乙状窦后径路耳内镜下内淋巴囊手术的应用解剖

Surgical anatomy of endolymphytic sac via retrosigmoidal sinus approach under oto-endoscope

目的探讨内镜下乙状窦后径路内淋巴囊手术的可行性。方法在12例24侧成人尸头上行开放性解剖,观察内淋巴囊和乙状窦、横窦之间的关系,并测量内淋巴囊的上下径和内外径以及内淋巴囊外侧缘和乙状窦内外侧缘之间的距离。然后在枕骨上、乙状窦后开孔,导入耳内镜,在镜下观察乙状窦和内淋巴囊,并模拟内淋巴囊开放手术。结果所有标本通过乙状窦后颅骨开孔,内压小脑均能导入内镜,并能清晰分辨内淋巴囊和乙状窦,且易进行内淋巴囊手术。内淋巴囊的内外径为(6.76±1.19)mm,上下径为(6.55±0.90)mm,内淋巴囊外侧距乙状窦内侧距离为(3.55±2.21)mm,内淋巴囊外侧距乙状窦外侧距离为(13.33±2.61)mm。结论经乙状窦后行内淋巴囊手术简便易行,患者创伤小,为一种理想的内淋巴囊手术方式。

Objective To estimate the feasibility of oto-endoscopic surgery of endolymphytic sac via retrosigmoidal sinus approach. Methods 12 formalin-fixed adult cadaveric head specimens （24 sides ） were studied for gross anatomy. The relationship between the endolymphytic sac and sigmoidal sinus was observed. Distances from the inner edge of endolymphytic sac to the inner and outer edges of sigmoidal sinus were measured respectively. The height and width of the endolymphytic sac were also measured. All data was analysed with SPSS. Endoscopic surgery of endolymphytic sac was imitated via retrosigmoidal sinus approach. Results Endoscopic surgery of endolymphytic sac was performed susscessfully in all specimens, and the endolymphytic sac could be fairly distinguished from sigmoidal sinus endoscopically. The average distances from the inner edge of endolymphytic sac to the inner and outer edges of sigmoidal sinus were （3. 55 ±2. 21 ） nun and （13.33±2.61） mm respectively. The height and width of the endolymphytic sac were （ 6. 55± 0. 90 ） mm and （6. 76±1. 19 ） mm. Conclusion Due to its simplicity and convenience with minimal trauma, endoscopic surgery via retrosiguloidal sinus approach may be a perfect surgical manner of endolymphytic sac.