内镜下经口咽入路行枕骨大孔扩大术的解剖学研究

The anatomical studies of endoscopic transoral-line expansion of the foramen magnum surgery

目的模拟在大体形态标本行内镜下经口咽入路行枕骨大孔扩大术的可行性,为临床治疗颅底凹陷症提供一定的解剖学依据。方法选取完整人体头颈部标本20具,将标本随机分为两组,第Ⅰ组10具(男7例、女3例),为传统手术组;第Ⅱ组10具(男7例、女3例),为内镜组。分别进行经口咽入路行枕骨扩大术模拟手术,内镜组采用MED-Ⅱ型手术系统。结果内镜下手术可以达到与传统手术同样的效果,但在咽后壁正中切口的长度和斜坡打磨方面,内镜组更具有优势;逆行法和磨除法均能实现对斜坡的部分切除,为了避免损伤硬脑膜,尽可能选用磨除法。结论内镜下经口咽入路行枕骨大孔扩大术在技术上是可行的,内镜手术组不仅能达到传统手术的扩大范围,而且对局部结构显露更为清晰,操作更为方便和精确,明显优于传统手术组。

Objective To providing some experimental evidence for the clinic treatment of basilar invagination,we explore the feasibility of endoscopic transoral surgery of expanding line of occipital bone through model experiment in specimen.Methods Select complete specimens of 20 head and neck,the specimens were randomly divided into two groups,the first group Ⅰ,10（8 male and 2 females）,for the traditional group; Group Ⅱ 10（7 male and 3 female）,for the endoscopic group.Respectively Transoral line simulation occipital augmentation surgery,Canon group were MED-II type surgery system.Results Operations between the traditional and endoscopic method have no significant difference,but in terms of the longth of incision in the median posterior pharyngeal wall and polishing the slope,the later is superior; Retrogradation and grinding division can achieve partial excision of the slope,in order to avoid the damage of the rear dura,as selecting grinding division.Conclusion Endoscopic Transoral line foramen magnum augmentation is technically feasible,endoscopic surgery group not only to achieve the expansion of the scope of traditional surgery,but also for the local structure is revealed more clearly and operate more convenient and precise,significantly better than traditional surgery group.