内镜下单鼻孔经鼻中隔与经蝶窦前壁入路的对比解剖学研究

Comparative endoscopic anatomic study on endonasal transsphenoidal via anterior wall of sphenoid sinus approach and endonasal transsphenoidal via nasal septum-sphenoid sinus approach

目的模拟内镜下经单鼻孔经鼻中隔与蝶窦前壁手术入路,评价两种入路的优缺点。方法内镜下分别对每组15具成人尸头行单鼻孔经鼻中隔入路及蝶窦前壁入路模拟手术,分别测量切口距离外鼻孔距离、鼻孔至鞍底平面上(手术路径上)手术器械在水平方向上所能摆动的最大角度及距离、以及其他相关解剖参数。结果单鼻孔鼻中隔入路和蝶窦前壁入路切口处距离外鼻孔距离分别是(5.19±0.15)cm和(6.91±0.14)cm,手术路径上器械在水平方向上所能摆动的最大角度分别是(44.77±2.04)°和(38.54±1.40)°,水平方向上所能摆动的最大距离分别是(1.25±0.15)cm和(0.59±0.52)cm。两种入路相关数据对比有统计学意义(P<0.001)。结论内镜下经单鼻孔蝶窦入路行鞍区病变切除中,相对蝶窦前壁入路经鼻中隔入路是一种损伤小,切口距离鼻孔短,定位明确而且操作空间及视角较大的手术入路,可双器械操作,值得临床推广。

Objective To compare endonasal transsphenoidal via anterior wall of sphenoid sinus approach with endonasal transsphenoidal via nasal septum- sphenoid sinus approach by imitation of the endoscopic surgery. Methods The head of 15 samples were dissected respectively via two above mentioned approaches as an imitation of the endoscopic surgery, and the distance between incision and external nostrils, maximum angle and range of swing were measured in the horizontal direction on operative route and other related anatomic parameters. Results Distances between incision and external nostrils of anterior wall of sphenoid sinus approach and nasal septum-sphenoid sinus approach are（5.19±0.15） cm versus（0.59 ± 0.52） cm; maximum angle and range of swing in horizontal direction on operative route are（44.77 ±2.04）° versus（38.54 ± 1.40）°, and（1.25 ± 0.15） cm versus（0.68 ± 0.05） cm. The correlation data of the two approaches were statistically significant（P〈0.001）. Conclusions Endonasal transsphenoidal via nasal septum-sphenoid sinus approach incurs milder damage, enjoys short distance to the outside of the nose, clear positioning, wider operation space and larger perspective surgical approach, which is worthy of clinical promotion.