经鼻腔-蝶窦垂体手术入路的解剖学观察

A clinic anatomical study on transnasal transsphenoidal pituitary surgery

目的 :寻找经鼻腔 蝶窦垂体手术确定垂体窝的解剖学依据。方法 :矢状锯开成尸头 6 0例、成人颅骨 30例和完整成人颅骨鼻腔 70例 ,观测经鼻腔 蝶窦垂体手术入路形态结构。结果 :鼻中隔后缘上端与垂体窝中部垂直相对 ,由此上端垂直向上平均 15 (11～ 2 1)mm为垂体窝。前鼻棘至鼻中隔后缘上端距离 x±s为 (76 .0± 2 .1)mm ,前鼻棘经蝶窦口至垂体窝距离 x±s为 (76 .2± 2 .3)mm。自蝶窦口向下内接近鼻中隔后缘上端扩大手术野即可安全显露并靠近垂体窝。结论

Aim:To find out the landmark for the pituitary fossa exactly in the transnasal transphenoidal pituitary surgery.Methods:The sigittal planes of nasal cavities of 30 adult skulls,60 cadaver heads,and nasal cavities of 70 whole skulls were examined for the structure of transnasal transsphenoidal pituitary in the surgery.Results:The superior end of nasal septal posterior margin was just vertically opposite to median part of pituitary fossa. The distance from this superior end to the pituitary fossa was 15(11～21)mm.The distance from nostril to this superior end of nasal septal posterior margin was( 76.0± 2.1)mm and almost was equal to the distance from nostril to pituitary fossa ( 76.2±2.3)mm. From the opening of sphenoid sinus to median and inferior towards the nasal septem,after the anterior wall was removed, the bone plate of pituitary fossa was shown safely.Conclusion: The superior end of nasal septal posterior margin is a landmark for the pituitary fossa exactly.