五线分区法在鞍区及其毗邻区域占位病变的手术入路选择过程中的应用

Application of the"five-line division method"in selecting surgical approach for spaceoccupying lesions in the saddle area and the adjacent areas

目的探讨“五线分区法”在鞍区及其毗邻区域占位病变的手术入路选择过程中的应用。方法利用天然解剖结构,在经过鞍区正中的颅脑轴面和正中矢状面的影像学图像上分别标出α、β、θ线和λ、ε线(即“五线”),从而在轴面和矢状面上将鞍区及其毗邻范围分别分为6个区域(1、2、3、1'、2'、3'区)和4个区域(Ⅰ、Ⅱ、Ⅲ、Ⅳ区),综合考虑后对鞍区及毗邻区域的巨大占位进行分类,并结合各类常用的鞍区手术入路特点及临床经验,对应出各占位相应的手术入路;随机收集2014年9月~2017年8月期间南方医科大学第三附属医院116例典型的鞍区及其毗邻区域占位病变的患者,用上述方法分析各占位情况在“五线分区法”中所对应的手术入路,并分析比较对应的手术入路与各病例在临床实际中选取的手术入路的一致性。结果以上116例病例的实际手术入路均在我院专家指导下选取,入路选择具有一定的权威性。利用“五线分析法”对应出的手术入路与临床上实际选取的手术入路具有较高的一致性、良好的客观性。结论“五线分区法”可对常见的鞍区及其毗邻区域占位病变的空间位置进行分类并能在其手术入路选取过程中提供较客观的参考价值。

Objective To explore the application of the“five-line division method”in selecting the surgical approach for occupying lesions in the saddle area and its adjacent areas.Methods Based on the natural anatomic structures,5 lines(alpha,beta,theta line and lambda,epsilon line)were drawn on the images of the craniocerebral axial plane crossing the middle of the saddle area and the craniocerebral median sagittal plane,thus dividing the saddle area and its adjacent areas into 6 regions in the axial plane(1,2,3,1',2',and 3'regions)and into 4 regions in the sagittal plane(I,II,III,and IV regions).Based on these divisions,the large space-occupying lesions in the saddle area and adjacent areas were classified and their respective surgical approaches were determined after reviewing the commonly used approaches in the saddle area and clinical experiences.We collected the data of 116 patients undergoing surgeries for space-occupying lesions involving the saddle and the adjacent areas in our hospital between September,2014 and August,2017,and analyzed their classifications and the corresponding surgical approaches based on the"five-line division method"to compare the consistency between the hypothetic approaches and the approaches adopted in the actual surgeries.Results The actual surgical approaches adopted in the 116 cases were all selected under the guidance of experts in our hospital.The hypothetic surgical approaches selected based on the“five-line division method”showed a good consistency with the actually adopted approaches.Conclusion The“five-line division method”can spatially classify the commonly seen space-occupying lesions involving the saddle area and its adjacent area to provide assistance in the selection of surgical approaches for such lesions.