内镜下经口咽入路至颅颈交界应用解剖学研究

Applied anatomy of the transoral-transpharyngeal approach to the lesions of the ventral craniocervical junction

目的研究内镜下经口咽入路至颅颈交界区域局部解剖学并测量相关解剖数据,为临床手术提供形态学数据。方法交替使用手术显微镜和0°、30°硬质内镜研究10例成人尸头,探讨经口咽至颅颈交界手术入路;测量与入路相关的60具成人颅骨标本数据。结果该入路的定位标志,即“路标”主要为寰椎前结节、齿突、咽结节、枕骨大孔前缘、IX～Ⅻ对脑神经、椎动脉及其分支、延髓等;沿途“路标”构成该入路的操作路线图。结论(1)解剖数据对于临床手术具有参考价值;(2)应用不同角度的内镜,仅切开软腭足以达斜坡下部至第2颈推的范围,应用特殊手术器械可完成上述区域病变的治疗。

Objective To study endoscopic anatomy of the lesions of the ventral craniocervical junction via transoraltranspharyngeal approach, and measure some anatomic data, in order to guide clinical surgical operation. Methods （1）Ten adult cadavefic specimens were studied with microscope and 0°, 30° hard endoscopes alternatively by imitating operations via transoral-transpharyngeal approach; （2）Sixty dry specimens were examined. Results The marks of road mapping for this approach include tuberculum antefius, dens, pharyngeal tubercle？ anterior part of greatoccipital foramen, hypoglossal canal, Ⅸ-Ⅻ cranial nerves vertebral artery and its branches and medullary bulb; The path way of road mapping for this approach was composed of these marks according to the surgical procedure. Conclusion （1）The anatomic data is valuable for clinical operation. （2）The lesions of the ventral craniocervical junction from lower clivus to C2 vertebrae can be reached via the approach by using endoscope with different angle only with the soft palate cut open along its midline. Diseases locate in the lesions can be treated via the approach.