南方医科大学学报

南方医科大学学报 ›› 2005, Vol. 25 ›› Issue (07): 903-905.

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蝶窦的解剖及其在经单鼻孔蝶窦入路的应用

林俊明, 秦尚振, 龚杰, 徐国政, 胡军民, 李俊   

  1. 解放军武汉总医院神经外科, 湖北, 武汉, 430070
  • 出版日期:2005-07-20 发布日期:2005-07-20
  • 基金资助:
    收稿日期:2005-12-2。
    作者简介:林俊明(1977- ),男,主治医师,南方医科大学2002级硕士研究生,E-mail:zasjm@163.com
    通讯作者:秦尚振,解放军武汉总医院神经外科

Anatomy of the sphenoidal sinus in transsphenoidal approach through a single nostril

LIN Jun-ming, QIN Shang-zhen, GONG Jie, XU Guo-zheng, HU Jun-min, LI Jun   

  1. 解放军武汉总医院神经外科, 湖北, 武汉, 430070
  • Online:2005-07-20 Published:2005-07-20

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摘要： 目的 为经单鼻孔蝶窦入路手术安全切除垂体腺瘤提供解剖学参数。方法 对8例新鲜成人尸体头颅标本和50例成人MRI的蝶窦进行观察,正中矢状位下,鼻小柱根部为O点,蝶窦前壁下缘为B点,蝶窦前壁上缘为C点,鞍底中点为D点,OA线为通过O点与上颌骨牙槽突的平行线,∠AOB’、∠AOC’、∠AOD’分别为∠AOB、∠AOC、∠AOD的补角,测量∠AOB’、∠AOC’、∠AOD’、OB、BC。结果 8例新鲜成人尸体头标本中,∠AOB’为(43.2±4.3)°,∠AOC’为(22.9±3.0)°,∠AOD’为(35.4±4.1)°,OB为(66.3±3.6)mm,BC为(20.9±1.5)mm,有2例出现蝶上筛房;50例成人MRI片中,∠AOB’为(44.1±5.5)°,∠AOC’为(25.7±6.4)°,∠AOD’为(34.2±5.9)°,OB为(68.7±4.9)mm,BC为(23.3±3.1)mm,有15例出现蝶上筛房;经两独立样本均数比较t检验及两独立样本率χ2检验,P>0.05,两组间无显著性差异。结论 术前充分利用MRI提供的信息,有助于术中安全进行蝶窦前壁开窗及鞍底开窗,术中鼻牵开器纵轴与OA线的最佳角度为39°。

Abstract: Objective To study the anatomy of the sphenoid sinus for safe pituitary adenoma resection via transsphenoidal approach through a single nostril. Methods Eight fresh adult cadavers and the magnetic resonance images (MRI) of the sphenoidal sinus of 5 adults were observed.In anteroposterior axes,the root of the nasal columella was defined as the point O,the inferior border of the sphenoidal sinus anterior wall as point B,the superior border of the spheniodal sinus anterior wall as point C,and the midpoint of the sellar floor as point D.Line OA ran through the point O in parallel with the maxillary alveolar process.∠AOB’、∠AOC’ and ∠AOD’ were the supplementary angles of ∠AOB,∠AOC and ∠AOD respectively,and ∠AOB’,∠AOC’,∠AOD’,OB,and BC were measured. Results In the 8 fresh adult cadavers,∠AOB’,∠AOC’,∠AOD’,OB,and BC were (43.2±4.3)°,(22.9±3.0)°,(35.4±4.1)°,66.3±3.6 mm,and 20.9±1.5 mm,respectively,with 2 cases having ethmoid cell superior to the sphenoid bone;in the MRI of 50 adults,the measurements were (44.1±5.5)°,(25.7±6.4)°,(34.2±5.9)°,68.7±4.9 mm,and 23.3±3.1 mm,respectively,with 15 cases having ethmoid cell superior to the sphenoid bone.Two independent-sample t test and Chi-square test revealed no significant differences in the measurements between the two groups (P>0.05). Conclusion Preoperative MRI facilitates safe opening of the anterior wall of the spheniodal sinus and the sellar floor,and the best angle between the axis of the speculum and line OA was 39°.

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