山东大学耳鼻喉眼学报 ›› 2015, Vol. 29 ›› Issue (2): 58-61.doi: 10.6040/j.issn.1673-3770.0.2014.328

• 论著 • 上一篇    下一篇

鼻内镜下经鼻径路解剖翼腭窝区临床观察

沈鹏1, 孙中武2, 李建瑞1, 杨立军1, 马亮2, 张明生2   

  1. 1. 清华大学附属北京市垂杨柳医院耳鼻咽喉科, 北京 100022;
    2. 北京航天总医院耳鼻咽喉科, 北京 100076
  • 收稿日期:2014-09-28 出版日期:2015-04-16 发布日期:2015-04-16
  • 作者简介:沈鹏和孙中武为共同第一作者。沈鹏。E-mail:shenpeng-2002@163.com; 孙中武。E-mail:13126671799@163.com
  • 基金资助:
    北京市优秀人才培养资助(D类)项目(2013D008001000006);北京市垂杨柳医院科研启动基金项目, 北京航天总医院创新基金项目(2013-515)

Endoscopic endonasal approach to the pterygopalatine fossa: an anatomic study

SHEN Peng1, SUN Zhong-wu2, LI Jian-rui1, YANG Li-jun1, MA Liang2, ZHANG Ming-sheng2   

  1. 1. Department of Otolaryngology, Beijing Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing 100022, China;
    2. Department of Otolaryngology, Beijing Aerospace General Hospital, Beijing 100076, China
  • Received:2014-09-28 Online:2015-04-16 Published:2015-04-16
  • Contact: 李建瑞。E-mail:ruixueshuo@sohu.com E-mail:ruixueshuo@sohu.com

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摘要： 目的 研究鼻内镜下经鼻径路观察翼腭窝区的临床解剖特点, 以期为手术提供参考。方法 5例(10侧)成人尸头标本经乳胶灌注后, 在0°鼻内镜下分别经蝶腭孔和上颌窦后壁两种手术径路显露翼腭窝, 再开放蝶窦, 充分暴露视神经、颈内动脉及蝶窦外侧壁相关结构, 观察各解剖结构的三维立体关系。结果 不同手术径路显露翼腭窝的范围不同, 祛除上颌窦内侧壁后能最大程度显露翼腭窝内所有解剖结构, 开放蝶窦后能观察翼腭窝与蝶窦区域相关结构的解剖关系。结论 只要熟悉鼻内镜下翼腭窝及邻近区域的解剖结构及关系, 选择合适的病例, 鼻内镜下经鼻行翼腭窝区手术是安全可行的。

关键词: 解剖, 翼腭窝, 鼻内镜外科手术

Abstract: Objective To investigate the related anatomy in the pterygopalatine fossa under endoscopy so as to provide anatomical data for endoscopic transnasal surgery. Methods Five (10 sides) cadaveric heads were dissected via sphenopalatine foramen approach and via the posterior wall of the maxillary sinus approach to show the pterygopalatine fossa, then the sphenoid sinus was dissected to show the optic nerve, internal carotid artery and other anatomical structures. Results Different approaches allowed for different exposure of the pterygopalatine fossa structures. All the important anatomical structures and their relations in and around the pterygopalatine fossa could be observed under endoscopy. Conclusion The endoscopic transnasal surgery in the pterygopalatine fossa is feasible and safe as if surgeons master the related anatomy and choose right cases.

Key words: Pterygopalatine fossa, Endoscopic surgical procedures, operative, Anatomy

中图分类号: 

  • R323.1
[1] Pasquini E, Sciarretta V, Fameti G, et al. Endoscopic endonasal approach for the treatment of benign schwannoma of the sinonasal tract and pterygopalatine fossa[J]. Am J Rhinol, 2002, 16(2):113-118.
[2] 张秋航, 杨大章, 韩军. 内镜经鼻翼腭窝肿瘤切除术[J]. 中国微侵袭神经外科杂志, 2006, 11(10):441-442. ZHANG Qiuhang, YANG Dazhang, HAN Jun. Endoscopic endonasal surgery for tumors in the pterygopalatine fossa[J]. Chin J Mini Invas Neurosurg, 2006, 11(10):441-442.
[3] 王刚, 陈雷, 韩东一. 颞下窝、翼腭窝占位性病变微创手术治疗(附4例报告) [J]. 中华耳科学杂志, 2008, 6(1):86-88. WANG Gang, CHEN Lei , HAN Dongyi. Minimal invasive surgery for space-occupying lesions in the infratemporal fossa and pterygopalatine fossa: a report of 4 cases[J]. Chin J Otol, 2008, 6(1):86-88.
[4] Xu F, Sun X, Hu L, et al. Endoscopic surgical treatment of neurogenic tumor in pterygopalatine and infratemporal fossae via extended medial maxillectomy[J]. Acta Otolaryngol, 2011, 131(2):161-165.
[5] 别远志, 孙敬武, 孙家强,等. 内镜下鼻腔泪前隐窝-上颌窦径路切除翼腭窝肿瘤[J]. 中华耳鼻咽喉头颈外科杂志, 2012, 47(1):26-29. BIE Yuanzhi, SUN Jingwu, SUN Jiaqiang, et al. Endoscopic transnasal prelacrimal recess-maxillary sinus approach for tumors in the pterygopalatine fossa[J]. Chin J Otorhinolaryngol Head Neck Surg, 2012, 47(1):26-29.
[6] 周兵, 黄谦, 崔顺九,等. 内镜下经鼻泪前隐窝径路切除翼腭窝及颞下窝神经鞘瘤[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(10):802-806. ZHOU Bing, HUANG Qian, CUI Shunjiu, et al. Removal of Schwannoma in the pterygopalatine and infratemperal fossa via endoscopic prelacrimal recess approach[J]. Chin J Otorhinolaryngol Head Neck Surg, 2013, 48(10):802-806.
[7] Guo T, Sun J W, Wang Y F, et al. Endoscopic endonasal surgery for pterygopalatine fossa schwannoma via prelacrimal recess-maxillary sinus[J]. B-ENT, 2014, 10(1):81-86.[8] 李华斌, 张绍祥, 许庚,等. 经鼻内窥镜翼腭窝手术的应用解剖学基础[J].中国临床解剖学杂志, 2001, 19(2):101-103. LI Huabin, ZHANG Shaoxiang, XU Geng, et al. Anatomic basis of endoscopic transnasal surgery in the pterygopalatine fossa[J]. Chin J Clin Anat, 2001, 19(2):101-103.
[9] Alfieri A, Jho H D, Schettino R, et al. Endoscopic endonasal approach to the pterygopalatine fossa:anatomic study[J]. Neurosurgery, 2003, 52(2):374-378.
[10] 盖志, 孙树岩. 鼻内镜下翼腭窝区解剖观察[J].中国耳鼻咽喉头颈外科, 2005, 12(8):499-501. GAI Zhi, SUN Shuyan. Applied anatomic study on the pterygopalatine fossa and its clinical significance[J]. Chin Arch Otolaryngol Head Neck Surg, 2005, 12(8):499-501.
[11] 张勤修, 刘世喜, 安会明,等. 翼腭窝鼻内镜临床解剖学研究[J].中华耳鼻咽喉头颈外科杂志, 2006, 41(1):35-37. ZHANG Qinxiu, LIU Shixi, AN Huiming, et al. Anatomic study of pterygopalatine fossa under endoscope[J]. Chin J Otorhinolaryngol Head Neck Surg, 2006, 41(1):35-37.
[12] 邓彬华, 彭玉成, 范静平,等. 鼻内镜下处理翼腭窝病变的应用解剖[J]. 第二军医大学学报, 2006, 27(8):820-822. DENG Binhua,PENG Yucheng, FAN Jingping, et al. Applied anatomy for management of pterygopalatine fossa lesions via endoscopic transnasal approach[J]. Acad J Sec Milit Med Univ, 2006, 27(8):820-822.
[13] 柳林整, 刘红军, 李维民. 翼管走行的解剖测量及其临床意义[J]. 山东大学耳鼻喉眼学报, 2008,22(2):139-141. LIU Linzheng, LIU Hongjun, LI Weimin. Measurement of pterygoid canal and its clinical significance[J]. J Otolaryngol Ophthalmol Shandong Univ, 2008, 22(2):139-141.
[14] Abuzayed B, Tanriover N, Gazioglu N, et al. Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomic study[J]. J Neurosurg Sci, 2009, 53(2):37-44.
[15] 敖勇, 张华. 鼻内镜下经鼻腔入路翼腭窝解剖学研究[J]. 临床耳鼻咽喉头颈外科杂志, 2009, 23(12):535-538. AO Yong, ZHANG Hua. The anatomical study of the pterygopalatine fossa under endoscopy via the nasal cavity approach[J]. J Clin Otorhinolaryngol Head Neck Surg, 2009, 23(12):535-538.
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