眼眶外侧手术入路相关成人尸头显微解剖学初步研究

摘要

Objective To study the microanatomy of cadaver skulls related to lateral orbital approach operation.Microanatomy data were recorded and analyzed by multi-angle digital camera.Methods Experimental study.Five adult formalin-fixed cadaver skulls were examined,simulating the lateral orbital approach procedure,the optic nerve,oculomotor nerve,ophthalmic artery,superior ophthalmic vein and various levels anatomical structures and adjacent regions were dissected and examined on both sides of each specimen under surgical microscope.Results Lateral orbit approach operation involved many important structures in the orbit.From the lateral side,ophthalmic artery (the second segment),ciliary ganglion and abducens nerve located outside of optic nerve were involved.From the superior side,ophthalmic artery (the third segment),superior ophthalmic vein,nasociliay nerve and the upper branch of oculomotor nerve located above the optic nerve were involved.From the inferior side:ophthalmic artery (the first segment),central retinal artery,the inferior branch of oculomotor nerve located below the optic nerve were involved.There were many blood vessel and nerves in the orbital apex,including optic nerve,oculomotor nerve,ciliary ganglion,abducens nerve,the ophthalmic division of the trigeminal nerve,ophthalmic artery and superior ophthalmic vein.Conclusions The anatomic structures involved in the lateral orbital approach surgery are complex,especially in the orbital apex.Optic nerve,oculomotor nerve,ophthalmic artery,superior ophthalmic vein are located in this region.The operative space is narrow,the damage of nerves and blood vessels will result in serious complications.%目的 初步研究眼眶外侧手术入路相关的成人尸头显微解剖学.方法 实验研究.模拟眼眶外侧手术入路,利用5具福尔马林固定的成人头颅湿标本,以视神经为视角中心,对眼眶视神经、眼动脉、动眼神经、眼上静脉及周围各层次(外侧、上方和下方)的重要结构进行显微解剖.5具头颅湿标本均进行了颜色乳胶血管灌注,红色乳胶灌注动脉系统,蓝色乳胶灌注静脉系统.记录上述重要结构走行及毗邻关系,并通过多角度观察、拍摄及描述.结果 手术涉及视神经、眼动脉、动眼神经、眼上静脉及周围较多重要结构.外侧:眼动脉第2段、睫状神经节、外展神经；上方:眼动脉第3段、眼上静脉、鼻睫神经、动眼神经上支；下方:眼动脉第1段、视网膜中央动脉、动眼神经下支.眶尖部:眶内绝大部分重要神经、血管均密集汇集于此,包括:视神经、动眼神经、睫状神经节、外展神经、三叉神经眼支、眼动脉及眼上静脉.结论 眼眶外侧手术入路相关解剖结构复杂,尤其是眶尖部,视神经、动眼神经、眼动脉及眼上静脉均密集汇集于此,手术操作空间狭小,神经、血管结构损伤可造成眼部严重并发症.