耳后经颞入路显露颈静脉孔区的显微解剖观测

Quantitative Studies on the Exposure of Jugular Foramen Region by Postauricular Transtemporal Approach

【目的】定量研究耳后经颞入路对颈静脉孔区的显露程度,为临床个体化选择手术入路、保护重要结构功能提供可靠的解剖依据。【方法】选择经10%福尔马林固定的成人头颈湿标本各6具(12侧),模拟耳后经颞入路的手术操作,并分成连续的五个步骤,用脑立体定向仪测定各步骤对颈静脉孔区的显露面积,用游标卡尺测量斜坡和三叉神经的显露长度及重要结构间的距离。【结果】迷路下入路对颈静脉孔区的显露面积是182.47±72.62 mm2,迷路后入路、部分切除迷路、切除耳蜗后对颈静脉孔区的显露程度依次增加(P<0.001)。部分切除迷路后,对斜坡和三叉神经的显露程度进一步显著增加(P<0.001)。【结论】迷路下入路和部分切除迷路经岩尖入路可自侧方完成对颈静脉孔区和岩斜坡区的充分显露,同时可以保留面神经、前庭蜗神经功能,是自侧方显露颈静脉孔区的理想手术入路。

[Objective]To evaluate the postauricular transtemporal approach based on quantitative meas- uremcnts of the exposure of the jugular foramen region obtained by each successive step of these approach, and to discuss how to protect the important structures such as labyrinth and cochlear. [Methods]With the aid of surgical microscope, the complete approach of the postaurieular transtemporal approach was reproduced with five successive steps in six specially prepared eadervarie head-neck specimens. After each step, the mierosurgieal anatomy of the jugular foramen region was investigated, and three standard sets of measurements were obtained using a stereotaetie device. The area of exposure to the jugular foramen was measured. [Results]The infra-labyrinthine approach provided exposure of 182.47± 72.62mm^2 jugular foramen region,and the exposure increased significantly after complete retrolabyrinthine approach, partial labyrintheetomy and transeoehlear ap- proach（ P 〈0.05）, whereas the least improvement in exposure occurred after translabyrinthine approach（ P 〉0.05）. The infra-labyrinthine approach could not expose the trigeminal nerve, and the length of elivus ex- posed was limit. The retrolabyrinthine approach provided exposure of 15.51± 3.00 mm elivus and 8.22 ± 1. 38mm trigeminal nerve. After partial labyrintheetomy, the exposure increased （ P 〈0.05）, whereas there was no significant increase by translabyrinthine and transeoehlear approaches. [Conclusion]The infra-labyrinthine approach and the partial labyrintheetomy approach provide satisfactory exposure to the jugular foramen region laterally with an excellent chance of hearing and facial nerve preservation.