内镜辅助下经口径路咽旁间隙的解剖

Parapharyngeal space anatomy via endoscopy-assisted transoral approach

目的探讨内镜辅助下经口径路咽旁间隙的解剖结构,了解该径路重要的解剖标志及颈内动脉、颈内静脉及后组颅神经等解剖结构的毗邻关系,为内镜辅助下经口径路切除咽旁间隙肿瘤提供解剖学依据。方法在内镜辅助下对新鲜尸头标本5例(共10侧)行经口径路咽旁间隙解剖。结果茎突前间隙以咽上缩肌及翼内肌作为解剖标志,茎突咽肌、茎突舌肌是茎突前间隙的后界也是进入茎突后间隙的标志,重要的血管及后组颅神经(舌咽神经、迷走神经、副神经、舌下神经)位于茎突后间隙。以茎突尖端为标志测量距舌咽神经、舌下神经及迷走神经的水平距离分别为(3.05±0.08)mm(2.94~3.14 mm)、(2.94±0.04)mm(2.44~2.56 mm)、(1.50±0.03)mm(1.46~1.56 mm);以茎突咽肌为标志进行测量,距舌下神经及迷走神经的水平距离分别为:(3.00±0.03)mm(2.96~3.04 mm)、(5.99±0.03)mm(5.94~6.04 mm),而舌咽神经基本紧贴该肌内侧面。副神经的走行距离茎突及茎突咽肌较远,经口手术径路几乎不会碰到。结论内镜辅助下经口径路可较好的暴露咽旁间隙结构,咽上缩肌、翼内肌、茎突咽肌、茎突舌肌是重要的解剖标志。

Objective To observe the anatomical characteristics of the parapharyngeal space via endoscopyassisted transoral approach.Methods The dissection was performed on 5 fresh cadaver heads(10 sides),and the structure of the lateral pharyngeal space was observed via endoscopy-assisted transoral approach.Results The superior constrictor muscle and the musculus medial pterygoid were the landmarks of the prestyloid space.Otherwise the critical marks which divided the parapharyngeal space into 2 parts were stylopharyngeus and styloglossus muscles.The internal carotid artery,the internal jugular vein and the posterior cranial nerves were laterally to the superior constrictor muscle,and meanwhile posterior to the stylopharyngeus and styloglossus muscles.The horizontal distances from the styloid process tip to the glossopharyngeal nerve,hypoglossal nerve and vagus nerve were measured as follows,respectively(3.05±0.08)mm(2.94-3.14 mm),(2.94±0.04)mm(2.44-2.56 mm),(1.50±0.03)mm(1.46-1.56 mm);with the pharyngeal muscle of styloid process as the standard the result showed that the glossopharyngeal nerve was close to the inner side of the muscle and the horizontal distance of hypoglossal nerve and vagus nerve were respectively(3.00±0.03)mm(2.96-3.04 mm)and(5.99±0.03)mm(5.94-6.04 mm).During the anatomy,the accessory nerve was far away from styloid process and styloid process pharyngeal muscle,which could hardly be touched and measured during the operation.Conclusion The parapharyngeal space can be well exposed by endoscopic-assisted transoral approach.The superior pharyngeal constrictor muscle,internal pterygoid muscle,stylopharyngeus and styloglossus muscles are essential landmarks in tumor resection of the pharyngeal space via transoral approach.