)腫瘤多發(fā),其偏后位置有頸內動靜脈、舌咽神經(jīng)、迷走神經(jīng)等走行,清晰辨別解剖結構對判斷此區(qū)腫瘤的組織來源及鑒別診斷有重要意義。 4、咽鼓管骨部內壁與頸內動脈相隔(1.28±0.31)mm的薄層骨質,提示中耳癌侵及咽鼓管時易轉移,為安全的行使中耳及顱中窩相關手術提供資料。
[Abstract]:Objective to observe the position relationship of eustachian tube and its adjacent structures continuously by observing the thin sectional anatomy images of the nasopharynx and lateral skull base of human body. To provide anatomical data for the safe operation of the eustachian tube. Methods Fifteen adult male head specimens (30 sides) without obvious organic lesions were selected, and were fixed, frozen and embedded with the thickness of 0.1mm (milling accuracy of 0.001mm machine tool). The Reid baseline is used as the benchmark for cross section milling. After each layer is cut, the images are captured by the computer software control camera, and the continuous sectional images of the eustachian tube region are obtained. The relevant software is used to measure the data and compare with the scale next to the original image. Get the real distance, observe and measure the eustachian tube and its surrounding important adjacent structure. Results the eustachian tube appeared on the cross section from the first time to the basic disappearance, milling a total of 197-254 sections, of which 63-89 showed a complete bone. 1. The width of pharyngeal mouth was (4.92 鹵2.68) mm., measured between the occipital mucosa of the eustachian tube and the eustachian tube. At the level of pharyngeal orifice, the posterior end of inferior turbinate was not seen in 11 sides. The distance between pharynx mouth and posterior mucosa of inferior turbinate in the remaining 19 specimens was (11.65 鹵3.42) mm.. 2. In the middle part of the eustachian tube, the lateral pharyngeal space was found to be an inverted pyramidal with a large and small base, the bottom of the pterygopalatine space was formed from the inferior temporal fossa upward, and the sphenoid bone was the posterior boundary and the apex. 3The thickness of the bone between the eustachian tube and the carotid artery was (1. 28 鹵0. 31) mm.. Conclusion and significance 1. The frozen milling fault technique is used to avoid the deformation and damage of some micro-structures caused by the traditional sawing method. The thickness of the layer is only 0.1 mm, the loss between slices is very small, and the specimen is relatively intact. Compared with the traditional images, the obtained images clearly show the anatomical location of the eustachian tube and its surrounding structures, which provides some anatomical data for surgical treatment in this area. 2. The observation of pharyngeal orifice of the eustachian tube showed that the width of the anterior and posterior occipital mucosal space of the pharynx was quite different and varied in shape, which was closely related to the diagnosis and treatment of allergic rhinitis, secretory otitis media and other diseases. 3, the lateral pharyngeal recess and the lateral skull base of the lateral pharynx space are complicated, the tumors in this area are multiple, the posterior position of the tumors are internal cervical arteriovenous, glossopharyngeal nerve, vagus nerve, etc. It is important to distinguish the anatomical structure of the tumor in this area. 4. The thin layer of bone between the internal wall of the eustachian tube and the internal carotid artery was (1. 28 鹵0. 31) mm, which suggested that the carcinoma of the middle ear could metastasize easily when it invaded the eustachian tube, which provided information for the safe operation of the middle ear and the middle cranial fossa.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R764.21

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