眶上锁孔及翼点入路对鞍区显露范围的定量研究

Quantitive study of range of exposure to sellar region by transorbital keyhole approach and transpterional approach

目的观察眶上锁孔入路及翼点入路手术对鞍区的显露范围。方法成人湿性头颅标本5具(10侧)．模拟经眶上锁孔入路和翼点入路的手术操作,在经眶上锁孔入路的基础上分别磨除眶上缘内板和前颅底骨嵴;在经翼点入路的基础上分别磨除蝶骨嵴和前床突．评价不同手术入路及其扩大后对鞍区的显露范围并计算显露面积。结果经眶上锁孔入路中磨除眶上缘内板后鞍区的显露面积[(2896．51±105．21)mm^2]较单纯眶上锁孔入路的面积[(2791．81±116．48)mm^2]增加(P＜0．05);经翼点入路中磨除蝶骨嵴后的显露面积[(3022．93±141．29)mm^2]和磨除前床突后的显露面积[(3373．14+190．39)mm^2]均较前明显增加(P＜0．01)．结论眶上锁孔入路中磨除眶上缘内板可显著增加鞍区显露面积;翼点入路中充分磨除蝶骨嵴和前床突可显著增大鞍区的显露面积。认为翼点入路是鞍区病变手术的首选入路。

[Objective]To study the range of exposure to sellar region by transorbital keyhole approach and transpterional approach.[Methods]Mimicked the transorbital keyhole approach and transpterional approach in 5 adult cadaver(10 sides).On the basis of the transorhital keyhole approach,extendedly removed the inner table of superior orbital margin and the anterior fossa ridge;extendedly resected the sphenoidal ridge and the anterior clinoidectomy after the transpterional approach was finished.After every operative step of different approaches, the exposure range of each extended step of two surgical approaches were evaluated and the exposure area was calculated.[Results]The exposure area after removal of the inner table of superior orbital margin[(2896.51±105.21) mm^2]increased remarkably than that[(2791.81±116.48)mm^2]in the transorbital keyhole approach(P＜0.05).The exposure area after removal of the sphenoidal ridge[(3022.93±141.29) mm^2]and after removal the anterior clinoidectomy[(3373.14±190.39) mm^2]increased remarkably with each step in the transpterional approach(P＜0.01).[Conclusions]Extended removal of the inner table of superior orbital margin in the transorbital keyhole approach can increase the exposure of sellar rigeon.Extended removal of the sphenoidal ridge and the anterior clinoidectomy in the transpterional approach can increase the exposure of sellar rigeon.The transpterional approach maybe the optimal surgical approach for sellar region.