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目的探讨单鼻孔经蝶入路手术切口的合理性。方法在手术显微镜下,解剖15个防腐头颅标本,观察鼻中隔及其动脉血供;分析135例手术,比较不同切口的手术野和术后鼻出血问题,关注其解剖学基础。结果在手术径路上,鼻中隔骨与软骨结合部距前鼻孔大约3cm。鼻后中隔动脉的主干、上下分支起始部及上支越过骨与软骨结合部的平均外径分别为1.7mm、1.1mm、1.2mm、0.7mm;上支沿蝶窦口的下外侧向内侧走行,与窦口平均相距8.2mm。发生术后鼻腔出血10例,其中超过800ml2例,均为鼻中隔后部切口,再次手术治愈。经扩大蝶窦口入路及鼻中隔后部切口入路手术野小而倾斜,也容易损伤鼻后中隔动脉;中后部切口入路稍宽敞,但寻找粘骨膜间隙费时;中部切口入路最宽敞,解剖层面清晰,切口处血管也较细小。结论鼻中隔中部切口可能最为合理,可以推崇。
Objective To investigate the rationality of single nostril transsphenoidal surgical incision. Methods Fifteen anticorrosive skull specimens were dissected under the operation microscope to observe the nasal septum and its arterial blood supply. 135 cases of operation were analyzed, and the operative field and postoperative epistaxis of different incisions were compared, and the anatomic basis was analyzed. Results In the surgical approach, the junction of the nasal septum and cartilage was about 3 cm from the anterior nostril. The posterior nasal septum artery of the trunk, the upper and lower branches of the initial branch and the upper branch over the bone and cartilage with the average diameter of 1.7mm, 1.1mm, 1.2mm, 0.7mm; Inside the line, with the average ostium of 8.2mm. Postoperative nasal bleeding occurred in 10 cases, of which more than 800ml2 cases were nasal septum posterior incision again cured. The enlarged sphenoid sinus approach and posterior nasal septum posterior incision surgery small and inclined surgery, but also easy to damage the posterior septal artery; mid-posterior incision approach a little spacious, but looking for mucoperiosteal space-time; the most incision approach Spacious, clear anatomical level, the incision at the smaller blood vessels. Conclusion The median nasal septum incision may be the most reasonable and can be respected.