眼动脉及其相关动脉的应用解剖学研究

目的：探讨介入栓塞上颌动脉治疗鼻出血引发单眼失明发生的原因,为防止类似严重并发症的发生提供相关血管的解剖学基础。方法：在100侧人脑标本上观察眼动脉、视网膜中央动脉和异常眼动脉的起始走行和出现率,以及眼动脉和上颌动脉的交通支路径。结果：眼动脉95％发自颈内动脉前床突上段,5％发自上颌动脉的分支脑膜中动脉,眼动脉和脑膜中动脉之间有交通支存在的占80％,视网膜中央动脉100％发自眼动脉。结论：上颌动脉栓塞导致单眼失明的原因是眼动脉异常起始脑膜中动脉或脱落的阻塞剂栓子或血栓经上颌动脉的脑膜中动脉与眼动脉交通支阻塞眼动脉或视网膜中央动脉所致。提示治疗难治性鼻出血栓塞上颌动脉时导管应置入上颌动脉末端,以避开脑膜中动脉;术后一旦有视物不清,4h内进行溶栓,视力可望恢复。     

鼻内镜翼腭窝上颌神经切除治疗三叉神经痛

目的：探讨一种有效治疗原发性三叉神经第二支（上颌支）痛的手术方法。方法：对136例（136侧）原发性三叉神经第二支（上颌支）痛的患者在鼻内镜下经上颌窦后进路翼腭窝内圆孔处切断翼腭窝神经和眶下神经全长切除。结果：135例患者术后疼痛消失。经2~8年随访观察,118例患者无复发疼痛,但有轻度术侧上颌神经支配区麻木和感觉异常。结论：鼻内镜下经上颌窦后进路翼腭窝内圆孔处切断翼腭窝神经和眶下神经全长切除适用于原发性三叉神经第二支（上颌支）痛的患者,手术效果好,避免了开颅手术的危险,在临床上值得推广应用。     

鼻腔上颌窦神经鞘瘤4例报告

神经鞘瘤起源于周围神经雪旺细胞 ,也称雪旺瘤 (ｓｃｈｗａｎｎｏｍａ) ,可发生于人体各部 ,因为除嗅神经和视神经因不含雪旺细胞外 ,其他神经均含此细胞 ,故该瘤可发生于人体各部 ,其中头颈部占 2 5 %～ 45 %。常见于口、耳、鼻、咽、喉各处 ,但发生于鼻腔、鼻窦较少见。我院 1 994年 1月～ 2 0 0 1年 6月收治鼻腔上颌窦神经鞘瘤 4例 ,均经手术和病理证实 ,术后观察 6个月～ 5年无复发。现将诊治中的体会报告如下。1　病例介绍例 1　女 ,5 8岁。因反复左鼻腔出血 2个月伴鼻塞 2 0ｄ就诊。检查 :左中鼻道内见一红色新生物 ,附少许血痂 ,蒂不…     

上颌窦神经鞘瘤误诊为上颌窦囊肿1例

患者 ,男 ,31岁。左鼻通气不畅 ,流涕 2年 ,近5ｄ左侧鼻塞加重 ,流黄涕 ,发热达 38.5℃ ,左面颊疼痛 ,左眼胀痛、流泪 ,经抗炎治疗症状不减轻 ,于2 0 0 0年 1 1月 2 4日收入院。体检 :体温 37.7℃ ,左面颊肿胀 ,左眼上下睑肿胀 ,眼球无移位 ,各方向运动可 ,无复视。左鼻腔外侧壁内移 ,下鼻甲肿大 ,表面光滑 ,收缩不敏感 ,鼻腔未见新生物。鼻窦ＣＴ示 :左侧上颌窦被软组织肿块填充 ,密度均匀 ,内壁吸收 ,肿物侵入鼻腔及左眶内下壁进入左眶 ,左鼻泪管阻塞。血常规 :白细胞 1 2 .3× 1 0 9/Ｌ。诊断 :左上颌窦囊肿并感染。于 1 1月 2 9日行上颌…     

鼻腔上颌窦神经鞘瘤1例

患者 ,女 ,64岁。反复左鼻腔出血 3个月伴鼻塞 1 5ｄ。患者 3个月前无诱因出现擤鼻后左鼻腔出血 ,出血量不等 ,多则 3～ 5滴 ,少则为涕中带血 ,未经诊治。近半个月来出现左鼻塞 ,但无头痛、面部麻木和疼痛 ,无嗅觉障碍。左鼻腔组织活检报告为 :左鼻腔出血性息肉。 2 0 0 0年 7月 2 6日到我科就诊 ,鼻窦ＣＴ检查报告 :符合左鼻腔、左上颌窦肿瘤 ,原发于鼻腔或上颌窦都有可能。于 7月 31日收住院。体检 :左中鼻道内可见一红色新生物 ,其上有大量血痂附着 ,蒂不清。当即取活检 ,病理诊断为 :左鼻腔神经鞘瘤。在局麻加强化下行左上颌窦根治术加…     

上颌动脉栓塞并发单眼失明1例

患者 ,男 ,34岁。因反复发作性鼻出血 10d ,于2 0 0 4年 1月 2 4日入院。入院诊断“鼻出血”。体检 :双侧下鼻甲后方有凝血块 ,并有出血 ,行鼻腔棉球填塞处理后 ,仍不能有效止血。入院当日反复出血 10余次 ,各种治疗方法均无效。患者以往无高血压和鼻塞病史 ,入院后各项常规检查和辅助检查除血红蛋白偏低外 ,其余均未见异常。入院第 2天行介入治疗。手术方法 :局部麻醉下 ,经双侧股动脉插管 ,分别置导管头于左右颈外动脉 ,用碘海醇 7ml以3ml/s的速度行侧位血管造影检查。结果显示 :双侧颈外动脉无异常 ,可见双侧上颌动脉和面动脉增粗 ,分支…     

上颌窦径路翼腭窝区域上颌神经高位切断术治疗三叉神经痛

翼腭窝是面深部的一个重要结构,与颅内外许多腔隙和窝相交通。经上颌窦径路处理翼腭窝区域病变由于手术径路深邃,视野受限,操作困难,易发生并发症。上颌窦径路上颌神经高位切断术是治疗三叉神经痛的有效手段。笔者在解剖学研究的基础上,通过对上述手术治疗的总结,为此区域手术治疗提供参考。     

上颌动脉翼腭段螺旋CT血管成像的研究

目的 研究上颌动脉翼腭段的走行及分支规律,为上颌动脉相关手术提供个体化处理的依据.方法 无翼腭窝病变的31例(62侧)头颅64层螺旋CT血管成像扫描分析,采用容积再现、曲面重建等方法观察上颌动脉翼腭段主要分支的显示及分型情况.结果 CT血管成像能清晰显示上颌动脉的主干及其分支,如腭降动脉、蝶腭动脉.在Choi和Park分型基础上,将腭降动脉与蝶腭动脉呈水平平行模式,走行类似字母英文"F"定义为F型,上颌动脉干形状分为Y型、T型、中间型、M型、F型及其他型分别占14.5%(9侧),9.7%(6侧),24.2%(15侧),32.3%(20侧),12.9%(8侧)和6.4%(4侧).结论 上颌动脉翼腭段的走行、分布及变异情况有规律可循,螺旋CT血管成像能为个体化手术提供可靠依据.     

上颌动脉翼腭段螺旋CT血管成像的研究

目的 研究上颌动脉翼腭段的走行及分支规律,为上颌动脉相关手术提供个体化处理的依据.方法 无翼腭窝病变的31例(62侧)头颅64层螺旋CT血管成像扫描分析,采用容积再现、曲面重建等方法观察上颌动脉翼腭段主要分支的显示及分型情况.结果 CT血管成像能清晰显示上颌动脉的主干及其分支,如腭降动脉、蝶腭动脉.在Choi和Park分型基础上,将腭降动脉与蝶腭动脉呈水平平行模式,走行类似字母英文"F"定义为F型,上颌动脉干形状分为Y型、T型、中间型、M型、F型及其他型分别占14.5%(9侧),9.7%(6侧),24.2%(15侧),32.3%(20侧),12.9%(8侧)和6.4%(4侧).结论 上颌动脉翼腭段的走行、分布及变异情况有规律可循,螺旋CT血管成像能为个体化手术提供可靠依据.     

上颌动脉翼腭段螺旋CT血管成像的研究

目的 研究上颌动脉翼腭段的走行及分支规律,为上颌动脉相关手术提供个体化处理的依据.方法 无翼腭窝病变的31例(62侧)头颅64层螺旋CT血管成像扫描分析,采用容积再现、曲面重建等方法观察上颌动脉翼腭段主要分支的显示及分型情况.结果 CT血管成像能清晰显示上颌动脉的主干及其分支,如腭降动脉、蝶腭动脉.在Choi和Park分型基础上,将腭降动脉与蝶腭动脉呈水平平行模式,走行类似字母英文"F"定义为F型,上颌动脉干形状分为Y型、T型、中间型、M型、F型及其他型分别占14.5%(9侧),9.7%(6侧),24.2%(15侧),32.3%(20侧),12.9%(8侧)和6.4%(4侧).结论 上颌动脉翼腭段的走行、分布及变异情况有规律可循,螺旋CT血管成像能为个体化手术提供可靠依据.     

经上颌窦内镜翼腭窝三叉神经上颌支部分切除术

目的 :探讨一种有效治疗年老体弱患者单独原发性三叉神经上颌支痛的手术方法。方法 :对 39例 4 0侧原发性三叉神经上颌支痛的年老体弱患者在内镜下经上颌窦至翼腭窝在圆孔处切除上颌神经 0 .5～ 1.0cm。结果 :术后全部病例疼痛消失 ,经 2年以上观察 ,术侧上颌神经分布区麻木、感觉异常 ,但无疼痛 ,2例分别于术后 5个月和 12个月出现术侧下颌神经痛 ,上颌区无痛。结论 :内镜下经上颌窦至翼腭窝行三叉神经上颌支部分切除术适用于年老体弱、长期单独局限于上颌神经痛的患者 ,但要求其上颌窦腔有一定程度发育和无炎症 ,手术远期效果好 ,避免了开颅手术的危险 ,在内镜下完成该手术较显微镜下更方便     

External carotid artery blood supply to the orbit

The utility of angiography and embolisation of selected branches of the external carotid artery is occasionally helpful in the management of recurrent epistaxis, pre-operative devascularisation of tumours such as angiofibromas, and other head and neck conditions. The use of embolisation for recalcitrant post-tonsillectomy bleeding due to the formation of an aneurysm or pseudoaneurysm of branches of the external carotid artery has been described [P. Simoni, J. Bello, B. Kent, Pseudoaneurysm of the lingual artery secondary to tonsillectomy treated with selective embolization, Int. J. Pediatr. Otorhinolaryngol. 59 (2) (2001) 125-128]. There are also reports of pseudoaneurysm formation on the internal carotid following tonsillectomy [F. Tovi, A. Leiberman, Y. Hertzanu, L. Golcman, Pseudoaneurysm of the internal carotid artery secondary to tonsillectomy, Int. J. Pediatr. Otolaryngol. 13 (1987) 69-75]. The repeated presentation of a 5-year-old girl with post-operative tonsillectomy bleeding on three separate occasions, each approximately 1 week apart, prompted the consideration of the diagnosis of aneurysm formation, and hence, angiography was performed. The anomalous finding from this study precluded embolisation due to the risk of blindness. This experience has prompted this review which highlights the important issues of angiographic assessment prior to embolisation. The relevance of this to external carotid artery ligation is also reflected upon.     

回返穿通动脉与面听神经关系的解剖学研究

目的：介绍回返穿通动脉(RPA)与面-听神经的关系，为桥小脑角(CPA)的前庭-耳蜗神经(VN)血管减压术提供有实用价值的解剖学资料。方法：测量20具经甲醛固定的成人尸颅，观察CPA内与面、听神经有关的RPA的解剖结构，重点是与VN间的位置关系。结果：RPA出现率为100％，发出1个分支的有30侧(75．0％)，2个分支的有10侧(25．0％)；位于面神经(FN)、VN之间有32侧(80．0％)，其中87．5％位于FN中外2／3。VN的血管接触率为95％，有2支或2支以上血管与VN接触的有20侧(50．0％)。结论：了解、熟悉RPA与面-听神经的关系，对提高VN显微血管减压术的成功率以及临床影像学的诊断价值具有指导意义。     

Infantile schwannoma of the maxillary sinus

A rare case of a 5-year-old female with schwannoma of the maxillary sinus is presented. She had complained of painless swelling of the left cheek and hard palate for a duration of one year. Preoperatively, a CT scan strongly suggested it to be a maxillary cyst with an erupted tooth rather than neoplasm. The tumour was completely removed after embolization of the left internal maxillary artery. The tumour was composed of spindle cells in a palisading pattern and intercellular collagenous fibres. Mitotic figures and atypical nuclei were not observed. Immunohistochemically, the majority of the cells were positive for NSE and S-100 protein, whereas GFA and PCNA showed little immunoreaction. The pathological diagnosis was Antony type A of schwannoma arising in the maxillary sinus.     

Radial artery graft for bypass of the maxillary to proximal posterior cerebral artery: An anatomical and technical study

Objective To examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to the external carotid artery (ECA) to PCA anastomosis used in posterior circulation bypass surgery.

Materials and methods The method was applied to five adult cadaver sides bilaterally. The MA was easily found 1–2 cm beneath the infratemporal crest after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally, 2–3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4-mm tipped drill. After sylvian fissure, the interpedincular and ambient cisternae were opened and the P2 segment of the PCA appeared. The graft was passed through the hole and dura to reach the P2 segment. Proximal to the infraorbital artery branch, the MA was freed from the surrounding tissue and transected. The proximal side of the radial artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the P2 segment of the PCA.

Results The average diameter of the MA proximal to the infraorbital artery branch was 2.6±0.3 mm. The average diameter of the P2 was 2.2±0.2 mm. The average length of the graft was 47±5.2 mm.

Conclusion As MA to proximal PCA bypass uses a short radial graft and as the calibers of the MA and PCA are >2 mm such a bypass may provide sufficient blood flow and represents a reasonable alternative to “ECA to PCA” bypass.     

柯-陆手术进路上颌窦成形术的实验与临床研究

目的：探讨提高上颌窦疾病疗效的方法。方法：在动物实验的基础上,应用鼻内窥镜和显微外科技术,对６８例良性上颌窦病变,循柯－陆手术进路,行前壁环钻术和中鼻道窦造口术及骨壁修复成形术。结果：术后第５周,犬窦腔粘膜再生和修复较完全,前臂骨瓣成形骨痂愈合,临床随访１８￣４２个月（平均２８个月）中鼻道窦口通畅９６％,结论：表明上颌窦成形术在彻底清除病灶的基础上,恢复窦腔解剖结构,保持生理性引流通道,有利于术后     

Dominant maxillary artery as a cause of failure in maxillary artery ligation for posterior epistaxis

Ligation of the maxillary artery is a logical and effective method for the arrest of severe uncontrollable posterior epistaxis. The failure rates for arrest of haemorrhage are given in the literature as 10–13%. In our centre, over the last 9 years, 23 patients have undergone maxillary artery ligation to control epistaxis without a failure. Bilateral maxillary artery ligation was carried out whenever the maxillary artery of the bleeding side was found to be of small diameter. To investigate whether there is an asymmetry in the size of the maxillary arteries we performed 13 cadaveric dissections. In 6 of the cadavers one maxillary artery was significantly larger than the other. This fact has hitherto not been observed by otolaryngologists or anatomists. Failure to arrest haemorrhage may have resulted from ligation of the non-dominant maxillary artery with consequent opening of cross-anastamoses from the dominant side.     

舌动脉和舌下神经的解剖特点及与舌根的解剖关系

目的:观察舌动脉、舌下神经的走行及其与舌表面标志点的关系,以及舌动脉、舌下神经的相互关 系,为临床提供舌动脉、舌下神经的形态学资料,指导舌根手术,提高手术安全性。方法:10具(20侧)甲醛固定、 颌面部发育正常的成人尸头标本,颈总动脉灌注红色乳胶。观察:①舌动脉和舌下神经的起源、走行、分段,测量 各段长度;②舌动脉和舌下神经与各解剖标志点的距离;③舌动脉和舌下神经的解剖关系。结果:舌动脉全长为 (9.73±0.83)cm;第1、2、3、4段分别为(1.81±0.46)cm、(2.98±0.45)cm、(1.24±0.39)cm、(3.79±0.28)cm。 舌动脉主干距舌盲孔前1cm、舌盲孔、舌盲孔后1cm及舌盲孔至舌骨、舌侧缘,舌动脉距舌侧缘的距离分别为 (2.34±0.20)cm、(2.48±0.14)cm、(2.43±0.26)cm、(2.53±0.33)cm、(2.14±0.16)cm、(1.11±0.09)cm。舌 下神经距舌盲孔前1cm、舌盲孔、舌盲孔后1cm、舌骨、舌侧缘及下颌骨内侧缘的距离分别为:(2.28±0.14)cm、 (2.36±0.18)cm、(2.34±0.21)cm、(1.25±0.42)cm、(1.86±0.32)cm、(2.64±0.28)cm。舌下神经与舌动脉最 小距离、舌下神经在舌骨大角距舌动脉距离、舌下神经与舌动脉交叉点距舌骨的垂直距离分别为: (0.38±0.38)cm、(0.35±0.31)cm、(1.48±0.26)c