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目的通过经单鼻孔-蝶窦入路的解剖学研究,为临床经单鼻孔-蝶窦手术安全切除垂体腺瘤提供准确定位的解剖学资料。方法用成人尸头湿标本20例,在显微镜下对经单鼻孔-蝶窦入路手术准确定位重要的解剖学标志:鼻中隔后缘上端、蝶窦开口、蝶嵴、犁骨、蝶窦间隔、鞍底等进行解剖观察和测量。结果(1)前鼻棘至鞍底、蝶窦口、颈内动脉和视神经的距离分别为(70.20±0.98)mm、(57.29±0.68)mm、(69.66±0.74)mm、(70.95±1.03)mm。(2)蝶窦开口至鞍底、视神经、颈内动脉、鞍结节中点、鞍背中点以及犁状骨游离面下缘(后鼻腔与咽部交界处)距离分别为(14.62±0.80)mm、(13.25±0.99)mm、(14.38±0.82)mm、(15.03±1.21)mm、(25.24±1.08)mm、(17.21±0.59)mm。(3)20例标本中有17例鞍底骨板在蝶窦内形成隆凸,可作为窦内鞍底确定的标志。(4)鼻中隔后缘上端、蝶嵴、犁骨后缘与鞍底中部垂直相对。结论蝶窦开口是定位蝶窦前壁重要的解剖标志。鼻中隔后缘上端、蝶嵴、犁骨后缘可作为确定鞍底中线的定位标志。
Objective To provide anatomical data for the accurate positioning of pituitary adenomas by single nostril-sphenoid sinus surgery through anatomy of single nostril-sphenoid sinus approach. Methods 20 cases of adult cadaveric wet specimens were used to accurately locate the important anatomical landmarks by single nostril - sphenoid sinus surgery under microscope: the upper edge of posterior nasal septum, sphenoid sinus opening, sphenoid ridge, vomer, sphenoid space, Saddle bottom and other anatomical observation and measurement. Results The distance from anterior nasal spine to sella, sphenoid ostia, internal carotid artery and optic nerve were (70.20 ± 0.98) mm, (57.29 ± 0.68) mm, (69.66 ± 0.74) mm, (70.95 ± 1.03) mm. (2) The distance between the sphenoid sinus opening to the base of the saddle, the midpoint of the optic nerve, the internal carotid artery, the midpoint of the saddle nodule, the midpoint of the saddleback, and the lower edge of the free face of the plow bone (junction of the posterior nasal cavity and pharynx) were (14.62 ± 0.80) mm, (13.25 ± 0.99) mm, (14.38 ± 0.82) mm, (15.03 ± 1.21) mm, (25.24 ± 1.08) mm and (17.21 ± 0.59) mm respectively. (3) There are 17 cases of septum plate in the sphenoid sinus forming a protuberance in 20 specimens, which can be used as the sign of the sinus saddle. (4) The posterior edge of the nasal septum, butterfly ridge, vomer trailing edge and the middle of the saddle vertical relative. Conclusion The sphenoid sinus ostium is an important anatomical landmark for anterior sphenoid sinus. The posterior edge of the nasal septum, butterfly ridge, the posterior edge of the vault can be used as a midline to determine the positioning of the sign.