鼻内镜下扩大的经鼻腔蝶窦入路治疗鞍周病变的解剖研究和临床应用

目的：通过扩大的经鼻腔蝶窦人路的内镜解剖学研究和初步临床应用，为扩大的经鼻腔蝶窦手术适应证及范围提供理论依据。方法：在4具(8侧)已经染料动脉灌注的成人尸头上模拟扩大经鼻腔蝶窦手术入路，同时测量海绵窦旁重要结构与鞍底的距离。结果：根据蝶窦后壁的骨性结构特征将蝶窦腔分为1个中间腔、2个旁中间腔及2个外侧腔。扩大经蝶手术入路可清晰显示鞍底骨膜、硬脑膜外层、海绵窦内侧壁、海绵窦内颈内动脉及其分支血管、动眼神经、滑车神经、外展神经及眼神经等结构；打开蝶骨平台可显示视神经、视交叉、垂体柄、鞍隔及视丘下部等解剖结构。临床初步用于治疗1例巨大侵入海绵窦的生长激素型垂体腺瘤患者，取得了较好的手术效果。结论：内镜扩大经鼻腔蝶窦手术入路可清晰显露蝶鞍周围的解剖结构，适用于鞍旁、鞍上病变的手术治疗，但应熟练掌握内镜鞍周解剖学及熟练的经鼻腔蝶窦手术经验。

Anatomy of the extended transsphenoidal approach under endoscopy and its application on treating the sellar and parasellar lesion

Objective:The endoscopic surgical anatomy of the extended transsphenoidal approach and its application was studied to establish the anatomic basis for parasellar lesion.Method:Four adult cadaveric heads were studied by imitating extended transsphenoidal approach and some anatomic parameters were measured.Result:The sphenoid sinus was divided into five compartments by posterior bony wall.The periosteum,dura,cavernous sinus,carotid artery,ocular nerve,trochlea nerve and abduce nerve crossing cavernous sinus could be visualized.After sphenoidal planum was removed,optic nerve,chiasm and pituitary gland could be displayed.A patient with gigantic pituitary adenoma was cured by extended transsphenoidal approach.Conclusion:The sellar and parasellar region can be visualized through extended transsphenoidal approach and lesion of sellar turcica can be treated by the approach.Surgeons should be skilled at endoscopic or microscopic sellar anatomy and have experience with transsphenoidal sugery.