基于解剖平面的内镜经口入路咽旁段颈内动脉定位方法及临床应用

王振霖; 张秋航; 刘俊其; 齐岩; 张思远; 侯思源

doi:10.16098/j.issn.0529-1356.2020.05.007

PDF(6055 KB)

解剖学报 ›› 2020, Vol. 51 ›› Issue (5) : 677-681. DOI: 10.16098/j.issn.0529-1356.2020.05.007

解剖学与耳鼻喉科学

基于解剖平面的内镜经口入路咽旁段颈内动脉定位方法及临床应用

王振霖* 张秋航* 刘俊其齐岩张思远侯思源

作者信息 +

A transoral endoscopic approach to locate the parapharyngeal segment of the internal carotid artery

WANG Zhen-lin* ZHANG Qiu-hang* LIU Jun-qi QI Yan ZHANG Si-yuan HOU Si-yuan#br#

Author information +

文章历史 +

摘要

目的探讨内镜经口入路中咽旁段颈内动脉（ICA）的定位方法。方法对4例新鲜尸头标本进行内镜经口入路至颞下窝/咽旁间隙解剖。在37例该区域肿瘤手术中应用基于解剖平面的ICA定位方法评价定位效果。结果在全部标本中均可清晰分辨咽缩肌层、头长肌前筋膜层和茎突咽筋膜层等解剖平面，后两者交界处稍外侧可作为定位咽旁段ICA的内侧入路标志。采用该方法在手术中实现了93.10% 的ICA准确定位成功。结论基于解剖平面的咽旁段ICA定位方法解决了内镜经口入路手术的难题，方法较为可靠。

Abstract

Objective To establish an anatomically-based method for locating the parapharyngeal segment of the internal carotid artery (ICA) via transoral endoscopy. Methods Applied anatomic study was performed in 4 fresh adult cadaver heads (8 sides) via transoral endoscopy to explore the infratemporal fossa/parapharyngeal space. The localization method based on anatomic plane was subsequently used in 37 cases of tumor surgery in this area, with the operational accuracy evaluated. Results Following dissection of the layers of pharyngeal constrictor, anterio fascia of the longus capitis and stylopharyngeal fascia, the junction of the latter two was identified as a potential landmark to locate the parapharyngeal ICA in surgery. Following practice on the patients, a success rate of 93.10% was achieved by using this method for ICA localization. Conclusion The parapharyngeal ICA localization method based on anatomic plane is clinically reliabie.

导出引用

王振霖张秋航刘俊其齐岩张思远侯思源. 基于解剖平面的内镜经口入路咽旁段颈内动脉定位方法及临床应用[J]. 解剖学报. 2020, 51(5): 677-681 https://doi.org/10.16098/j.issn.0529-1356.2020.05.007

WANG Zhen-lin ZHANG Qiu-hang LIU Jun-qi QI Yan ZHANG Si-yuan HOU Si-yuan. A transoral endoscopic approach to locate the parapharyngeal segment of the internal carotid artery[J]. Acta Anatomica Sinica. 2020, 51(5): 677-681 https://doi.org/10.16098/j.issn.0529-1356.2020.05.007

中图分类号： R766

参考文献

［1］ Labib MA, Prevedello DM, Carrau R, et al. A road map to the internal carotid artery in expanded endoscopic endonasal approaches to the ventral cranial base［J］. Neurosurgery,2014,10 (Suppl 3):448-471.
［2］ Gardner PA, Kassam AB, Snyderman CH, et al. Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series［J］. J Neurosurg, 2008,109(1):6-16.
［3］ Perry A, Graffeo CS, Meyer J, et al. Beyond the learning curve: comparison of microscopic and endoscopic incidences of internal carotid injury in a series of highly experienced operators［J］. World Neurosurg, 2019,131:e128-e135.
［4］ Shan JL, Jiang H, Li F. Anatomic features of the prevertebral facia and its significance in the anterior cervical approach［J］. Chinese Journal of Clinical Anatomy, 2011,29(1):13-16. (in Chinese)
单建林,姜恒,李放.颈椎椎前筋膜的解剖特点及其与周围结构的关系［J］.中国临床解剖学杂志,2011,29(1):13-16.
［5］ Zhang Q, Lv H, Wang Z, et al. Endoscopic transoral approach for extracranial hypoglossal schwannoma［J］. ORL J Otorhinolaryngol Relat Spec, 2011,73(5):28-286.
［6］ Bouthillier A, van Loveren HR, Keller JT. Segments of the internal carotid artery: a new classification［J］.Neurosurgery,1996,38(3):425-32.
［7］ Prasad SC, Piccirillo E, Chovanec M, et al. Lateral skull base approaches in the management of benign parapharyngeal space tumors［J］. Auris Nasus Larynx, 2015, 42(3):189-198.
［8］ Gerges MM, Godil SS, Younus Ⅰ, et al. Endoscopic transorbital approach to the infratemporal fossa and parapharyngeal space: a cadaveric study［J］. J Neurosurg, 2019, 1:1-12.
［9］ Oakley GM, Ebenezer J, Hamizan A, et al. Finding the petroclival carotid artery: the vidian-eustachian junction as a reliable landmark ［J］. J Neurol Surg B Skull Base, 2018,79(4):361-366.
［10］ Fahmy CE, Carrau R, Kirsch C, et al. Volumetric analysis of endoscopic and traditional surgical approaches to the infratemporal fossa［J］. Laryngoscope, 2014, 124(5):1090-1096.
［11］ Liang L, Qu L, Chu X, et al. Meningeal architecture of the jugular foramen: an anatomic study using plastinated histologic sections［J］.World Neurosurg,2019, 127:e809-e817.
［12］ Ryan S, Blyth P, Duggan N, et al. Is the cranial accessory nerve really a portion of the accessory nerve? Anatomy of the cranial nerves in the jugular foramen ［J］.Anat Sci Int,2007,82(1):1-7.
［13］ Zhang BY, Lu YT, Li JX. Transoral endoscopic dissection of parapharyngealspace［J］.Journal of Otolaryngology and Ophthalmology of Shandong University,2015,29(4):38-41.(in Chinese)
张宝莹,卢永田,李建兴.口内径路咽旁间隙的内镜解剖结构［J］.山东大学耳鼻喉眼学报,2015,29(4):38-41.
［14］ Yang DW, Zhou HL, Li JX, et al. Anatomical sign of parapharyngeal spaceoperation via endoscopy-assited transoral approach［J］.Journal of Regional Anatomy and Operative Surgery,2016,25(6):391-394. (in Chinese)
杨党卫,周华磊,李建兴,等.内镜下经口入路咽旁间隙手术的解剖标志［J］.局解手术学杂志,2016,25(6):391-394.
［15］ Polev GA, Carrau RL, Golbin DA, et al. Intraoral endoscopic ligation of maxillary artery in the infratemporal fossa［J］. J Craniofac Surg, 2019,30(1):137-140.