内镜下经外耳道耳蜗下径路切除岩尖病变的应用解剖学研究

doi:10.6040/j.issn.1673-3770.0.2019.177

摘要/Abstract

摘要： 目的

探索内镜下经外耳道耳蜗下径路切除岩尖病变的手术入路，观察内镜下后下鼓室及圆窗周围重要的解剖标志，寻找定位耳蜗下通道的解剖标志，同时在高分辨颞骨CT三维重建下量化耳蜗下通道，为该手术入路提供国人恒定的解剖标志及影像学依据。

方法

1.应用10具（20侧）新鲜冰冻成人尸头，模拟内镜下经外耳道耳蜗下径路岩尖气房切除，寻找定位耳蜗下通道的解剖标志；术前在颞骨CT上分别测量耳蜗底转至颈内动脉与颈静脉球夹角之间的距离，以及耳蜗底转至颈静脉球之间的距离。2.回顾性阅读分析85例患者（170侧）颞骨高分辨CT，记录耳蜗下通道与岩尖气房在颞骨CT上的影像学特征，归类其分型情况。

结果

1.20侧冰鲜尸头以及170侧临床患者颞骨CT测量：耳蜗底转至颈内动脉与颈静脉球夹角之间的距离分别为（6.46±1.02）mm、（6.83±1.50）mm；耳蜗底转至颈静脉球之间的距离分别为（3.67±0.58）mm、（3.82±1.29）mm，其中，耳蜗底转至颈内动脉与颈静脉球夹角之间的距离：气化型岩尖分别为（6.79±0.60）mm、（7.19±1.44）mm，非气化型岩尖分别为（6.28±1.17）mm、（6.68±1.50）mm；耳蜗底转至颈静脉球的距离：气化型岩尖分别为（4.06±0.36）mm、（4.06±1.42）mm, 非气化型分别为（3.45±0.58）mm、（3.74±1.22）mm。2.耳蜗下通道与颞骨岩尖气房CT分型：A型气化型31.18%（53耳），B型板障型57.65%（98耳），C型硬化型11.18%（19耳）。

结论

高分辨颞骨CT可作为内镜下经外耳道耳蜗下径路岩尖病变切除的术前重要参考。从解剖学的角度，内镜下经外耳道耳蜗下径路切除岩尖病变是可行的，能够避免损伤内听道、耳蜗、迷路，保存听力，可作为临床治疗上岩尖后下部分较小病变的重要术式之一。

关键词: 内窥镜检查, 外耳道, 耳蜗下通道, 岩尖病变, 岬末脚, 柱骨, 解剖学

Abstract: Objective

To explore endoscopic transcanal infracochlear approach for resection of the petrous apex and observe structures of the middle ear. The study also aimed to identify anatomical landmarks for locating the infracochlear corridor as well as quantify the corridor under three-dimensional reconstruction of high-resolution CT(HRCT) of temporal bone. The purpose is to provide a constant anatomical landmark and imaging basis for surgical intervention.

Methods

1.Ten (20 sides) fresh frozen adult cadaver heads were used. Preoperative temporal bone CT was used to measure the vertical distance between the basal turn of the cochlea and angle between the internal carotid artery and jugular bulb, as well as the distance between the basal turn of the cochlea and jugular vein bulb. 2. Retrospective analysis of high-resolution CT(HRCT) of the temporal bone in 85 patients (170 sides) was performed to record and summarize the imaging characteristics between the infracochlear corridor and cells of the petrous apex.

Results

1. CT measurements of temporal bones of 20 sides in the frozen cadavers and 170 sides in patients showed that vertical distance between the basal turn of the cochlea and angle between the internal carotid artery and jugular bulb were (6.46 ±1.02) mm and (6.83 ±1.50) mm, respectively, and that between the basal turn of the cochlea and jugular bulb were (3.67±0.58) mm and (3.82±1.29) mm, respectively. Among them, the vertical distance between the pneumatized petrous apices were (6.79 ± 0.60) mm and (7.19 ± 1.44) mm, and that between the non-pneumatized apices were (6.28 ± 1.17) mm and (6.68 ± 1.50) mm, respectively. The distances from the basal turn of the cochlea to the jugular bulb with respect to the pneumatized petrous apices were (4.06 ± 0.36) mm and (4.06 ± 1.42) mm, respectively; and that of the non-pneumatized portions were (3.45 ± 0.58) mm and (3.74 ± 1.22) mm, respectively. 2. Results of CT classification of the infracochlear corridor and petrous apex of the temporal bone were as follows: Type A, pneumatized type 31.18% (53 ears); Type B, marrow type 57.65% (98 ears), and Type C, sclerosed type 11.18% (19 ears).

Conclusion

High-resolution CT (HRCT) may be considered an important pre-operative reference tool for endoscopic transcanal infracochlear approach for resection of the petrous apex. From an anatomical point of view, endoscopic resection of lesions in the petrous apex is feasible using the transcanal infracochlear approach as it can avoid damage to the internal auditory canal, cochlea, and labyrinth, and preserve hearing. The technique can be considered one of the important surgical methods for treatment of minor lesions in the posterior and inferior aspects of the upper petrous apex.

Key words: Endoscopy, Transcanal, Infracochlear approach, Petrous apex, Finiculus, Fustis, Anatomy

中图分类号:

R764.1

卢飞燕,卢永田,周俊伟,刘渊. 内镜下经外耳道耳蜗下径路切除岩尖病变的应用解剖学研究[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 62-68.

Feiyan LU,Yongtian LU,Junwei ZHOU,Yuan LIU. Applied anatomy of endoscopic resection of the petrous apex through the transcanal infracochlear approach[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 62-68.

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参考文献 18

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研究对象	测量指标	最小值（min）	最大值（max）	距离（mm）	t	F	P
10具标本颞骨CT	a	4.3	7.8	6.46±1.02	10.654	0.514	＜0.001
10具标本颞骨CT	b	2.6	4.5	3.67±0.58	10.654	0.514	＜0.001
85例患者颞骨CT	a	3.2	11.1	6.83±1.50	19.776	2.964	＜0.001
85例患者颞骨CT	b	1.3	8.1	3.82±1.29	19.776	2.964	＜0.001

研究对象	测量指标	气化型岩尖	非气化型岩尖	t	F	P
10具标本颞骨CT	a	6.79±0.60	6.28±1.17	1.050	0.616	0.15
10具标本颞骨CT	b	4.06±0.36	3.45±0.58	2.495	2.003	0.01
85例患者颞骨CT	a	7.19±1.44	6.68±1.50	2.093	0.025	0.019
85例患者颞骨CT	b	4.06±1.42	3.74±1.22	1.534	3.109	0.06

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