基于解剖平面的内镜经口入路咽旁段颈内动脉定位方法及临床应用

A transoral endoscopic approach to locate the parapharyngeal segment of the internal carotid artery

目的探讨内镜经口入路中咽旁段颈内动脉(ICA)的定位方法。方法对4例新鲜尸头标本进行内镜经口入路至颞下窝/咽旁间隙解剖。在37例该区域肿瘤手术中应用基于解剖平面的ICA定位方法评价定位效果。结果在全部标本中均可清晰分辨咽缩肌层、头长肌前筋膜层和茎突咽筋膜层等解剖平面,后两者交界处稍外侧可作为定位咽旁段ICA的内侧入路标志。采用该方法在手术中实现了93.10%的ICA准确定位成功。结论基于解剖平面的咽旁段ICA定位方法解决了内镜经口入路手术的难题,方法较为可靠。

Objective To establish an anatomically-based method for locating the parapharyngeal segment of the internal carotid artery(ICA)via transoral endoscopy.Methods Applied anatomic study was performed in 4 fresh adult cadaver heads(8 sides)via transoral endoscopy to explore the infratemporal fossa/parapharyngeal space.The localization method based on anatomic plane was subsequently used in 37 cases of tumor surgery in this area,with the operational accuracy evaluated.Results Following dissection of the layers of pharyngeal constrictor,anterio fascia of the longus capitis and stylopharyngeal fascia,the junction of the latter two was identified as a potential landmark to locate the parapharyngeal ICA in surgery.Following practice on the patients,a success rate of 93.10%was achieved by using this method for ICA localization.Conclusion The parapharyngeal ICA localization method based on anatomic plane is clinically reliabie.