Advances in clinical anatomy of the transnasal approaches to the parapharyngeal segment of the internal carotid artery
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摘要: 位于颅内的颈内动脉节段走行于颅底骨性结构内或颅内，具有明确的解剖标志且解剖结构较为固定，而位于颅外的咽旁段颈内动脉被软组织包围，缺乏清晰可识别的解剖定位标志且常存在解剖变异，其与经鼻内镜手术关系密切，一旦在术中误伤会导致严重并发症甚至死亡。目前对于经鼻内镜下咽旁段颈内动脉相关的临床解剖学研究主要聚焦于其解剖变异与解剖标志。本文将从这两个方面进行综述，旨在为外科医师在经鼻内镜手术时提供解剖学参考从而降低手术风险。Abstract: The intracranial segment of the internal carotid artery located inside the skeleton structure of skull base or inside the skull has clear anatomical landmarks and fixed anatomical structure. However, the parapharyngeal segment of the internal carotid artery located outside the cranial is surrounded by soft tissues, lacks clear and recognizable anatomical landmarks and sometimes has anatomical variation, which is closely related to transnasal endoscopic surgery. Intraoperative accidental injury can lead to serious complications or even death. Currently, clinical anatomical studies related to the parapharyngeal segment of the internal carotid artery under transnasal endoscopic surgery mainly focus on its anatomical variation and anatomical landmarks. This article reviews on these two aspects in order to provide anatomical reference for surgeons to reduce surgical risks during transnasal endoscopic surgery.
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Key words:
- endoscopic sinus surgery /
- internal carotid artery /
- anatomy /
- parapharryngeal space
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表 1 咽旁段颈内动脉走行变异分型
分型 变异角度α/° 主要相关因素 迂曲 延伸或起伏成“S”或“C”形 衰老、身体质量指数（BMI） 卷曲 360° 胚胎发育 折曲 血管病变 Ⅰ型（轻度） 60°≤ɑ＜90° Ⅱ型（中度） 30°≤ɑ＜60° Ⅲ型（重度） 0°＜ɑ＜30° 
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表 2 咽旁段颈内动脉走行变异临床影像学分级
分级 颈内动脉损伤风险 发生变异的区域 至咽壁最短距离/mm Ⅰ级 低 鼻咽部、口咽部 ≥10 Ⅱ级 中 喉咽部 ≥5 鼻咽部、口咽部 5~10 喉咽部 2~5 Ⅲ级 高 鼻咽部、口咽部 2~5 喉咽部 ≤2 Ⅳ级 极高 鼻咽部、口咽部 ≤2
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