鼻内窥镜筛窦切除术的应用解剖

Applied anatomy for endoscopic ethmoidectomy

目的：鼻内窥镜筛窦切除术时常出现眶内及颅内严重并发症，本研究为此类手术提供重要解剖数据，依此避免手术并发症的出现。方法：在６０个完整成人尸体头部标本上对鼻内窥镜下行筛窦切除术的应用解剖进行了研究，通过颅正中矢状切面、水平切面，设计了１１条测线、９个测角和５项观察。结果：①前鼻棘至手术有关重要解剖结构的距离及角度约分别为：钩突中部３５ｍｍ、４９°，筛泡中部３７ｍｍ、５２°，中鼻甲基板４３ｍｍ、５８°，筛板前部５０ｍｍ、７１°；②中鼻甲前端至蝶窦口距离为３５ｍｍ，中鼻甲前端顶部附着处为筛顶与筛板的分界；③中鼻道外侧壁（上颌窦内侧壁）与纸样板在同一垂直面。结论：中鼻甲是鼻内窥镜鼻窦切除术的重要内部标志。

Objective:To provide anatomy data for the endoscopic intranasal ethmoidectomy in order to avoid injuring the adjacent structures,such as orbit,anterior cranial fossa and carotid artery during the operation.Methods:Sixty adult cadavers (34 males and 26 females) were studied with special attention to the anatomy for endoscopic ethmoidectomy.ll term measure lines,9 term measure angles and 5 term surveys were designed.Results:① The distance and angle between the anterior nasospinale and ethmoid anatomic marks (the center of uncinate process,the center of ethmoidal bulla,the basal lamellac,the anterior cribriform plate )were 35 mm,49°,37 mm,52°,43 mm,58°,50 mm,71° respectively.②The distance between the anterior extremity of middle turbinate and the ostium of sphenlid sinus was 35 mm,and the attachment part of the anterior extremity of middle turbinate was the boundary of cribriform plate and the fovea ethmoidalis.③The lateral wall of the middle meatus,was always close to the same vertical plane as the lamina papyracea.Conclusions:The middle turbinate is an important internal mark and the anterior nasospinale is external mark of the endoscopic ethmoidectomy.