颈静脉孔区不同手术入路显露结构的对比分析及显微解剖研究

Contrast analysis and microdissection of the exposure of the jugular foramen region via different surgical approaches

目的研究枕下远外侧入路、耳后乙状窦前经颞入路、改良的耳后头颈入路对颈静脉孔区显露范围与结构的区别。方法用10%的福尔马林固定的成人头颈湿标本6具(12侧),随机分为A、B、C三组,每组2具标本,在高倍显微镜下模拟颈静脉孔区手术入路。其中A组模拟枕下远外侧入路、B组模拟耳后乙状窦前经颞入路、C组模拟改良的耳后头颈入路进行显微解剖研究,比较各条手术入路所显露的结构及范围。结果枕下远外侧入路对颈静脉孔区颅内结构显露良好;耳后乙状窦前经颞入路对颈静脉孔孔内结构、鼓室、乳突气房及颈动脉鞘周围的结构显露良好;改良的耳后头颈入路则通过后、外、上、下等多个角度对颅内外结构均显露良好。结论不同的手术入路对颈静脉孔区的显露范围及结构各不相同,改良的耳后头颈入路能够更好的从多角度对颅内外结构显露,从而达到一期全切肿瘤。

Objective To investigate the difference of the extent and structure of the foramen jugulare region from a far lateral inferior suboccipital approach, post aur presigmoid approach, improved post aur head and neck approach. Methods Six emblamed adult cadaveric heads were randomally and equally assigned to three groups（group A、B、and C）. Jugular foramen operative approach was simulated under high power microscope. The far lateral inferior suboccipital approach was applied to A, the post aur presigmoid approach was applied to B, the improved post aur head and neck approach was applied to C to proceed microdissection studies;exposed structure and scope were compared among the above-mentioned surgical approaches. Result The far lateral inferior suboccipital approach was better for jugular foramen area to exposeintracranial structures, post aur presigmoid approach was better to expose internal structures in the jugular foramen、tympanum、mastoid air cell and structures around cervical artery sheath; improved post aur head and neck approach was better for exposure of extracranial-intracranial（EC-IC） structures through multiple angles such as rear, outside, above and below. Conclusion The exposure range and structures of jugular foramen area vary in different surgical approaches. Improved post aur head and neck approach with its multiple angles was better at exposure of intracranial and extracranial structures, so that total resecction of tumor can be achieved.