内镜下经口入路咽旁间隙手术的解剖标志

Anatomical sign of parapharyngeal space operation via endoscopy-assisted transoral approach

目的观察内镜下经口入路咽旁间隙手术的解剖恒定标志,为处理咽旁间隙病变、提高手术成功率提供依据。方法对2015年1月至2015年9月获得的10具新鲜尸头进行CT多平面重建及三维重建,观察咽旁间隙等咽旁结构,然后应用内窥镜,于口内行内镜辅助咽旁间隙解剖。结果 CT图像上,极低密度的鼻咽向后外侧延伸形成咽隐窝,咽旁间隙位于咽隐窝的外侧,呈前窄后宽的低密度三角形阴影,翼内肌、翼外肌、咬肌、颞肌位于咽旁间隙的外侧,呈中密度阴影,茎突位于咽旁间隙的前部阴影,咽旁间隙后部颈内动脉呈中密度阴影。咽旁间隙内血管、神经显影不清晰。茎突位于颅底颞骨鼓部下,长(24.98±2.01)mm,咽旁间隙内结构均位于茎突及其周围深肌面,如茎突外侧有颈外动脉、面神经及乳突,茎突根部的内侧有颈静脉孔及舌下神经管外口,前内方有颈动脉管外口、棘孔和卵圆孔,后方有茎乳孔。左右侧茎突根部到周围毗邻组织结构的距离比较,差异无统计学意义(P>0.05)。除茎突根部至茎乳孔外,男性茎突根部到周围毗邻组织结构的距离均大于女性,差异具有统计学意义(P<0.05)。结论内镜辅助下经口入路咽旁间隙手术以茎突等作为解剖学标志,以茎突到毗邻解剖结构的距离为参考,有助于咽旁间隙周围神经、血管等的寻找和辨认。

Objective To observe the anatomical constant sign of the parapharyngeal space operation via endoscopy-assisted transoral approach,and provide evidence for the treatment of the lesions of the pharyngeal space and improve the success rate of the operation. Methods CT multi plane reconstruction and three dimensional reconstruction were performed on 10 fresh dead bodies who were acquired from January 2015 to September 2015,the structure of the lateral pharyngeal space was observed,and the parapharyngeal space operation was performed via endoscopy-assisted transoral approach.Results The CT images showed that dispharynx of very low density extended posterior-lateral into the pharyngeal recess,lateral pharyngeal space located in the lateral pharyngeal recess,a low density triangular shadow with a nar-row of the front and width in the back,wing within muscles,wing outside muscles,masseter and temporal muscle located in the lateral pharyn-geal side clearance,which showed a medium density shadow,styloid process located in the front shadow of pharynx side clearance,the back of the internal carotid artery of pharynx side clearance,which showed medium density shadow.The blood vessels in the pharyngeal space and the nerve development was not clear.Stem styloid located in the temporal bone of the skull base drum subordinates,with length of （24.98 ± 2.01）mm,the internal structures of parapharyngeal space located in styloid process and around the surface of the deep muscular,the outside of styloid process had external carotid artery,facial nerve and mastoid.Inside of the base of styloid process had jugular vein foramen and hypo-glossal canal outside hole,the front inner side had carotid canal outside hole,the foramen spinosum,and oval foramen,the rear with stem hole.The distance between left and right side of root of styloid process to adjacent structures was compared,and the difference had no statisti-cal significance（P 〉0.05）.In addition to the root of the styloid process to stylomastoid foramen.The difference of root of styloid process of males to adjacent structure was greater than that of the females,the difference had statistical significance（P 〈0.05）.Conclusion Endo-scopic-assisted transoral approach to the parapharyngeal space operation hasthe styloid process as the marks of anatomy,the distance of styloid process to adjacent anatomical structures is as the reference,which helps to find and identify the parapharyngeal space of peripheral nerve, blood vessel,etc.