内镜下经鼻眶内手术入路的解剖

doi:10.16098/j.issn.0529-1356.2020.05.014

摘要/Abstract

摘要：

目的观察内镜经鼻眶内手术的关键解剖标志并探讨其临床应用。方法 3例（6侧）新鲜尸头，颈总动脉、椎动脉以及颈内静脉硅胶灌注后，采用STORZ 内镜系统和内镜手术器械，行内镜经鼻入路眶内区的入路解剖，并应用Storz Image 1系统采集高清图像。选择两例患者采取此径路进行手术。结果内镜经鼻入路可以暴露眶内侧壁和部分眶下壁骨质，以及深层的眶骨膜、肌锥外脂肪。并能深入暴露内直肌、上斜肌和下直肌。经内直肌和下直肌之间的潜在间隙进入肌锥内，去除眶脂体显露重要的血管神经结构：眼动脉及其分支下内侧肌干、视神经和动眼神经的分支。临床上采用内镜经鼻入路处理眶内病变，选择眶内肌锥内球后金属异物和累及翼腭窝和颞下窝的眶尖海绵状血管瘤，手术均顺利，达到了预期手术目的，术后恢复良好，无手术并发症。结论深入把握眶内关键解剖结构，选择恰当病例进行内镜下经鼻入路治疗，具有安全、有效及微创性。

关键词: 眶内结构, 经鼻, 鼻眶手术, 异物, 海绵状血管瘤, 内镜, 解剖学, 人

Abstract:

Objective To identify the anatomic landmarks of endoscopic endonasal intraorbital approach, and to present two illustrative cases. Methods Three silicon-injected adult cadaveric heads (6 sides) were dissected, using the endosopic surgical instruments to perform the endoscopic endonasal intraorbital approach and the Karl Storz Image1 system to record the entire process. Results Important landmarks, such as the medial orbital wall, part of the inferior orbital floor, periorbita in the deep layer, and intraorbital fat in the superficial layer could be identified using this approach. Furthermore, medial rectus muscle, superior oblique muscle and inferior rectus muscle could also be recognized. Following dissecting the space between the medial rectus muscle and the inferior rectus muscle, the intraconal space could be accessed. After removing the intraconal fat, important vessels and nerves were identified, including the ophthalmic artery and its inferior medial muscular trunk, the optic nerve, and the branches of oculomotor nerve. One case was metallic intraorbital intraconal foreign body and the other one was cavernous hemangioma in the orbital apex involving the pterygopalatine fossa and infratemporal fossa. These two surgeries were both successfully performed, and the aims of the operation were all achieved. Both patients recovered well, and no postoperative complications ccurred. Conclusion An understanding of the landmarks of the intraorbital structures is paramount for surgically dealing with diseases located within or adjacent to this region. The endoscopic endonasal intraorbital approach is safe, effective and minimally invasive for appropriately selected cases.

Key words: Intraorbital structure, Transnasal, Rhino-orbital surgery, Foreign body, Cavernous hemangioma, Endoscopy, Anatomy, Human

中图分类号:

R765.6

刘剑锋赵建辉赵宇王艺贝陈忠岩韩军杨大章. 内镜下经鼻眶内手术入路的解剖[J]. 解剖学报, 2020, 51(5): 719-725.

LIU Jian-feng ZHAO Jian-hui ZHAO Yu WANG Yi-bei CHEN Zhong-yan HAN Jun YANG Da-zhang. Anatomy of endoscopic endonasal intraorbital surgery[J]. Acta Anatomica Sinica, 2020, 51(5): 719-725.

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