摘要目的 探讨经鼻内镜入路咽旁颈内动脉的解剖定位与保护,为临床手术提供解剖学资料.方法 对5例成人头颅标本(10侧)通过模拟显微镜下耳前颞下-颞下窝入路和经鼻内镜经斜坡入路相结合的方法进行解剖观察,相关数据均采用游标卡尺进行测量.结果 显微镜下咽旁颈内动脉位于前方的腭帆提肌和后方的茎突咽肌之间,两者之间的距离为(14.7 ±0.4) mm(14.2～15.3 mm);经鼻内镜视角下咽旁颈内动脉位于腭帆提肌的后方,其附着处距颈动脉管入口前缘的距离为(5.1±0.2) mm(4.9 ～5.5 mm);咽旁颈内动脉全段均位于颈动脉鞘内,表面有交感神经附着,后组脑神经出颅后沿动脉鞘后方下行,舌咽神经和舌下神经在茎突肌群的后方跨过颈内动脉向前方走行,颈动脉鞘表面有恒定的茎突咽筋膜,在动脉鞘前方延续为头长肌表面的筋膜;咽旁颈内动脉走行上自颈动脉管外口,向下逐渐靠近中线,颈动脉管入口前缘、咽结节水平、寰枕交界水平咽旁颈内动脉前缘至斜坡中线的距离分别为(23.2±2.5)mm(20.6～25.8 mm)、(19.3±1.1) mm(17.9～20.7 mm)、(15.5±1.3) mm(14.1 ～16.9 mm).结论 经鼻内镜入路中腭帆提肌可作为定位咽旁颈内动脉的标志;茎突咽筋膜及其向前延续的头长肌筋膜是保护该段颈内动脉的解剖屏障.

abstractsObjective To explore the localization and protection of the parapharyngeal segment of the internal carotid artery,and to provide anatomical data for clinical surgery.Methods Five adult cranial specimens (10 sides) were dissected by simulating the preauricular sub-temporal fossa approaches under microscope and the endoscopic endonasal transclival approaches,and the relevant data were measured by vernier calipers.Results Microscopically,the parapharyngeal internal carotid artery was located between the levator veli palatini anteriorly and the stylopharyngeal muscle posteriorly.The distance between the two muscles was 14.7 ± 0.4 mm(14.2-15.3 mm).From the endoscopic perspective,the parapharyngeal segment of internal carotid artery was located behind the levator veli palatini muscle,and the distance from its attachment to the anterior border of the carotid canal was 5.1 ±0.2 mm (4.9-5.5 mm).The parapharyngeal internal carotid artery was located in the sheath of the carotid artery with sympathetic nerve attached on its surface.The posterior group nerves descended behind the sheath of the artery.The hypoglossopharyngeal nerve and hypoglossal nerve crossed the internal carotid artery in the posterior part of the styloid muscle groups and moved forward.There was a constant stylopharyngeal fascia on the surface of the carotid sheath,which extended to the fascia on the surface of the long cephalic muscle in front of the carotid sheath.The parapharyngeal internal carotid artery gradually approached the midline from the external orifice of the carotid artery.At the level of the carotid canal,the level of pharyngeal tubercle,and the level of the atlantooccipital junction,the distances from the anterior border of the parapharyngeal segment of the internal artery to the middle line of the clivus were 23.2 ±2.5 mm (20.6-25.8 mm),19.3 ± 1.1 mm (17.9-20.7 mm) and 15.5 ±1.3 mm (14.1-16.9 mm) respectively.Conclusions The levator veli palatini muscle could act as the landmark of the parapharyngeal segment of internal carotid artery.The stylopharyngeal fascia and the fascia of the longus capitis major are anatomical barriers to protect parapharyngeal segment of internal carotid artery under the endoscopic endonasal approach.