内镜下经鼻中下斜坡腹侧手术的应用解剖

Applied anatomy of the endoscopic endonasal approach to the ventral middle-lower part of clivus

目的为内镜下经鼻中下斜坡腹侧手术提供解剖学依据。方法20具经10％福尔马林固定之完整成人头颅标本，解剖观察经鼻至中下斜坡手术入路的解剖学特点，确立手术标志，并测量与经鼻入路相关的解剖数据。新鲜完整头颅部标本5例，模拟手术。结果内镜经鼻颅颈交界手术的手术标志包括：中鼻甲、后鼻孔、咽鼓管咽口、鼻咽部黏膜、头长肌和颈长肌、咽结节、枕骨大孔前缘中点。经鼻入路完全暴露中下斜坡，最短距离为（89．60±2．52）mm；蝶窦前下壁和下斜坡磨除范围分别以两侧翼管和破裂孔为界，各自为距中线（9．37±0．59）mm和（10．75±0．63）mm。结论内镜经鼻入路可充分显露中下斜坡腹侧结构。

Objective To establish the surgical landmarks of the endoscopic endonasal approach to the ventral region of middle-lower part of clivus and provide anatomic basis. Methods Twenty 10% formalin-fixed intact adult head specimens were used to dissect and observe the anatomic feature of this access in order to establish the surgical landmarks of the approach, and some relative anatomic data were measured. Five fresh and intact head specimens injected with colored latex were used, and completely analogical operation via endoscopic endonasal approach to the middle-lower part of clivus was performed in all cases. Results Anatomic landmarks of the approach included middie turbinate, ehoana narium, eustachian tube ostium, nasopharynx mucosa, longus eapitis and longus eolli, pharyngeal tubercle, and basion. To expose the ventral region of middle-lower part of clivus completely, the shortest distance was （ 89. 60±2. 52 ） mm. The ranges of stripping the inferior wall of sphenoid sinus and the lower clivus were bounded by pterygoid canal and foramen lacerum, and the distances from the median line were （9. 37 ±0. 59） mm and （ 10. 75 ± 0. 63 ） mm, respectively. Conclusions The structures of the ventral middlelower part of clivus can be revealed sufficiently via an endoscopic endonasal approach.