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目的模拟内镜下经单鼻孔经鼻中隔与蝶窦前壁手术入路,评价两种入路的优缺点。方法内镜下分别对每组15具成人尸头行单鼻孔经鼻中隔入路及蝶窦前壁入路模拟手术,分别测量切口距离外鼻孔距离、鼻孔至鞍底平面上(手术路径上)手术器械在水平方向上所能摆动的最大角度及距离、以及其他相关解剖参数。结果单鼻孔鼻中隔入路和蝶窦前壁入路切口处距离外鼻孔距离分别是(5.19±0.15)cm和(6.91±0.14)cm,手术路径上器械在水平方向上所能摆动的最大角度分别是(44.77±2.04)°和(38.54±1.40)°,水平方向上所能摆动的最大距离分别是(1.25±0.15)cm和(0.59±0.52)cm。两种入路相关数据对比有统计学意义(P<0.001)。结论内镜下经单鼻孔蝶窦入路行鞍区病变切除中,相对蝶窦前壁入路经鼻中隔入路是一种损伤小,切口距离鼻孔短,定位明确而且操作空间及视角较大的手术入路,可双器械操作,值得临床推广。
Objective To simulate endoscopic nasal septum and sphenoid sinus anterior wall surgery via single nostril endoscopy to evaluate the advantages and disadvantages of the two approaches. Methods Fifteen adult cadaver heads underwent endoscopic nasal septum approach and sphenoid sinus anterior approach respectively. The distance between the incision and the external nostril, the distance between the nostril and the sellar plane (on the surgical path) The maximum angle and distance the instrument can swing in the horizontal direction, and other relevant anatomical parameters. Results The distances between the nasal septum and the anterior nasal sphenoidis were (5.19 ± 0.15) cm and (6.91 ± 0.14) cm, respectively. The maximal angles that the instrument could swing in the horizontal direction on the surgical path were Are (44.77 ± 2.04) ° and (38.54 ± 1.40) °, respectively, and the maximum distances that can swing in the horizontal direction are (1.25 ± 0.15) cm and (0.59 ± 0.52) cm, respectively. The data of the two approaches were statistically significant (P <0.001). Conclusions In the endoscopic resection of the sellae of the sellae by the single nostril sphenoid sinus approach, the approach to transnasal septum relative to the anterior sphenoidal sinus wall is a less invasive method with a shorter incision distance from the nostril, a clear positioning and larger operating space and visual angle Surgical approach can be dual-device operation, it is worth clinical promotion.