鼻腔自主神经临床解剖研究———鼻内镜下高能量聚焦超声治疗变应性鼻炎的靶点选择

Clinical anatomical study of nasal autonomic nerve-obtaining target points for the treatment of allergic rhinitis by blocking nasal autonomic nerve with high intensity focused ultrasound under nasal endoscope

摘要:

目的：为鼻内镜下高能量聚焦超声阻断鼻腔自主神经治疗变应性鼻炎选择治疗靶点提供解剖学依据。方法：选取10具（20侧）正中矢状位锯开的国人成人头颅标本，在显微镜下解剖蝶腭神经鼻后上内侧支、鼻后上外侧支及鼻后下神经，研究其走行及分布，测量鼻后上内侧支鼻中隔面起始处与后鼻孔上缘及鼻底、中鼻甲内侧面的鼻后上外侧支与中鼻甲下缘中点、鼻后下神经达下鼻甲上缘处与下鼻甲后缘的距离。结果：（1）蝶腭神经鼻后上内侧支在鼻中隔面上均自后上方向前下方走行，走行路线近似直线或反抛物线，其中10侧鼻后上内侧支以一主支走行于鼻中隔面上，均于鼻中隔前中段处达鼻中隔底，8侧以2主支走行于鼻中隔面上，靠鼻底支（下支）于鼻中隔前中段处达鼻中隔底（2侧因矢状位锯开尸头时破坏一侧中隔面未能解剖）；鼻后上内侧支鼻中隔面起始处距后鼻孔上缘（9.04±1.51） mm（下支）、（15.76±2.17） mm（上支），距鼻底（18.95±2.69） mm（下支）、（23.39±2.42） mm（上支）。（2）鼻后上外侧支在中鼻甲内侧面上自中鼻甲上缘后端向前下倾斜到达中鼻甲中下部后段后向前几乎平行于法兰克福平面或中鼻甲下缘走行，止于中鼻甲前缘或下缘前段；中鼻甲内侧面的鼻后上外侧支距中鼻甲下缘中点（5.70±1.82） mm。（3）鼻后下神经于下鼻甲上缘后段进入下鼻甲；鼻后下神经达下鼻甲上缘处距下鼻甲后缘（7.28±1.36） mm。结论：鼻内镜下高能量聚焦超声治疗变应性鼻炎，可选择蝶腭神经鼻后上内侧支鼻中隔面起始处、鼻后上外侧支经中鼻甲内侧面前后缘中点处、鼻后下神经达下鼻甲上缘处作为鼻腔自主神经的阻断靶点。

Abstract:

Objective：To provide anatomical references for the treatment of allergic rhinitis by blocking nasal autonomic nerve with high intensity focused ultrasound under nasal endoscope. Methods：Ten （20 sides） adult head specimens sawn in midline sagittal were choosen，posterosuperior medial nasal branch and posterosuperior lateral nasal branch of sphenopalatine nerve as well as posteroinfe－rior nasal nerve were anatomized under microscope to study and research their branches and ramification and to measure the distance from point of posterosuperior medial nasal branch started from nasal septum to superior border of choana and nasal bottom，the dis－tance from posterosuperior lateral nasal branch in medial surface of middle turbinate to midpoint of inferior border of middle turbinate and the distance from point of posteroinferior nasal nerve reaching at inferior turbinate to posterior border of inferior turbinate. Re－sults：（1）Posterosuperior medial nasal branch of sphenopalatine nerve disturbed on the nasal septum from backward and upward to forward and downward；the route approximated straight line and reverse-parabola line. The nerves in 10 sides disturbed on surface of nasal septum as a main never，all reaching the bottom of nasal septum from anterior-middle segment of nasal septum. The nerves in 8 sides disturbed on surface of nasal septum as two main never branches，the branch near nasal bottom（inferior branch） reaching the bottom of nasal septum from anterior-middle segment of nasal septum（two sides was destroyed when anatomized）. The distances were （9.04±1.51） mm（inferior branch） and （15.76±2.17） mm （superior branch） to superior border of choana，（18.95±2.69） mm（inferior branch） and （23.39±2.42） mm（superior branch） to nasal bottom. （2）Posterosuperior lateral nasal branch of sphe－no-palatine nerve distributed on medial surface of middle turbinate，and moved from posterior segment of superior border of middle turbinate，travelled slantingly and reached posterior segment of middle-lower part of middle turbinate，then travelled forward nearly parallel to Frankfurt horizontal plane or inferior border of mid－dle turbinate，terminated at anterior segment of anterior border or inferior border of middle turbinate and the distance between the nerve and midponit of middle turbinate was （5.70±1.82） mm. （3）Posteroinferior nasal nerve turned into the inferior turbinate from superior border of posterior segment of inferior turbinate；the distance between the nerve from superior border and inferior border of inferior turbinate was （7.28±1.36） mm. Conclusions：In treatment of allergic rhinitis with high intensity focused ultrasound under nasal endoscope，the points of posterosuperior medial nasal branch started from nasal septum，posterosuperior lateral nasal branch through the connection of the midpoint of posterior and anterior border of middle turbinate，posteroinferior nasal branch up to superior border of inferior turbinate，can be chosen as reference points to block the autonomic nerves.