经鼻蝶窦手术入路相关的血管显微解剖学研究

A microscopic anatomy study on the vessels associated with transnasal sphenoidal approach

目的研究经鼻蝶窦手术入路相关血管的显微下解剖特点。方法10具动静脉灌注染料的成人新鲜尸头上，5具行正中矢状位切开，5具模拟经鼻蝶窦手术入路，分别在显微镜下观察手术路径上血管的走行特点，与垂体和周围重要组织结构的相互关系，测量相互之间的距离。结果鼻中隔后动脉上支至蝶窦开口下极的距离为（3.91±0.82）mm（2.85～5.15）mm，鼻中隔后动脉下支至蝶窦开口下极的距离为（6.16±1.23）mm（4.42～8.28）mm。颈内动脉海绵窦段分为5段，有3个动脉分支。颈内动脉前曲段的内侧缘距垂体中线的距离为（11.94±1.90）mm（9.02～14.86）mm，后曲段的内侧缘距垂体中线的距离为（7.96±2.07）mm（5.64～11.58）mm。结论蝶腭动脉、海绵间窦、颈内动脉海绵窦段的分支－垂体下动脉是经鼻蝶窦手术入路中容易引起出血的血管，尤其是颈内动脉海绵窦段是最重要的解剖结构。术前要有充分的准备，术中仔细的显微操作，以免发生大出血这一严重并发症。

Objective To investigate the microscopic feasures of vessels associated with the transnasal sphenoidal approach. Methods Transnasfi＇l sphenoidal approach was performed on five adult cadaver heads that the latex was poured into the artery and veins. Other five adult cadaver heads were cut down sagittally in center. The appearance characteristic of the vessels and the relationship with pituitary gland and important structure around were observed under microscope. The mutual distance at different levels was measured. Results The distance between the superior branch of posterior nasal septal artery and the lower margin of sphenoidal ostium is（3.91±0.82）mm （2.85±5.15mm）, the distance of the inferior branch is（6.16--4-_ 1.23）mm （4.42±8.28 mm）. The cavernous internal carotid artery can be divided into 5 segments and 3 vessel branches. The distance between the media edge of the anterior bend of internal carotid artery and the midline of pituitary gland is（11.94±1.90）mm （9.02±14.86 mm）, the distance between the posterior bend and internal carotid artery is（7.96±2.07）mm （5.64±11.58 mm）. Conclusions The sphenopalatine artery, intercavernous sinus and the inferior pituitary artery of cavernous internal carotid artery are the hemorrhage vessels via the transnasal sphenoidal approach. The cavernous internal carotid artery is the most important structure. Sufficient preparation before operation and careful manipulation during operation can avoid the serious bleeding complication.