成人蝶窦解剖及变异的多层螺旋CT观察

Study of variations in adult sphenoid sinus by multislice spiral computed tomography

目的 明确蝶窦及其周围结构的精细影像解剖,探讨蝶窦不同气化类型与邻近结构的关系,为鼻内镜及颅底外科手术安全实施提供可靠依据.方法 收集首都医科大学附属北京同仁医院2007年3至11月260例副鼻窦患者多层螺旋CT资料,利用多层螺旋CT中的多平面重建（MPR）技术,从横断面、冠状面和矢状面对蝶窦及其周围结构进行系统地连续动态观察.结果 蝶窦气化类型发生率分别为：未发育型0.19%,甲介型1.54%,鞍前型8.08%,半鞍型22.88%,全鞍型20.58%,鞍枕型46.73%.不同类型窦腔在左右两侧间的分布差异无统计学意义.鞍背气化Ⅰ型48.08%,Ⅱ型25.19%,Ⅲ型26.73%,其中98.6%见于鞍枕型蝶窦.蝶窦腔内副分隔或骨嵴发生率为51.5%,随着蝶窦在蝶骨体内气化范围的增大,蝶窦内骨嵴的发生率明显提高,差异有统计学意义.蝶上筛房在不同类型蝶窦腔中的分布差异无统计学意义.翼管、圆孔突入蝶窦发生率分别为39.2%、15.8%,均见于翼突气化者.颈内动脉管0级13.5%,1级50.0%,2级26.9%,3级9.6%（其中88.0%见于鞍枕型,10.0%见于全鞍型） 随着蝶窦在蝶骨体内气化范围的增大,2、3级颈内动脉管发生率明显提高,差异有统计学意义（P〈0.05）.视神经管0级4.4%,1级19.2%,2级26.0%,3级29.1%,4级21.3%.随着蝶窦气化范围的增大,3、4级视神经管发生率明显增多,差异有统计学意义（P〈0.05）.结论 多层螺旋CT容积扫描、结合MPR技术多方位连续动态观察可准确显示蝶窦精细结构及其与周围结构立体关系,为鼻内镜及颅底外科手术安全实施提供可靠依据.

Objective Explore the anatomic variations of adult sphenoid sinus and delineate the precise relationship between sphenoid sinus and adjacent structures.MethodsUsing multi planner reformation （MPR）,the images of 260 spiral computed tomography （CT） scans were reviewed through a doctor station.Results The sphenoid was divided into 6 types：no development,conchal,pre-sellar,half-sellar,full-sellar and post-sellar.The prevalence was 0.19%,1.54%,8.08%,22.88%,20.58% and 46.73% respectively.And there was no difference between left and right.The prevalence of accessory septa or bone spur inside sphenoid sinus was 51.5%.With the gasification spreading,the prevalence was rising.And there was statistical significance among them.The dorsum sella was divided into three types：Ⅰ,Ⅱ,Ⅲ.And its prevalence was 48.08%,25.19% and 26.73% respectively.The difference of sphenoethmoid distribution among the various type sinus had no statistical significance.The prevalence of vidian canal and foramen rotundum protrusion was 39.2% and 15.8% respectively.And all occurred in pterygoid process cells.Internal carotid artery （ICA） was divided into 4 types.And the prevalence of type 0 to 3 was 13.5%,50.0%,26.9% and 9.6% respectively.With the gasification spreading,the prevalence of types 2,3 was rising.And there were statistical significance among them.The prevalence of type 0 to 4 CN Ⅱ was 4.4%,19.2%,26.0%,29.0% and 21.4% respectively.With the gasification spreading,the prevalence of type 3,4 CN Ⅱ was rising.And the difference had statistical significance.Conclusion MPR and multislice spiral CT can facilitate a precise study of anatomic variations in adult sphenoid sinus and delineate the relationships between sphenoid sinus and adjacent structures.Caution must be exercised during sphenoid and trans-sphenoid surgery to minimize the risk of inadvertently injuring the adjacent structures.