内镜口内进路咽旁间隙解剖恒定标志.docx

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内镜口内进路咽旁间隙解剖恒定标志

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[摘要]目的：观察经口入路内镜下咽旁间隙的解剖恒定标志,了解颈内动、静脉及后组颅神经等解剖结构的毗邻关系，为提高经口入路内镜下咽旁间隙病变、肿瘤切除手术成功率提供解剖依据。方法：2015年1月~2016年3月，对10具（20侧）灌注新鲜尸头先行CT扫描及三维重建，观察咽旁间隙等咽旁结构，然后应用内镜口内径路行咽旁间隙解剖。结果：CT图像上，咽旁间隙位于咽隐窝的外侧，呈低密度三角形，翼内肌、翼外肌、咬肌、颞肌位于咽旁间隙的外侧，呈中密度阴影，茎突位于咽旁间隙的前部阴影，咽旁间隙后部颈内动脉呈中密度阴影。解剖发现，经口进路可以良好暴露翼内肌外侧至咽上缩肌的咽旁间隙区域。茎突及其附着的茎突舌肌及茎突咽肌在这一解剖路径中具有关键的解剖标识作用。在茎突舌肌及茎突咽肌的后方，咽上缩肌的外侧能清楚的暴露颈内动脉、颈内静脉及IX-XII对颅神经。结论内镜口内进路咽旁间隙解剖中咽上缩肌、茎突、茎突舌肌、茎突咽肌是重要的解剖标志，颈内动脉位于咽上缩肌的外侧，靠近咽上缩肌内侧能够保护颈内动脉。

[关键词]咽旁间隙；经口入路；内镜辅助；解剖标志

Anatomicalconstantsignoftheendoscopicapproachtotheparapharyngealspace

LiJianxing,YangDangwei,LuYongtian

（E.N.T.Department,TheCentralHospitalofLonghuaDistrict,Shenzhen,Guangdong518110,E.N.T.DepartmentShenzhenSecondPeople,sHospital,Shenzhen518035）

Abstracts:Objective:Toobserveanatomicalconstantsignoftheendoscopicapproachtotheparapharyngealspace,andprovideevidenceforthetreatmentofthelesionsofthepharyngealspaceandimprovethesuccessrateoftheoperation.Methods:Tenfreshdeadbodies(twentysides)wereacquiredfromJanuary2015toMarch2016,CTscanningandthreedimensional?reconstructionwereperformedfirst,thestructureofthelateralpharyngealspacewasobserved,andthentheendoscopewasapplied,endoscopicassistedanatomicalpharyngealspaceinthemouth.Results:OntheCTimage,?dispharynx?ofverylowdensityextendedposterior-lateralintothepharyngealrecess,lateralpharyngealspacelocatedinthelateralpharyngealrecess,alowdensitytriangularshadowwithanarrowofthefrontandwidthintheback,wingwithinmuscles,wingoutsidemuscles,?masseterandtemporalmusclewerelocatedinthelateralpharyngealsideclearance,itshowedamediumdensityshadow,styloidprocesswaslocatedinthefrontshadowofpharynxsideclearance,thebackoftheinternalcarotidarteryofpharynxsideclearance,showedmediumdensityshadow.Itcanexposetheparapharyngeal