寰椎侧块与颈内动脉在经口咽前路手术中的意义

目的　通过对颈部血管CTA扫描，研究寰椎侧块与颈内动脉的毗邻关系，以避免经口咽前路手术过程中损伤颈内动脉。 方法　回顾性选择2012年1月-2015年6月在我院行TARP手术的患者145例，术前均行颈部CTA扫描及三维重建，以横突孔内侧缘为界，根据颈内动脉的位置分为外侧组和内侧组，并进一步划分为4个区。分别测量2组患者双侧颈内动脉内侧缘、双侧横突孔内侧缘至寰椎正中线距离，术后颈内动脉偏移距离，比较两组左右两侧各参数之间是否存在显著差异。 结果　内侧组双侧颈内动脉内侧缘至寰椎正中线距离（d），同侧颈内动脉内侧缘与横突孔内侧缘至寰椎正中线距离（d与l），内、外组同侧颈内动脉至寰椎正中线距离（d与D）之间比较均有显著差异，P<0.05。内侧组术后颈内动脉向外偏移距离分别为3.12 mm（女）、3.83 mm（男）。 结论　经口咽前路手术前行颈部血管CTA扫描对了解颈部血管与寰椎侧块的位置关系，避免颈内动脉损伤有重要意义。

The application of CTA in TARP: studying in the relationship of ICA and atlas lateral mass

Objective　To avoid ICA injury in TARP surgery by studying anatomic structural relationships between atlas and carotid artery from three-dimensional CTA reconstruction.　Methods　A series of 145 cases underwent TARP surgery were retrospectively selected from January 2012 to June 2015, in whom had performed CTA in neck before surgery. The images were reconstructed by multi-planar reconstruction techniques. The cases with the medial border of the ICA located outside the medial edge of transverse foramen in the atlas transverse center line level were divided into lateral group and the medial group. The parameters were measured including distance from the medial edge of the ICA to perpendicular lines drawn in the axial plane, distance from the medial border of the foramen transversarium to perpendicular lines, deviation distance of the medial edge of the ICA postoperatively. Statistical analysis was carried out to determine if there was a significant difference between lateral and medial by comparing both sides of each segment. The location of the ICA was categorized into 4 areas of C1 lateral mass. Results In the medial group，the differences of bilateral d, ipsilateral d and l, D and d were significant（P<0.05）. The offset distance of ICA postoperative was 3.12 mm (F), 3.83 mm (M). The difference was statistically significant compared with the preoperative value. Conclusions It is necessary that every patient performs the three-dimensional CTA preoperative to determine the anatomical structures between ICA and C1 lateral mass, then avoid ICA injury and improve the safety of the surgery. Strict periosteal stripping should be taken in surgical exposure process, and the left side in particular should to be more careful.