内窥镜下鼻内泪囊鼻腔吻合术的应用解剖研究

Anatomical guidelines for endoscopic intranasal dacryocystorhinostomy

目的观测泪囊窝的解剖结构及其毗邻关系,为内窥镜下鼻内泪囊鼻腔吻合术提供可靠的解剖学参数。方法在20个尸头上观测泪囊窝的大小、骨质厚度及其毗邻关系。结果泪囊窝长径17.86±1.40mm,前后径7.64±0.29mm。泪前嵴骨质较厚,泪后嵴次之,泪颌缝处最薄。泪囊窝后上界与中鼻甲前端附着处毗邻,距离0～4.46mm。中鼻道前方骨棱对应上颌骨额突,泪后嵴与钩突基部相平行,钩突上端对应泪囊和鼻泪管交接处。泪囊窝与筛前动脉存在三种毗邻关系。结论中鼻甲前端附着处、钩突上端和中鼻道前方骨棱为泪囊窝在鼻腔外侧壁上的定位标志,泪颌缝中点为造孔首选部位。

PURPOSE To identify the anatomic landmarks as guidelines for locating the lacrimal sac endonasally.METHODS On 20 adult cadaver head specimens, the size and the thickness of the lacrimal sac fossa were determined. The distance of the lacrimal sac fossa to well-known nasal structures was measured to define anatomic guidelines and to set criteria for locating the sac.RESULTS The vertical and horizontal diameters of the lacrimal sac fossa were 17.86 ± 1.40mm and 7.64 ± 0.29mm. The lacrimal bone was thinner and much thinner at the lacrimomaxillary suture. The sac was located at the junction of the superioanterior attachment of the middle turbinate to the lateral nasal wall. The ridge before the middle meatus corresponded to the frontal process of the maxilla. The junction of the nasolacrimal and sac lay immediately lateral to the top of uncinate process. There are three relationships between the lacrimal sac fossa and anterior ethmoid artery. CONCLUSION The attachment of the middle tur-binate,the ridge before the middle meatus and the unci-nate process are important anatomic markers for the endo-scopic transnasal dacryocystorhinostomy. The relationship of the lacrimal bone to well - known structures located on the lateral nasal wall should be know.