部分迷路切除对桥小脑角区显露及其损伤程度的评价

Anatomic evaluation of the degree of exposure and damage to the cerebellopontine angle region during partial labyrinthectomy approach

目的:对迷路入路对桥小脑角区的显露程度及其损伤程度进行定量综合评价。方法:通过对成年国人带颈头颅标本6具(12侧),模拟常规的经迷路入路的手术操作,在迷路后入路的基础上,分别磨除部分半规管(上半规管和后半规管)和全部半规管。每个手术步骤完成后,按Ammirat标准进行评价不同手术入路及其扩大后对桥小脑角区的显露程度,用Horgan法计算出显露面积,并根据损伤程度评分评价3种手术入路及其扩大后的损伤程度。结果:经迷路后入路及其磨除部分半规管和全部半规管的显露程度评分分别为1分、1分和2分,显露面积分别为(304.29±39.74)mm2、(416.13±90.14)mm2和(610.47±109.36)mm2,磨除部分半规管后显露面积较迷路后入路明显增加(P<0.001),而磨除全部半规管后显露面积较磨除部分半规管无显著扩大(P=0.562)。而经迷路后入路及其磨除部分半规管和全部半规管的损伤程度评分分别为1分、9分和12分。结论:单纯迷路后入路对桥小脑角区显露有限,在单纯迷路后入路的基础上磨除部分半规管(上半规管和后半规管),对桥小脑角区的显露程度和显露面积明显扩大,但相应的损伤程度扩大,磨除全部半规管较磨除部分迷半规管路并不能明显扩大显露程度和显露面积,且损伤程度明显扩大。

Objective： To make comprehensive and quantitative assessment to the exposure and damage degree of the tmnslabyrinthine approach on the cerebellopontine angle region. Methods： The study was performed in 6 adult Chinese cadaver heads （12 sides）. The operation procedures oftranslabyrinthine approach were imitated to remove part semicircular canal （superior semicircular canal and posterior semicircular canal） and total semicircular canal after retrolabyrinthine approach . After completion of each operative step, the exposure degree to the the cerebellopotine angle region of each operative approach were evaluated according to Ammirat standard. Horgan method was used to calculate the exposure area, The injure degree of three kinds of operations were also judged according to the damage degree scoring standard. Results： The scoring of The exposures core on the retrolabyrinthe approach , removal of part semicircular canal and removal of total semicircular cana after retrolabyrinthe approach were 0, 1 and 2 respectively, Explosure area were （304.29± 39.74） mm^2, （416.13±90.14） mm^2, （610.47±109.36） mm^2 respectively, The exposure area after the removal of part semicircular cana obviously increased compared with the retrolabyrinthe approach and remain the same level compared with the removal of total semicircular cana. While the scoring of the damage degrees of three steps above were 1, 9 and 12 respectively. Conclusions： The study show the single retrolabyrinthe approach can not sufficiently expose the cerebellopotine angle region, Compared with the the removal of part semicircular cana, the exposure degree and the exposure area of total excison of semicircular canal can not obviously enlarged and the damage degree obviously increased.