鼻内镜下经蝶窦蝶鞍区手术中蝶窦前壁的应用解剖

Applied anatomy of anterior wall of sphenoid sinus for transsphenoidal endoscopic sella surgery

目的：为鼻内镜下经蝶窦蝶鞍区手术准确寻找蝶窦口，避免损伤蝶腭动脉提供解剖学资料。方法：在15例国人头颅标本上，用游标卡尺和角规对30侧蝶窦前壁进行解剖学（走行、位置、外径以及与相关结构的距离）观察和测量。结果：鼻小柱根部至蝶窦口下极及蝶腭孔的距离分别为（60．40±3．21，58．10～72．76）mm和（62．14±1．93，59．50～73．40）mm；蝶腭孔至蝶窦口下极的距离为（12．20±1．10，8．10～16．35）mm，在蝶腭孔处蝶腭动脉的外径为（1．99±0．13，1．50～2．80）mm；蝶窦口下极至鼻中隔后上动脉及鼻中隔后下动脉的距离分别为（3．49±0．24，2．78～5．20）mm和（6．42±1．08，4．30～8．50）mm。结论：蝶窦口是经蝶窦蝶鞍区手术的重要标志；开放蝶窦时宜从蝶窦口内下方开放，以免损伤蝶腭动脉。

Objective：To provide anatomic data for accurately localizing aperture of sphenoidal sinus without injurying sphenopalatine arteries in endoscopic transsphenoidal sella surgery. Methods： The anterior walls of spheroid sinus were observed and measured （layout, position, external diameter,distances to other structures of interest） with a vernier caliper and an angle gauge on 15 adult cadavers. Results： The distances from the root of columella nasi to the inforior pole of sphenoidal sinus aperture and the sphenopalatine foramen were （60.40±3.21,58.10-72.76） mm and （62.14±1.93,59.50-73.40） mm, respectively. The distance from the inforior pole sphenoidal sinus aperture to the sphenopalatine foramen was （12.20±1.10,8. 10-16.35） mm. The diameter of the sphenopalatine artery was （1.99 ±0.13,1. 50-2. 80） mm. The distances from the inforior pole of sphenoidal sinus aperture to the superior and inferior posterior artery of nasal septum were （3.49±0. 24,2. 78-5.20） mm and （6.42±1, 08, 4.30-8. 50） mm, respectively . Conclusion： Aperture of sphenoidal sinus is an important marker in endosopic transsphenoidal sella surgery. The anterior wall of sphenoid sinus should be opened from the inforior pole of sphenoidal sinus aperture to avoid injurying sphenopalatine artery.