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鼻內(nèi)鏡下鼻腔淚囊造口術(shù)應(yīng)用解剖數(shù)據(jù)的研究

發(fā)布時(shí)間:2018-06-24 來源: 短文摘抄 點(diǎn)擊:


  [摘要] 目的 應(yīng)用解剖學(xué)方法測量鼻腔淚囊解剖數(shù)據(jù),為鼻科醫(yī)生內(nèi)鏡手術(shù)提供數(shù)據(jù)和指導(dǎo),以提高鼻腔淚囊造口成功率,減少并發(fā)癥。方法 以2012年1月—2017年1月南京醫(yī)科大學(xué)解剖教研室28個(gè)無病損完整尸頭(56側(cè))為研究對象。觀察鼻淚管解剖結(jié)構(gòu)及中鼻甲腋、總淚小管和淚囊的解剖關(guān)系,鼻內(nèi)鏡下不銹鋼游標(biāo)卡尺測量鼻淚管長度、中鼻甲腋與淚囊頂、中鼻甲腋與淚囊底、總淚小管入口與淚囊底間距離等指標(biāo)。結(jié)果 尸頭標(biāo)本鼻淚管長度(15.87±1.93)mm,中鼻甲腋至淚囊頂距離(7.81±1.63)mm,中鼻甲腋至淚囊底距離(7.62±1.88)mm,總淚小管入口至淚囊底距離(11.20±1.69)mm。結(jié)論 鼻內(nèi)鏡下鼻腔淚囊造口術(shù)以中鼻甲腋為主要標(biāo)志,有利于準(zhǔn)確定位淚囊管。但淚囊與鼻淚管解剖變異較大,建議術(shù)前影像學(xué)觀察淚囊與中鼻甲腋的解剖關(guān)系,選擇鼻丘隆突下緣處為鼻淚管上口位,下鼻道前端頂壁、側(cè)壁處為鼻淚管上口位。
  [關(guān)鍵詞] 鼻內(nèi)窺鏡;鼻腔淚囊造口術(shù);應(yīng)用解剖學(xué);解剖數(shù)據(jù)
  [中圖分類號] R777 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1674-0742(2018)01(c)-0071-03
  [Abstract] Objective The application of anatomical method to measure nasal lacrimal sac anatomic data and to provide the data and guidance for the endoscopic operation of rhinologists to improve the success rate of nasal lacrimal sac stoma and to reduce the complications. Methods From January 2012 to January 2017, 28 intact cadaveric heads (56 sides) of Department of Anatomy, Nanjing Medical University were studied. The anatomic structure of the nasolacrimal duct and the anatomy of the middle turbinate axillary and total lacrimal duct and lacrimal sac were observed. The length of the nasolacrimal duct was measured by endoscopic stainless steel vernier caliper. The middle turbinate axillary and dacryocystorhinostomy, Lacrimal duct entrance and the distance between the dacryocystis and other indicators were observed. Results Cadaveric head specimens of nasolacrimal duct length (15.87±1.93)mm, middle turbinate and lacrimal sac top distance(7.81±1.63)mm, middle turbinate and lacrimal sac bottom distance (7.62±1.88)mm, the total entrance to the lacrimal canaliculus bottom distance(11.20±1.69)mm. Conclusion Nasal endoscopic dacryocystorhinostomy is the main sign of the middle turbinate, which is helpful for the accurate localization of the lacrimal duct. But dacryocystitis and nasolacrimal duct anatomical varied a lot, it was recommended preoperative imaging anatomy observation of lacrimal sac and middle turbinate, nasal inferior edge for long hill with the nasolacrimal duct under the nose, front top wall and side wall at the upper position of nasolacrimal duct.
  [Key words] Nasal endoscope; Nasal cavity ostomy; Applied anatomy; Anatomical data
  鼻內(nèi)鏡下鼻腔淚囊造口術(shù)是臨床治療慢性淚囊炎等淚道疾病的常用手術(shù),能通過吻合淚囊與鼻粘膜使淚液等分泌物經(jīng)淚囊直接進(jìn)入鼻道,從而解除淚溢現(xiàn)象[1]。臨床實(shí)踐證實(shí),其應(yīng)用具有視野清晰、操作精細(xì)、微創(chuàng)安全等優(yōu)點(diǎn),不僅能對因處理鼻淚管堵塞,且無面部畸形與瘢痕,效果肯定。但是,淚囊、鼻淚管位置隱蔽,毗鄰結(jié)構(gòu)變異大,術(shù)中易損傷,因此,明確鼻淚管解剖位置及準(zhǔn)確定位成為提高手術(shù)成功率、減少并發(fā)癥損害的關(guān)鍵[2]。既往,臨床關(guān)于鼻腔淚囊解剖數(shù)據(jù)的文獻(xiàn)報(bào)道結(jié)論準(zhǔn)確性較差,是導(dǎo)致鼻腔淚囊造口偏低甚至失敗的原因之一。文章現(xiàn)以2012年1月—2017年1月南京醫(yī)科大學(xué)解剖教研室提供的28個(gè)無病損完整尸頭為例,觀察淚囊與中鼻甲腋解剖關(guān)系,測量鼻腔淚囊解剖數(shù)據(jù),旨在為鼻腔淚囊造口提供有價(jià)值的數(shù)據(jù)和指導(dǎo),具體報(bào)道如下。

相關(guān)熱詞搜索:鼻腔 解剖 數(shù)據(jù) 研究 內(nèi)鏡下

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