内镜下鼓室窦和面神经隐窝的应用解剖学

Applied anatomy of sinus tympani and facial recess under endoscope

目的:探讨硬质内镜下进行鼓室窦和面神经隐窝的应用解剖学研究,为内镜在中耳手术中的应用提供解剖学资料。方法:采用成人颞骨标本30侧(左16,右14),分别使用30°和70°内镜经外耳道观察后鼓室的结构,比较不同角度内镜下观察后鼓室的视野,在内镜下制作隐窝模型,用游标卡尺对模型进行测量。结果:测量模型得到的结果为:鼓室窦深度(2.65±1.27)mm(1.06￣5.80mm),宽度(2.45±0.67)mm(0.78￣3.64mm),面神经隐窝深度(2.11±0.42)mm(1.18￣2.94mm),宽度(2.47±0.48)mm(1.58￣3.46mm);结论:(1)对于面神经管内侧的后鼓室部分,无论使用30°或者70°内镜都可以得到很好的观察;(2)要想彻底的观察面神经骨管外侧的后鼓室部分,尤其是面神经隐窝,70°内镜优于30°内镜;(3)30°内镜在通过外耳道放入中耳腔时更容易把握方向感和深浅度;(4)2.7mm内镜在操作的方便性和视野的大小方面可以达到一个恰当的平衡。

Objective：To explore the anatomic characteristics of sinus tympani and facial recess and provide anatomical data for the operation on the middle ear using endoscope technique. Methods： Thirty temporal bones （left 16, right 14） harvested from cadavers were dissected. Using endoscope with different angles of 300 and 700, the view of posterior tympanum were observed and compared through external auditory canal. The cast of facial recess was made under the guiding of endoscope, and its sizes were measured by sliding caliper. Results： The depth of sinus tympani was about （2.65±1.27） mm （1.06～5.80 mm）, while the width （2.45±0.67） mm （0.78～3.64 mm）. The depth of facial recess was about （2.11±0.42） mm （1.18～2.94 mm）, the width （2.47±0.48） mm （1.58～3.46 mm）. Conclusiou： For the portion of posterior tympanum medial to facial nerve canal, a better view will be obtained under endoscope regardless of angle. However, for the portion lateral to facial nerve canal, especially facial recess, 70° endoscope was better to observe than 30° endoscope just for the 70° endoscope provide a wider view for lateral surface. 30° endoscope can control orientation and depth more easily when it is guided into middle ear through external auditory meatus. 2.7 mm endoscope can reach a better coordination between convenience of operation and the field of vision.