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目的比较各颈静脉孔区手术入路的显露范围,为选择恰当的手术入路切除不同范围的颈静脉孔区病变提供解剖学依据。方法成人头颈标本6具随机将标本分为A、B、C三组,每组2具尸头。其中A组应用颈侧入路、B组依次采取鼓室底入路和改良鼓室底入路、C组依次选择Ⅰ型颞下窝入路及改良Ⅰ型颞下窝入路进行颈静脉孔区解剖,比较各手术入路对颈静脉孔区及其周围解剖区域的显露程度。结果颈侧入路对颈静脉孔的颅外部分及咽旁间隙显露良好;鼓室底入路在颈侧入路的基础上进一步显露乳突、乙状窦垂直段、颈静脉球、颈静脉孔神经部;Ⅰ型颞下窝入路又在鼓室底入路的基础上扩大显露外耳道深部、中耳腔及岩骨内颈内动脉垂直段;改良鼓室底入路和改良Ⅰ型颞下窝入路很好地弥补了鼓室底入路和Ⅰ型颞下窝入路对乙状窦水平段和颈静脉孔血管部显露不足的缺陷。结论不同颈静脉孔区手术入路对颈静脉孔区的显露程度各不相同。以此为依据,根据颈静脉孔区病变的范围选择手术入路对有效显露和切除病变,减少结构和功能破坏具有现实的指导意义。
Objective To compare the exposure range of each jugular foramen region in order to provide anatomical basis for choosing the appropriate surgical approach to remove different ranges of jugular foramen area lesions. Methods Six adult head and neck specimens were randomly divided into three groups A, B and C, each with 2 cadaver heads. In group A, the approach of neck approach was used. In group B, the approach of tympanic base approach and modified tympanic approach were used in turn. In group C, type I temporo-inferior fossa approach and modified type I infratemporal fossa approach were used to dissect jugular foramen , The comparison of each surgical approach to the jugular foramen area and the surrounding anatomical area of the degree of exposure. Results The lateral approach of the jugular foramen revealed a good appearance of the extracranial part of the jugular foramen and the parapharyngeal space. The tympanic approach further revealed the mastoid, the vertical segment of the sigmoid sinus, the jugular bulb, the jugular foramen Department of neurosurgery; type Ⅰ infratemporal fossa approach again in the tympanic fundus approach based on the expansion of the exposed external auditory canal deep, middle ear cavity and petrous bone internal carotid artery vertical segment; modified tympanic fundus approach and improved type Ⅰ infratemporal fossa Road well to make up for the tympanic floor and type Ⅰ infratemporal fossa entrance of the horizontal segment of the sigmoid sinus and jugular foramen vascular defects revealed deficiencies. Conclusions The surgical approach of different jugular foramen region has different exposure to the jugular foramen region. Based on this, selecting the surgical approach according to the range of the jugular foramen area has the realistic guiding significance for effectively revealing and removing the lesion and reducing the structure and function destruction.