鼻内镜下经鼻腔入路翼腭窝解剖学研究

目的：通过鼻内镜下鼻腔外侧壁入路对翼腭窝的解剖学研究，为临床内镜下翼腭窝手术入路提供解剖学基础。方法：10具新鲜尸头采用内镜下鼻腔外侧壁入路对翼腭窝进行解剖，观测手术径路中重要标志及穿经血管神经结构，并观测翼腭窝内结构及其与周围结构的关系。结果：①翼腭窝及其周围结构解剖关系复杂，颌内动脉及其分支变异较大；②蝶腭孔、眶下管、圆孔和翼管是翼腭窝重要骨性标志，同时翼腭窝可作为进入颞下窝和蝶窦的通路。结论：①熟知翼腭窝及其周围恒定的解剖标志可保持方向感，提高手术安全性；②鼻内镜下经鼻腔外侧壁入路可充分暴露翼腭窝，视野清晰，术中对重要神经血管控制较好，可根据病变范围变通手术径路；③经鼻内镜下鼻腔外侧壁入路可进入翼腭窝临近区域，处理临近区域病变。

The anatomical study of the pterygopalatine fossa under endoscopy via the nasal cavity approach

Objective：To provide a basic anatomical study of clinical endoscopic surgical approach, we investigated the pterygopalatine fossa anatomy through lateral wall of the nasal cavity approach under endoscopy. Method：To observe important symbols and the neurovascular structure and its relations with the surrounding structure of pterygopalatine fossa, we dissect ten fresh cadaveric heads via lateral wall of the nasal cavity approach under endoscopy. Result：①The anatomical relations between pterygopalatine fossa and the surrounding structure were complicated, and internal maxillary artery and its branches were variated greatly. ②Sphenopalatine foramen, infraorbital canal, foramen rotundum and pterygoid canal were the important symbol of bone of pterygopalatine fossa, and pterygopalatine fossa could be used as a access into the infratemporal fossa and sphenoid sinus. Conclusion：① An intimate knowledge of the constant anatomical symbols of the pterygopalatine fossa and the surrounding structure would maintain a sense of direction and improve surgery safety. ②The pterygopalatine fossa could be exposed fully under endoscopy, and the vision was clear. Besides,the important nerves and vessels would be well protected, and operative approach was flexible according to the scope of pathological changes. ③The near anatomic region could be accessed and the pathological changes could be treated through the endoscopic surgical approach.