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摘要: 目的 通过测量翼管神经切断术中涉及到的重要解剖参数辅助术中精确定位翼管神经、预防手术并发症的发生。方法 对50例(100侧)慢性鼻窦炎、鼻窦囊肿、变应性鼻炎等疾病患者进行高分辨率CT(HRCT)检查，测量其腭鞘管后口至腭骨蝶突上缘中点、腭骨蝶突上缘中点至翼管外口、翼管外口至腭大管以及翼管外口至圆孔之间距离。结果 腭鞘管后口、腭骨蝶突上缘、翼管外口、腭大管和圆孔在定位翼管神经、预防并发症发生方面具有重要价值，腭鞘管后口至腭骨蝶突上缘，腭骨蝶突上缘至翼管外口，翼管外口至腭大管，翼管外口至圆孔的距离分别为(12.46±1.19) mm，(3.23±0.36) mm，(6.09±0.75) mm，(7.6±1.16) mm。结论 HRCT可作为术前定位翼管神经外口及其相关重要解剖标志距离的有利工具，术前所获距离参数对术中定位翼管神经及预防并发症具有指导价值。Abstract: Objective Measuring the important anatomic parameters related to vidian neurectomy to locate the vidian nerve accurately and prevent the surgical complications.Methods High resolution CT(HRCT) was used to measure the distance parameters between the important anatomic landmarks in 50 patients (100 sides) with chronic rhinosinusitis, sinus cyst or allergic rhinitis et al. The distance from the posterior opening of the palatovaginal canal to the upper edge of the sphenoidal process of palatine bone, the upper edge of the sphenoidal process of palatine bone to the external opening of the vidian canal, the external opening of the vidian canal to the greater palatine canal, and the external opening of the vidian canal to the foramen rotundus were measured.Results The posterior opening of the palatovaginal canal, the upper edge of the sphenoidal process of palatine bone, the external opening of the vidian canal, the greater palatine canal, and the foramen rotundum are of great value in locating vidain nerve and preventing surgical complications. The distance from the posterior opening of the palatovaginal canal to the upper edge of the sphenoidal process of palatine bone, the upper edge of the sphenoidal process of palatine bone to the external opening of the vidian canal, the external opening of the vidian canal to the greater palatine canal, and the external opening of the vidian canal to the foramen rotundus were(12.46±1.19) mm, (3.23±0.36) mm, (6.09±0.75) mm and(7.6±1.16) mm respectively.Conclusion HRCT can be used as a powerful tool for preoperative localization of the external pterygoid nerve orifice and its related important anatomical landmarks, and the preoperative distance parameters obtained are valuable for intraoperative localization of the pterygoid nerve to prevent the occurrence of complications.
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表 1 男女不同侧别参数统计结果
参数 男性 女性 左侧 右侧 左侧 右侧 测量距离/mm 腭鞘管后口到腭骨蝶突上缘中点 12.52±1.10 12.66±1.10 12.18±1.20 12.38±1.45 腭骨蝶突上缘中点到翼管外口 3.27±0.28 3.15±0.34 3.31±0.33 3.22±0.49 翼管外口到腭大管 6.24±0.63 6.00±0.72 6.08±0.79 6.03±0.94 翼管外口到圆孔 7.66±1.14 7.52±1.17 7.69±1.25 7.54±1.20 经过腭鞘管后口水平线到第一根线旋转角度/(°) 22.27±2.53 22.69±3.30 30.00±6.20 22.38±4.73 翼管与蝶窦底壁的关系 Ⅰ型 12 14 12 9 Ⅱ型 7 5 5 6 Ⅲ型 10 10 4 6 翼管外口与内侧板的关系 A型 26 27 20 20 B型 3 2 1 1 C型 0 0 0 0 
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