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| 鼻内镜下经蝶垂体手术中海绵间窦的应用解剖 |
| 刘环海,廖建春,范静平,王海青,邓彬华,王宝东,党瑞山,胡国汉,胡建道 |
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| (第二军医大学长征医院耳鼻咽喉科,上海,200003;第二军医大学基础医学部人体解剖学教研室,上海,200433;413医院耳鼻喉科,舟山,316000) |
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| 摘要: |
| 目的:为鼻内镜下经蝶窦垂体手术选择安全手术进路,避免损伤海绵间窦导致大出血提供解剖学参数.方法:在20例国人头颅标本上,应用手术显微镜和鼻内镜对海绵间窦,包括前海绵间窦、下海绵间窦、后海绵间窦、基底窦、鞍背窦,进行解剖学观察,测量相关解剖学数据,并对结果进行分析.结果:前海绵间窦、下海绵间窦、后海绵间窦、基底窦、鞍背窦的出现率分别为95﹪(19例)、75﹪(15例)、10﹪(2例)、100﹪(20例)、30﹪(6例);前后径分别为(2.08±0.90)、(5.14±2.54)、(1.30±0.40)、(2.26±1.02)、(2.01±0.80) mm;上下径分别为(2.74±0.96)、(1.10±0.74)、(1.48±0.29)、(15.67±4.54)、(3.35±1.93) mm.前海绵间窦的下极至下海绵间窦的前极距离(5.78±1.89) mm.结论:鼻内镜下经蝶垂体手术时,打开鞍底骨质后,尽量避开海绵间窦暴露垂体,无法避开时,必须在损伤前合理选择切口和止血方法,避免大出血. |
| 关键词: 海绵间窦、蝶窦、垂体、鼻内镜、解剖学 |
| DOI：10.3724/SP.J.1008.2006.00823 |
| 投稿时间：2006-03-21修订日期：2006-07-10 |
| 基金项目:第二军医大学长征医院"十五"联合攻关课题(2004002). |
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| Applied anatomy of intercavernous sinuses for transsphenoidal endoscopic pituitary surgery |
| LIU Huan-hai,LIAO Jian-chun,FAN Jing-ping,WANG Hai-qing,DENG Bin-hua,WANG Bao-dong,DANG Rui-shan,HU Guo-han,HU Jian-dao |
| (第二军医大学长征医院耳鼻咽喉科,上海,200003;第二军医大学基础医学部人体解剖学教研室,上海,200433;413医院耳鼻喉科,舟山,316000) |
| Abstract: |
| Objective：To search for a safe approach for transsphenoidal endoscopic pituitary surgery, so as to avoid injury of intercavernous sinuses during the operation. Methods： The anterior intercavernous sinus, posterior intercavernous sinus, inferior intercavernous sinus, basilar sinus, and dorsum sella sinus of 20 Chinese adult cadavers were surgically observed; and the relevant data were obtained and analyzed. Results： The existence rates of anterior intercavernous sinuses, posterior intercavernous sinuses, inferiorintercavernous sinuses, basilar sinuses, dorsum sella sinuses were 95%（19）, 75%（15）, 10%（2）, 100% （20） and 30%（6）,respectively; their anteroposterior diameters were （2.08±0. 90） mm,（5. 14±2. 54） mm,（1.30±0.40） mm,（2.26±1.02） mm, and （2. 01 ± 0. 80） mm, respectively; and their supra-inferior diameters were （2. 74 ± 0. 96） mm, （1.10±0.74） mm, （1.48±0.29） mm, （15.67±4.54） mm, and （3.35±1.93） mm, respectively. The distance between inferior edge of anterior intercavernous sinus and the anterior edge of posterior intercavernous sinus was （5. 78 ± 1. 89） mm. Conclusion：The intercavernous sinus should be avoided to expose the pituitary after opening the antapex of sella trucica during transsphenoidal endoscopic pituitary surgery. When the intercavernous sinus can not be avoided, reasonable incision and hemostatic method should be selected before operation to prevent severe bleeding. |
| Key words: intercavernous sinuses pituitary transnasal endoscopic anatomy |
