内镜辅助下后鼓室微创手术入路的临床解剖学研究

目的　为内镜辅助下后鼓室微创手术入路提供解剖学基础。  方法　利用成人15例（30侧）头部标本，解剖并测量后鼓室及其与周围结构之间的位置关系。  结果　面神经锥段中点分别到水平半规管最凸点、鼓室窦前缘中点、卵圆窗中点、圆窗中点、岬小桥下端、岬后脚下端的距离是（3.21±0.41）、（2.79±0.25）、（3.97±0.37）、（6.48±0.53）、(4.85±0.39)、(6.21±0.57)mm；砧骨窝中点至锥隆起顶端、面神经锥段中点、镫骨头中点、圆窗中点、卵圆窗中点、匙突顶点的距离分别为（4.43±0.36）、（3.10±0.28）、(6.55±0.55)、(9.56±0.82、(6.67±0.65)、(4.63±0.39)mm；鼓室窦的深度、横截面短径、横截面长径分别是（3.10±0.27）、（1.05±0.10 ）、（1.89±0.19）mm；后鼓室窦深度、横截面长径、横截面短径分别是(1.15±0.10)、(0.83±0.29)、(0.63±0.51)mm；外侧鼓室窦横截面近似椭圆型，其深度、上下径、左右径分别是 (1.63±0.12)、（0.36±0.03）、(0.74±0.09）mm；面隐窝外侧气房直径(0.28±0.13)mm。  结论　后鼓室解剖结构精细复杂，对其解剖结构的精准定位有利于彻底清除病变和防止术后并发症的发生。

Microsurgical anatomic study of posterior tympanum operation approach by endoscope-assisted

Objective　To study structures of the posterior tympanum and to provide theoretical reference for surgical approach related to the middle ear.    Methods    30 sides of 15 cadaveric heads had their mastoids outlined and the relationship between the posterior tympanum and the other structures were observed and measured.    Results    The average distances from the midpoint of pyramid segment of facial canal to the most salient point of lateral semicircular canal, the midpoint of the anterior margin of the sinus tympani, the midpoint of vestibular window, the midpoint of cochlear window, the lower end of the ponticulus, and the lower end of the pseudosubiculum were（3.21±0.41）mm,（2.79±0.25）mm,（3.97±0.37）mm,（6.48±0.53）mm, (4.85±0.39)mm, (6.21±0.57)mm,  respectively. The average distances from the midpoint of incual fossa to the top of the pyramidal eminence, the midpoint of pyramid segment of the facial canal, the midpoint of the head of stapes, the midpoint of cochlear window, the midpoint of the vestibular window, and the cochleariform process were（4.43±0.36）mm、（3.10±0.28）mm、(6.55±0.55)mm, (9.56±0.82)mm, (6.67±0.65)mm, (4.63±0.39)mm, respectively. The average depth of sinus tympani, the average short diameter of cross section, and the average long diameter of cross section were （3.10±0.27）mm,（1.05±0.10 ）mm,（1.89±0.19）mm, respectively. The average depth of posterior tympanic sinus, the average long diameter of cross section, and the short diameter of cross section were (1.15±0.10) mm, (0.83±0.29) mm, (0.63±0.51) mm, respectively. The average depth of lateral sinus tympani, the superior inferior diameter, and the anteroposterior diameter were (1.63±0.12)mm,（0.36±0.03）mm and (0.74±0.09）mm. The average diameter of lateral facial recess gas cell was (0.28±0.13) mm.    Conclusion   Posterior tympanum with fine structure which is easy to be potential regional residual lesion is narrow. It is very important to clearly understand the anatomical structure, so as to completely clear lesions and prevent the occurrence of postoperative complications.