口腭咽入路的解剖基础及手术中应用

Anatomic basis and clinical application of the transpalatal-transpharyngeal approach

目的探讨口腭咽入路相应的解剖学结构和临床应用效果。方法在15具动脉灌注乳胶的成人尸头上模拟口腭咽入路,在显微镜下观察腭大孔、切牙孔的位置,骨嵴的比例,腭大动脉的走行,硬腭部软组织的结构特点并测量颅底重要解剖结构间的距离;对2006年3月至2010年6月经口腭咽入路行显微手术治疗的18例颅底中线区肿瘤患者的资料进行回顾性分析。结果切牙孔距牙槽嵴前端的距离为(5.18±2.44)mm,骨嵴的比例为93.3%,54支腭大动脉走行于硬腭半宽的中内2/3侧,术式的暴露范围主要受限于双侧的视神经、颈内动脉、舌下神经管内口等结构;本组18例中12例全切除,6例次全切除,并发症包括1例脑脊液鼻漏,1例构音不良,无死亡、偏瘫等严重并发症。结论口腭咽入路切除颅底中线区肿瘤具有暴露充分、手术创伤小、并发症少的优点。该入路是切除颅底中线区肿瘤的较佳入路。

Objective To explore anatomic basis and clinical application of the transpalatal-transpharyngeal approach.Methods Simulated surgery via transpalatal-transpharyngeal approach was performed on 15 adult cadaveric heads injected red latex through arteries.The greater palatine foramen,incisor foramen,bone crest,palatine large artery and the soft tissue in hard palate were dissected and observed under microscope.The distances among important structures of skull base were measured and analyzed.The data of 18 cases with tumors in midline of skull base operated upon through transpalatal-transpharyngeal approach from March 2006 to July 2010 were analyzed retrospectively.Results The distance from the incisor foramen to the front alveolar crest was（5.18±2.44）mm.The proportion of bone crest was about 93.3%.54 palatine large arteries coursed through the 2/3 half-width of the hard palate.The lateral limits of expose were found to be the optic nerves,carotid arteries,endostoma of hypoglossal canals and so on.Of the 18 patients,12 were totally removed tumors,and 6 were subtotally removed tumors.The complications included rhinorrhea in 1 case and hypernasal in 1 case.There was no operative mortality and hemiplegia.Conclusions Transpalatal-transpharyngeal approach for resecting tumors in the midline part of skull base was an ideal approach,with satisfying exposure,alleviative operative trauma and fewer complications.