内镜辅助下经口径路咽旁间隙的解剖

目的 探讨内镜辅助下经口径路咽旁间隙的解剖结构,了解该径路重要的解剖标志及颈内动脉、颈内静脉及后组颅神经等解剖结构的毗邻关系,为内镜辅助下经口径路切除咽旁间隙肿瘤提供解剖学依据。方法 在内镜辅助下对新鲜尸头标本5例(共10侧)行经口径路咽旁间隙解剖。结果 茎突前间隙以咽上缩肌及翼内肌作为解剖标志,茎突咽肌、茎突舌肌是茎突前间隙的后界也是进入茎突后间隙的标志,重要的血管及后组颅神经（舌咽神经、迷走神经、副神经、舌下神经）位于茎突后间隙。以茎突尖端为标志测量距舌咽神经、舌下神经及迷走神经的水平距离分别为（3.05±0.08）mm（2.94～3.14 mm）、(2.94±0.04）mm（2.44～2.56 mm）、（1.50±0.03）mm（1.46～1.56 mm）;以茎突咽肌为标志进行测量,距舌下神经及迷走神经的水平距离分别为;（3.00±0.03）mm（2.96～3.04 mm）、（5.99±0.03）mm（5.94～6.04 mm）,而舌咽神经基本紧贴该肌内侧面。副神经的走行距离茎突及茎突咽肌较远,经口手术径路几乎不会碰到。结论 内镜辅助下经口径路可较好的暴露咽旁间隙结构,咽上缩肌、翼内肌、茎突咽肌、茎突舌肌是重要的解剖标志。     

基于解剖平面的内镜经口入路咽旁段颈内动脉定位方法及临床应用

目的 探讨内镜经口入路中咽旁段颈内动脉（ICA）的定位方法。方法 对4例新鲜尸头标本进行内镜经口入路至颞下窝/咽旁间隙解剖。在37例该区域肿瘤手术中应用基于解剖平面的ICA定位方法评价定位效果。结果 在全部标本中均可清晰分辨咽缩肌层、头长肌前筋膜层和茎突咽筋膜层等解剖平面,后两者交界处稍外侧可作为定位咽旁段ICA的内侧入路标志。采用该方法在手术中实现了93.10% 的ICA准确定位成功。结论 基于解剖平面的咽旁段ICA定位方法解决了内镜经口入路手术的难题,方法较为可靠。     

多模态电磁导航辅助新鲜尸头经鼻内镜的颅底解剖测量

目的 利用电磁导航观察并测量经鼻内镜入路(EEA)至腹侧颅底重要解剖结构,为临床手术提供数据。方法 在10具新鲜尸头上利用电磁导航测量中央、旁中央腹侧颅底的解剖结构,其中颈内动脉(ICA)最为重要。结果 电磁导航有助于判断重要的神经血管走行。腹侧颅底的ICA分为5段+7大分支,各自的长度、走行等均做了测量和记录。结论 ICA的识别和保护是EEA处理腹侧颅底病变的关键,电磁导航辅助可以提高EEA手术效率和安全性。     

内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖

目的通过解剖学研究,探讨内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖特点和方法,寻找手术入路中的重要解剖标志点,测量相关解剖数据,为内镜经鼻入路处理Meckel囊区病变提供解剖学依据。方法 5例共10侧新鲜成人头颅标本,采用内镜经鼻、上颌窦、翼突入路解剖和暴露Meckel囊区,寻找该手术入路中重要的解剖标志,研究具体的解剖方法,测量相关的解剖数据,解剖过程中使用导航。结果鼻小柱下缘至后鼻孔上缘为(66.5±3.3)mm,至蝶窦口下缘为(61.2±1.6)mm,至腭蝶管前口下缘为(64.6±1.4)mm,至蝶腭孔下缘为(62.8±2.3)mm,至翼管前口下缘的距离为(75.4±3.3)mm,翼管前口下缘与腭蝶管前口上缘距离为(2.1±0.7)mm,与圆孔下缘距离为(7.5±0.7)mm,腭蝶管长度为(6.4±0.5)mm,翼管长度为(13.3±1.2)mm。以腭蝶管为解剖标志可以寻找到翼管前口;以翼管为解剖标志可以寻找到岩骨段颈内动脉前膝部,以斜坡旁颈内动脉隆突可以寻找到斜坡旁颈内动脉,以圆孔可以寻找到上颌神经。导航能够准确定位上述解剖标志。结论运用内镜经鼻、上颌窦、翼突入路可以解剖和暴露Meckel囊区。此入路是由Meckel囊前方四边形区域暴露该区域,此四边形内侧为斜坡旁段颈内动脉,下方为岩骨段颈内动脉,上方为展神经,外侧方为上、下颌神经;实验数据和导航可以辅助定位重要的解剖结构和标志。     

咽旁间隙的三维断层解剖学及临床意义

目的 :为咽旁间隙疾病的影像诊断提供解剖学基础。方法 :选用成人尸体头颈部标本 60例 ,分别作冠状、矢状、横断层解剖。在经咽隐窝的断面上 ,观察咽旁间隙及咽旁结构的解剖学关系 ,利用游标卡尺及关联方格分别测量其宽度和面积。结果 :咽旁间隙的冠状、矢状、横断面积分别为 :( 3 48.8± 1.88)mm2 (左 )、( 3 5 0 .0± 2 .0 4)mm2 (右 ) ,( 4 2 5 .0± 2 .3 2 )mm2 (左 )、( 4 2 4.6± 2 .2 8)mm2 (右 ) ,( 4 47.6± 2 .18)mm2 (左 )、( 4 46.4± 2 .10 )mm2 (右 )。两侧咽旁间隙及咽旁结构呈对称性 ,断面宽度和面积均无显著性差异 (P >0 .0 5 )。冠状、矢状、横断层是分别显示咽旁前间隙、咽旁间隙、咽旁后间隙及其结构的最佳断层解剖。结论 :( 1)翼内肌、腭帆提肌、腭帆张肌、咽鼓管、颈内动脉、颈内静脉及茎突是MRI等影像诊断的重要解剖学标志。 ( 2 )咽旁间隙的三维断层解剖对咽旁间隙肿瘤等疾病的影像诊断具有重要意义     

咽旁间隙的CT影像解剖学及临床意义

目的　为咽旁间隙疾病的CT诊断提供影像解剖学资料。方法　选用 6 0例扫描对称的正常CT片 ,在咽隐窝水平层面观察咽旁间隙及咽旁结构的解剖学关系 ,用游标卡尺及关联方格测量其宽度和面积。结果　咽旁间隙呈近似三角形 ,断面面积分别为左 (4 2 6± 3 1 2 )mm2 和右 (4 3 1± 2 96 )mm2 ,两侧咽旁间隙及咽旁结构呈对称性 ,断面面积和宽度无显著性差异 (P >0 0 5 )。自茎突至咽隐窝的连线将咽旁间隙分为咽旁前、后间隙 ,CT图像能较好显示咽旁后间隙内各结构的相互关系。咽旁脂肪组织、颈内动脉、颈内静脉、茎突、翼内肌是CT诊断的重要解剖学标志。结论　咽旁间隙的影像解剖学对咽旁间隙疾病CT诊断具有重要的临床意义     

咽旁间隙的横断层影像解剖及临床意义

目的为咽旁间隙疾病的影像识别和诊断提供断层解剖学依据。方法选用成人尸体头颈部20例,CT扫描后制成横断面,经咽隐窝层面观察咽旁间隙及咽旁结构的解剖学关系,利用游标卡尺和求积仪分别测量其径线及面积。结果在咽隐窝层面上,咽旁间隙呈近似三角形,面积分别为(447.6±2.18)mm2(左)、(446.4±2.10)mm2(右),两侧咽旁间隙及咽旁结构呈对称性。自茎突至咽隐窝的连线将咽旁间隙分为咽旁前、后间隙,CT图像能较好地显示咽旁后间隙内各结构的相互关系。结论咽旁脂肪组织、颈内动脉、颈内静脉、茎突和翼内肌是CT影像诊断的重要解剖学标志,咽旁间隙的横断层解剖对该区疾病的影像诊断具有重要的临床意义。     

内镜齿突切除术的经下颌下入路解剖

目的 通过颈椎CT影像与内镜下寰、枢椎齿突解剖,为内镜下颅颈交界区手术提供依据。方法 选取150例颈椎高分辨薄层平扫CT测量评估寰枢椎及其毗邻结构关系,估算齿突切除术安全界。3例新鲜灌注尸头,采用STORZ内镜系统及内镜手术器械,经下颌下入路行内镜下寰枢椎齿突解剖。结果 通过CT测量得出寰椎前弓长度均值等,估算齿突切除安全界面积为(240.9±39.92)mm²,其中男性(248.3±49.64)mm²,女性(233.2±24.54)mm²。经下颌下的内镜入路寰枢椎解剖及齿突切除解剖以一侧下颌角与舌骨连线中点处横行切口,显露下颌下三角区域,内镜下经下颌下三角区暴露二腹肌及舌骨大角,沿咽后间隙逐层钝性分离至椎前间隙,暴露椎前筋膜,去除椎前组织后充分暴露寰椎、枢椎齿突、寰枕关节、寰枢关节、及部分枕骨大孔区。结论 通过CT影像学估算齿突切除的安全界面积,结合内镜下颌下入路解剖暴露寰枢椎齿突,在内镜的明视下进行有效、安全的手术器械操作,提示经内镜下颌下入路切除齿突在实现充分减压的同时又能极大程度降低脑脊液漏的发生率,减少感染的机...     

颈内动脉岩内段的应用解剖

颈内动脉岩内段是颈内动脉位于颞骨岩部颈动脉管中的一段,其毗邻关系复杂。深入研究颈内动脉岩内段的解剖学特征,有助于耳显微外科和侧颅底外科的发展。本文就近几年来颈内动脉岩内段的显微解剖、影像解剖和手术解剖的进展综述如下。     

咽旁间隙的断层解剖学观测

目的为咽旁肿瘤的CT等影像诊断提供解剖学资料。方法选用20例成尸头颈部横断层标本,在咽隐窝层面观察咽旁间隙及邻近结构的解剖关系,用游标卡尺及关联方格纸测量其宽度和面积。结果 观测咽旁间隙及邻近结构的解剖关系后,发现其两侧宽度及面积均无显著性差异(P>0.05),脂肪平面存在率分别为77.8％和60.0％。结论咽旁间隙的断层解剖对早期咽旁肿瘤的CT等影像诊断具有重要的临床意义。     

咽旁间隙肿瘤手术径路及其应用解剖

结合咽旁间隙应用解剖,对咽旁间隙肿瘤手术径路,包括经颈径路、经颈-腮腺径路、下颌骨截骨术、颞下窝径路、经口径路、经鼻径路进行概述。探讨术中保护颈动脉鞘的解剖标志,并详细介绍以上各手术径路的临床应用、手术要点,为临床开展咽旁间隙肿瘤手术提供参考。     

Anatomic evaluation of the carotid artery bifurcation in cadavers: implications for open and endovascular therapy

Knowledge of carotid bifurcation (CB), common carotid artery (CCA) and its branches and their recognition during diagnostic imaging are also important for vascular surgical procedures in the region, such as carotid endarterectomy or radical neck dissection, catheterization and aneurysms. The surgical anatomy of the carotid arteries was studied in 20 cadavers. Micrometric values of the CB and its relation with surrounding structures, measurements belonging to the external carotid artery (ECA) and internal carotid artery (ICA), and metric data, such as lower face including the greater horn, laryngeal prominence have been evaluated by making linear measures. The diameter of the CCA at the CB under 2 cm and CB diameter was measured as 8.1 +/- 2.24 mm and 12.79 +/- 2.87 mm, respectively. Evaluating data related to the ICA and the ECA in samples, the aspect was measured the ICA and the ECA in the CB discrimination point as 21.52 +/- 20.53 degrees . In the most location of the ECA origin according to the ICA has been determined as medial position in 35 specimens. The origin of the superior thyroid artery (STA) was found to be at the same level with the CB in 40% and below it in 25% specimens. This study has provided measured objective criteria for the arterial features of the neck region, which are crucial during surgery. The origins of the branches of the CCA act as key landmarks for adequate and appropriate placement of the cross-clamp on the carotid arteries.     

扩大经鼻-蝶窦入路至颅底中央区的显微及内镜解剖学研究

目的：为临床单纯内镜或内镜辅助下经鼻一蝶窦入路至颅底中央区的手术提供解剖学标志和参数。方法：乳胶灌注汉族成人尸头湿标本10例,在神经内镜下及手术显微镜下模拟经鼻-蝶窦入路至颅底中央区的手术,按手术步骤分鼻腔内、蝶窦内及蝶鞍和周围结构3部分进行观察和测量。结果：蝶窦是内镜下经鼻-蝶窦入路中的关键结构。蝶窦后壁常见的解剖标志有鞍底、斜坡凹陷、视神经颈内动脉隐窝、颈内动脉隆起、视神经隆起、蝶骨平台;其中,斜坡凹陷是确定鞍底最可靠的标志。此入路可分别向前、中、后颅底方向扩展,内镜下可清晰显露硬脑膜下及海绵窦内部分结构。结论：采用内镜经鼻-碟窦入路是显露颅底中央区病变的良好的手术方法。     

A description of arterial variants in the transoral approach to the parapharyngeal space

This study demonstrates variations in the vascular anatomy of the parapharyngeal space (PPS) as seen from the transoral approach compared with the transcervical approach. The PPS was dissected in injected cadaveric specimens. Anatomical measurements, including those of branches of the external and internal carotid arteries (ECA and ICA) and the styloglossus and stylopharyngeus muscles, were recorded and analyzed. In 67% (8/12) of cases, the ascending palatine artery (APA) originated from the facial artery and crossed the styloglossus muscle. The diameter of the APA at its origin was 1.4 ± 0.3mm. In 75% (9/12) of cases, the ascending pharyngeal artery (aPA) arose from the medial surface of the ECA near its origin. In 58% (7/12) of cases, the aPA ascended vertically between the ICA and the lateral pharynx to the skull base, along the longus capitus muscle. The aPA crossed the styloglossus muscle 12.6 ± 3.9mm from the insertion into the tongue. In 92% (11/12) of cases, the ECA and ICA were separated by the styloid diaphragm and pharyngeal venous plexus. In 8% (1/12), the ECA bulged into the parapharyngeal fat between the styloglossus and stylopharyngeus muscles adjacent to the pharyngeal constrictors. Knowledge of the precise anatomy of the PPS is important for transoral robotic surgery (TORS). Control of the vessels that supply and traverse the PPS can help the TORS surgeon avoid those critical structures and reduce surgical morbidity and potential hemorrhage. Clin. Anat. 27:1016–1022, 2014. © 2014 Wiley Periodicals, Inc.     

The pre-styloid compartment of the parapharyngeal space: a three-dimensional digitized model based on the Chinese Visible Human

To build a digitized visible model of the parapharyngeal space of the Chinese Visible Human and to provide a sectional anatomic basis for radiological and clinical diagnosis of the parapharyngeal space, sectional anatomy data of the parapharyngeal space were selected from the Chinese Visible Human male and female to compare with MR imaging findings in the axial planes. From these data the parapharyngeal space and surrounding structures were segmented. They were then reconstructed in three dimensions on PC. In the axial planes of the sectional anatomy and MR imaging, the shape, content and relations of the parapharyngeal space were clearly displayed and the dominant plane for showing the parapharyngeal space was elicited. The three-dimensional reconstructed images displayed perfectly the anatomic relationships of the parapharyngeal space, parotid, muscles, mandible and vessels. All reconstructed structures can be displayed singly, in groups or as a whole; any diameter or angle of the reconstructed structures can be easily measured. The Chinese Visible Human male and female data set can provide complete and accurate data. The digitized model of the parapharyngeal space and its surroundings offers unique insights into the complex anatomy of the area, providing morphologic data for imaging diagnosis and surgery of the parapharyngeal space.Grant sponsor: National Science Fund of China (NSFC)Grant number: 30270698, 60373112