摘要
目的:探索内镜经口入路咽后淋巴结切除术相关解剖和手术方法。方法:在复旦大学附属眼耳鼻喉科医院解剖实验室对3例(6侧)新鲜冰冻尸头标本进行内镜经口入路咽后间隙解剖学研究,依次显露咽上缩肌、翼内肌、腭帆张肌腱、茎突前间隙脂肪、腭升动脉及其分支、茎突舌肌、茎突咽肌、茎突舌骨肌、颈外动脉、腭帆提肌、颈动脉鞘、咽升动脉以及头长肌。采用0°Karl Storz鼻内镜对上述解剖结构进行拍照并记录毗邻关系。回顾1例转移性咽后淋巴结病例,详细介绍内镜经口入路咽后淋巴结切除术手术方法和技巧。结果:所有标本均通过内镜经口入路显露咽后间隙及相关解剖结构。茎突舌肌、茎突咽肌和腭帆提肌是定位颈内动脉的标志。咽上缩肌、翼内肌、茎突肌群、头长肌及颈动脉鞘是定位咽后淋巴结的标志。腭升动脉、咽升动脉及颈内动脉是内镜经口入路咽后淋巴结切除术中涉及的主要动脉。结论:内镜经口入路是安全、彻底切除咽后淋巴结的新术式。
Objective: The aim of this study is to explore the anatomy and surgical approach of retropharyngeal lymphadenectomy via endoscopic transoral approach. Methods: The retropharyngeal spaces were studied with three fresh frozen cadaver head(6 sides) in the anatomical laboratory of Eye, Ear, Nose and Throat Hospital of Fudan University through endoscopic transoral approach. The superior pharyngeal constrictor muscle, medial pterygoid muscle, tendon of tensor veli palatini muscle, fat of prestyloid space, ascending palatine artery and its branches, styloglossus, stylopharyngeus, stylohyoideus, external carotid artery, levator veli palatini, carotid sheath, ascending pharyngeal artery and longus capitis muscle were revealed in order. The above-mentioned structures were photographed with a 0° Karl Storz nasal endoscope and adjacent relationships were recorded. A case of metastatic retropharyngeal lymphadenopathy was reviewed and the surgical methods and techniques of retropharyngeal lymphadenectomy via endoscopic transoral approach were introduced in detail. Results: The retropharyngeal space and related anatomical structures were exposed through endoscopic transoral approach in all specimens. The styloglossus, stylopharyngius and levator veli palatini are the markers of locating the internal carotid artery. The superior pharyngeal constrictor muscle, medial pterygoid muscle, styloid muscle group, longus capitis muscle and carotid sheath are the markers that can be used to locate the retropharyngeal lymph nodes. Ascending palatine artery, ascending pharyngeal artery and internal carotid artery are the main arteries involved in retropharyngeal lymphadenectomy via endoscopic transoral approach.Conclusion: Endoscopic transoral approach is a new surgical technique to perform retropharyngeal lymphadenectomy safely and completely.
作者
孙希才
薛凯
刘强
张焕康
刘全
蒋晓文
赵可庆
顾晔
宋小乐
余洪猛
SUN Xicai;XUE Kai;LIU Qiang;ZHANG Huankang;LIU Quan;JIANG Xiaowen;ZHAO Keqing;GU Ye;SONG Xiaole;YU Hongmeng(Department of Otolaryngology,Eye ENT Hospital,Fudan University,Shanghai,200031,China;Department of Radiology,Eye&ENT Hospital,Fudan University;Department of Otolaryngology,Huazhong University of Science and Technology Union Shenzhen Hospital(Nanshan Hospital);Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor(2018RU003),Chinese Academy of Medical Sciences)
出处
《临床耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2022年第2期81-86,共6页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
基金
中国医学科学院医学与健康科技创新工程项目(No:2019-I2M-5-003)
上海市科学技术委员会科技创新行动计划临床医学项目(No:19411950600)
上海市卫生局/局级项目(No:201940143)
上海申康医院发展中心/诊疗技术项目(No:SHDC22021214)
上海市科学技术委员会/生物医药处/西医引导项目(No:20Y11902000)。
关键词
内镜
经口入路
咽后淋巴结
咽后间隙
颈内动脉
endoscope
transoral approach
retropharyngeal lymph node
retropharyngeal space
internal carotid artery
