内窥镜下经鼻腔-蝶窦入路切除垂体腺瘤的解剖学研究

An anatomy study for transnasal transsphenoidal endoscopic pituitary surgery

目的 为进一步推广和提高内窥镜下经鼻腔 蝶窦入路提供帮助。方法 采用解剖尸头直接观察和内窥镜下测量距离 ,结合活体的CT、MRI图像上观察及测量的方法 ,对 15例 30侧尸头、 10 0侧CT片和 10 0例MRI片的手术入路相关解剖学特点和解剖距离进行研究。结果 全鞍型蝶窦占 82 % ,2 9%合并枕骨气化 ,蝶上筛房出现率为 11% ;前鼻棘至蝶窦口的距离为 6 0 39± 5 38mm ;前鼻棘至鞍底距离为 75 47± 6 36mm ;视神经管多位于蝶窦口侧上方、蝶筛交界处 ,蝶窦口至视神经管的最短距离为 11 0 9± 1 48mm。颈内动脉多位于蝶窦口的后外上方 ,蝶窦口至颈内动脉的最短距离为17 14± 1 6 3mm。结论 内窥镜技术适合于经鼻腔蝶窦入路切除鞍区肿瘤 ;术前的影像学检查、对于手术相关的解剖学结构的认识及熟练的窥镜手术操作技能是保证手术成功的关键因素。

Objective To study the anatamy of sphenoid sinus and adjacent structures for transnasal transsphenoidal endoscopic pituitary surgery. Methods The anatomical characteristics and data were studied on 15 cadavers, 100 MRI films and 66 CT films.Results The distance from nostril to ostium of sphenoid sinus was 60 39±5 38mm;from nostril to sella turcica was 75 47±6 36mm;from ostium of sphenoid sinus to the optic canal was 11 09±1 48mm,to carotid artery was 17 14±1 63mm.Conclusion Transnasal transsphenoidal endoscopic techinique is appropriate for resecting sellar tumors. Preoperative CT or MRI scan, knowledge of the anatomy of the sphenoid sinus and adjacent structures, skillfull operative techinique are all important for transnasal transsphenoidal endoscopic pituitary surgery.