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目的通过模拟内镜下经双鼻孔至Meckel腔手术入路,对Meckel腔及入路的相关结构进行解剖学研究,为临床内镜下Meckel腔手术提供解剖学及形态学资料。方法对10具(20侧)动静脉灌注乳胶的成人尸头标本,完全模拟经双鼻孔至Meckel腔的手术入路逐层显微解剖,对入路相关解剖标志进行观察、分析、拍摄和测量。结果该入路可分4步,即寻找上颌窦口,进入上颌窦,进入翼腭窝和进入Meckel腔。鼻小柱距上颌窦口的距离为(45.07±2.01)mm,与蝶腭孔的距离为(64.84±3.00)mm,距翼管前孔距离为(71.34±2.99)mm。以鼻小柱至鼻后棘的连线为底边,其与鼻小柱与上颌窦口连线的夹角为(38.81±1.72)。其与鼻小柱与蝶腭孔连线的夹角为(25.92±2.05)°。蝶腭动脉及翼管动脉平均外径分别为(2.21±0.24)mm和(1.07±0.27)mm。翼腭窝区结构复杂,其内上颌动脉及其终支蝶腭动脉和腭降动脉变异较大,沿蝶腭动脉逆行解剖有助于寻找上颌动脉及其分支结构。解剖分离翼腭窝内神经、血管等结构,追踪翼管神经血管束,依据翼管后端正对颈内动脉破裂孔段的特点,解剖分离四方形空间可较直接进入Meckel腔。结论侵犯Meckel腔肿瘤的入路选择应该个体化,应依据肿瘤主体在Meckel腔的位置及范围等决定选1种或联合入路;内镜下经双鼻孔至Meckel腔入路可较直接地暴露Meckel腔的前下内面及翼腭窝区域的解剖结构;手术中重要的解剖标志为蝶腭孔、翼管神经、翼管和上颌神经;翼腭窝中浅部血管结构的解剖有助于深部神经结构的保护,深部神经结构(如翼管神经和上颌神经)和其穿行的骨孔有助于在颅底辨别和控制颈内动脉。
Objective To anatomize the structures of Meckel cavity and access by simulating the operation through the two nostrils to the Meckel cavity under endoscopy and to provide anatomical and morphological data for clinical endoscopic Meckel cavity surgery. Methods Ten adult cadaver heads with arteriovenous and intravenous injection of latex were randomly divided into two groups. The anatomic landmarks were observed, analyzed, photographed and measured . Results The approach can be divided into 4 steps, namely looking for the maxillary sinus mouth, into the maxillary sinus, into the pterygopalatine fossa and into the Meckel cavity. The distance between columella and maxillary ostium was (45.07 ± 2.01) mm, distance to sphenopalatine fossa was (64.84 ± 3.00) mm, and distance from foramen anterior (71.34 ± 2.99) mm. The connection between the columella and the posterior nasal spine was taken as the base. The angle between the columella and maxillary sinus ostium was (38.81 ± 1.72). The angle between the columella and the sphenopalatine foramen was (25.92 ± 2.05) °. The mean diameters of the sphenopalatine artery and the artery of the wing were (2.21 ± 0.24) mm and (1.07 ± 0.27) mm, respectively. The structure of the pterygopalatine fossa region is complex. The variation of palatal arteries and palatal arteries in the maxillary arteries and their terminal spheroids is quite different. The retrograde anatomy along the sphenopalalline artery is helpful to find the maxillary artery and its branches. According to the characteristic that the posterior end of the wing pipe is opposite to the ruptured segment of the internal carotid artery, the anatomically separated tetragonal space can be directly accessed into the Meckel cavity. Conclusion Meckel cavity tumor invasion should be individualized approach should be based on the main body of the tumor in the Meckel cavity location and extent of decision to choose a combination or joint approach; endoscopic transnasal nostril to Meckel cavity approach can be more directly exposed Anterior and medial face of Meckel cavity and anatomy of pterygopalatine fossa region; important anatomical landmarks for the surgery are sphenopalatine foramen, pterygoid nerve, wing and maxillary nerve; anatomy of shallow vessels in pterygopalatine fossa contributes to deep The protection of the nerve structure, deep nerve structures (such as the vascularized nerve and maxillary nerve) and the perforation of the bone hole help to identify and control the internal carotid artery in the skull base.