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目的:为鼻内镜下经蝶窦垂体手术选择安全手术进路,避免损伤海绵间窦导致大出血提供解剖学参数。方法:在20例国人头颅标本上,应用手术显微镜和鼻内镜对海绵间窦,包括前海绵间窦、下海绵间窦、后海绵间窦、基底窦、鞍背窦,进行解剖学观察,测量相关解剖学数据,并对结果进行分析。结果:前海绵间窦、下海绵间窦、后海绵间窦、基底窦、鞍背窦的出现率分别为95%(19例)、75%(15例)、10%(2例)、100%(20例)、30%(6例);前后径分别为(2.08±0.90)(、5.14±2.54)、(1.30±0.40)(、2.26±1.02)、(2.01±0.80)mm;上下径分别为(2.74±0.96)、(1.10±0.74)(、1.48±0.29)、(15.67±4.54)、(3.35±1.93)mm。前海绵间窦的下极至下海绵间窦的前极距离(5.78±1.89)mm。结论:鼻内镜下经蝶垂体手术时,打开鞍底骨质后,尽量避开海绵间窦暴露垂体,无法避开时,必须在损伤前合理选择切口和止血方法,避免大出血。
OBJECTIVE: To provide a safe surgical approach for transnasal endoscopic transsphenoidal pituitary surgery and to provide anatomic parameters to prevent the cavernous sinus from causing major hemorrhage. Methods: Anatomy was performed on 20 spontaneous skull specimens using surgical microscope and endoscopic sinus surgery. The anatomical study was performed on the intercavernous sinus including anterior intercavernous sinus, inferior intercavernous sinus, posterior intercavernous sinus, basilar sinus, The relevant anatomical data were measured and the results analyzed. RESULTS: The incidence rates of anterior intercavernous sinus, inferior intercavernous sinus, posterior intercavernous sinus, basilar sinus and saddle sinus were 95% (19 cases), 75% (15 cases), 10% (2 cases), 100 (2.08 ± 0.90), (5.14 ± 2.54), (1.30 ± 0.40), (2.26 ± 1.02) and (2.01 ± 0.80) mm, respectively. The diameters of upper and lower diameter (2.74 ± 0.96), (1.10 ± 0.74) (1.48 ± 0.29), (15.67 ± 4.54) and (3.35 ± 1.93) mm, respectively. The distance between the anterior pole of the anterior intercavernous sinus and the inferior intercavernous sinus was (5.78 ± 1.89) mm. Conclusion: When transnasal endoscopic transsphenoidal surgery, open the saddle floor after the bones, as far as possible to avoid the cavernous sinus pituitary exposure, can not be avoided, you must choose a reasonable incision and hemostasis before injury to avoid bleeding.