经单侧鼻孔-蝶窦入路手术的解剖标志观察

Anatomic landmarks of the endonasal transsphenoidal surgery

目的:探讨经单侧鼻孔-蝶窦入路手术中具有导向价值的一系列解剖学标志。方法:在148例显微手术中,观察相关的重要解剖结构,分析它们在手术导向中的定位价值。结果:中鼻甲、上鼻甲、蝶窦粘膜开口、后鼻孔、蝶窦前壁轮廓、鼻中隔骨部与软骨交接区、蝶窦前壁骨质形态特征、蝶窦前壁的滋养动脉、蝶窦分隔、鞍底隆起等均是手术径路上的重要"路标",其形态均有一定变异,但总体方位大体一致,它们组成了经鼻蝶手术的路线图。结论:找到蝶窦口是准确进入蝶窦的金标准,经鼻中隔粘骨膜间隙进路时所见的"船头"征是导向蝶窦骨性开口的重要标志,探测蝶骨平板的方位可以辅助确定不太隆起的鞍底。准确识别、合理运用标志性解剖结构,可以使手术更为微创化。

Objective： To explore valuable anatomic landmarks for endonasal transsphenoidal surgery. Methods： During the mierosurgical procedures of 148 cases, the relative anatomic structures were observed and analyzed. Results：The important anatomic landmarks during the surgical approach concerning with middle nasal concha, superior nasal concha, the mucosal aperture of sphenoidal sinus, the posterior naris, the outline of anterior wall of sphenoid sinus viewed within the nasal cavity, the conjunction between the bone part and the cartilage part of the nasal septum, the osseous anterior wall of sphenoid sinus, the nourishing arteries of the anterior wall of sphenoid sinus, the septation of the sphenoidal sinus and the swelling of sellar floor. In spite of variations, above structures were constant landmarks among different individuals, which was valuable for performing endonasal transsphenoidal approach. Conclusions The gold standard of entering the sphenoid sinus accurately is to find the aperture of sphenoidal sinus. Approaching along the inter-mucoperiosteal gap, the ＂Boat top＂ is an important landmark for targeting the osseous aperture of sphenoidal sinus. For the identification of the fiat sellar floor, it is a helpful procedure to explore the planum sphenoidale. Accurate identification and reasonable application of these anatomic landmarks can make the surgery more minimally invasive.