蝶窦开放不同方法的应用解剖学比较

Different surgical approaches to the sphenoid sinus:an anatomical study

目的对开放蝶窦手术入路的不同方法进行比较,为蝶窦手术提供临床解剖学标志。方法应用10具(20侧)成人头颅标本,按照不同的方法开放蝶窦,测量主要结构之间的距离,观察手术中的解剖学标志。结果前鼻孔到蝶窦前壁的距离(65.36±3.58)mm;前鼻孔到蝶鞍底部的距离(79.18±3.71)mm;鼻后孔弓到颅底的距离(21.18±4.31)mm;后鼻孔弓到蝶窦开口的距离(13.22±3.36)mm。蝶窦开口与鼻小柱基部的连线与鼻底成角35.72°±3.48°;后鼻孔弓与鼻小柱基部的连线与鼻底成角29.56°±3.61°;蝶窦前壁与颅底交界处与鼻小柱基部的连线与鼻底成角45.72°±3.63°。蝶窦前壁形状有很大变异,应根据局部结构进行定位,不同的的方法适应不同的个体。中鼻甲、上鼻甲、上鼻道是很好的定位标志。结论根据手术的目的可以选择不同的方法开放蝶窦,中鼻甲、上鼻甲以及后鼻孔弓都是定位蝶窦的恒定标志。

Objective To investigate the surgical approaches to the sphenoid sinus with anatomical methods. Methods In 10 （20 sides ） formalin- fixed heads of adults, the distances between the main structures of sphenoid sinus were measured according to the different surgical approaches to this sinus, and the anatomical landmarks were also observed. Results The distance from the anterior naris to the anterior wall of the sphenoid sinus was （65.36±3.58） mm and that to the bottom of the hypophyseal fossa was （79. 18 ±3.71） mm. The distances from the superior margin of the choanae to the basicranial bone plate and the spenoid ostium were （21. 18± 4. 31） mm and （13. 22 ±3. 36） mm respectively. The angle formed by the line （from the spenoid ostium to the base of nasal eolumella ） and the base of nasal cavity was （ 35.72 ± 3.48 ）° ; that formed by the line （ from the arcus choanalis to the base of nasal columella ） and the base of nasal cavity was （ 29.56 ± 3.61 ）°, and that by the juncture （of the anterior sphenoidal wall and the skull base and the base of nasal eolumella ） and the base of nasal eavitly was （ 45.72±3.63 ）° . The above - mentioned parameters were variable individually; the middle and superior turbinates, superior meatus were perfect surgical landmarks for sphenoid sinus. Conclusion Different surgical approaches to the sphenoid sinus should be chosen based on the target of the operation ; the arcus ehoanalis, the middle and superior turbinates are invariable ofientative landmarks for sphenoid sinus.