经鼻内镜手术中游离带蒂鼻中隔黏膜瓣的解剖研究

目的 探讨经鼻内镜手术中应用游离带蒂鼻中隔黏膜瓣修复颅底缺损的可行性以及黏膜瓣的覆盖范围。方法 应用5个尸体头颅标本（共10侧鼻腔），通过DrafⅢ入路暴露颅前窝底，从鼻腔外侧壁显露蝶腭动脉出蝶腭孔的部位，采用传统方法获得黏膜瓣，暴露颅颈交界区。标记黏膜瓣覆盖颅前窝底和颅颈交界区的范围，然后切除腭骨蝶突和眶突，游离黏膜瓣蒂部，再标记将游离蒂部的鼻中隔黏膜瓣覆盖颅前窝底和颅颈交界区的范围。结果 术中均成功制作游离带蒂鼻中隔黏膜瓣。左右侧颅前窝底区域的覆盖长度分别增加了（1.10±0.16）cm、（1.12±0.16）cm，左右侧颅颈交界区的覆盖长度分别增加了（1.12±0.08）cm、（1.16±0.18）cm。结论 经鼻内镜手术中制作游离带蒂鼻中隔黏膜瓣是可行的，扩大游离蒂部的带蒂鼻中隔黏膜瓣能增加覆盖范围。

Anatomical study of dissociative pedicled nasoseptal flap during endoscopic endonasal surgery

Objective To investigate the feasibility of dissociative pedicled nasoseptal flap for repairing the skull base defect during endoscopic endonasal surgery and the coverage of the flap. Methods Five skull specimens (10 sides of nasal cavity) were used to expose the anterior skull base through Draf Ⅲ approach, and the sphenopalatine artery exiting the sphenopalatine foramina was exposed from the lateral wall of the nasal cavity. The pedicled nasoseptal flap was harvested by the conventional method, and the craniocervical junction was exposed. The coverage extent of the nasoseptal flap over the anterior skull base and craniocervical junction were marked with a line. Finally, the sphenoid process and orbital process of the palatine were removed and the dissociation of pedicle was completed. The areas of the dissociative pedicled nasoseptal flap covering the anterior skull base and craniocervical junction were marked again compared with the previous ones. Results Dissociative pedicled nasoseptal flaps were successfully harvested during the operation. After dissociation, the length of covering anterior skull base area increased by (1.10±0.16) cm and (1.12± 0.16) cm on the left and right sides, respectively; the length of covering craniocervical junction area increased by (1.12±0.08) cm and (1.16± 0.18) cm on the right and left sides, respectively. Conclusions It is feasible to dissociate the pedicle of nasoseptal flap during endoscopic endonasal surgery. The dissociative pedicled nasoseptal flap can increase the extent of covering skull base defect.