鞍膈的解剖特点及其临床意义

摘要/Abstract

摘要：

目的　研究鞍膈的解剖特点，探讨其临床意义。方法应用成人15例尸头标本，在显微镜下进行解剖观察和测量。结果视交叉偏向蝶鞍左侧20%（3例），居于中线上66.7%（10例），偏向右侧13.3%（2例）。鞍隔孔完全被视交叉覆盖73.4%（11例），未被完全覆盖26.6%（4例）。鞍隔孔相对于视交叉的位置偏向左侧26.7%（4例），居于中线上66.7%（10例），偏向右侧6.6%（1例）。从上面观，鞍膈呈下凹型80%（12例），平坦型13.3%（2例），上凸型6.7%（1例）。鞍隔孔测量前后径为2.20 ~ 12.10 mm，左右径为3.10 ~ 13.40 mm；依据鞍隔孔的大小将鞍膈分为3种类型：紧密型，占13.3%（2例）；常见型，占73.4%（11例）；扩大型，占13.3%（2例）。垂体柄靠近鞍背前缘占53.3%（8例），居中占40%（6例），6.7%（1例）位于鞍结节后缘。结论鞍隔孔大小的变异可影响垂体瘤的生长方式，熟悉鞍膈及其周围解剖结构对鞍区手术具有重要意义。

关键词: 鞍膈, 视交叉, 垂体柄, 应用解剖

Abstract:

Objective　To evaluate the anatomic characteristics of diaphragma sellae and its surrounding structures and discuss its clinical implications. 　Method　Fifteen heads of adult cadavers were observed and measured under the operative microscopy.　Result 　The midpoint of the optic chiasm (OC) was located on the midline in 66.7% (10 cases) and at the left and right sides of the sella turcica in 20%(3 cases) and 13.3%(2 cases), respectively. The foramen of diaphragma sellae (FDS) was completely covered by OC in 73.4%(11 cases), and was partially covered in 26.6%(4 cases). The position of FDS relative to OC was situated in the midline in 66.7 %(10 cases), in the left side in 26.7%(4 cases) and in the right side in 6.6% (1 case). Diaphragm sellae appeared concave in 80% (12 cases), convex in 13.3%(2 cases) and flat in 6.7%(1 case) when viewed from above. The average of anteroposterior diameter of FDS was 6.59 mm (range, 2.20 ~ 12.10 mm ) and the average transverse diameter was 7.32mm (range, 3.10 ~ 13.40 mm). we classified the diaphragm sellae into three types according to the FDS diameters variations: constricted type in 13.3%(2 cases); normal type in 73.4% (11 cases); and enlarged type in 13.3%(2 cases). Pituitary stalk was sited in front of dorsum sellae in 53.3% (8 cases), in the middle part in 40% (6 cases) and in the back of tuberculum sellae in 6.7% (1 case).　Conclusion The variation in the diameter of FDS could exert influence on the growth pattern of pituitary adenomas and the detailed anatomic knowledge of diaphragma sellae and its ambient structures is helpful in improving the quality of operation in the sellar region.

Key words: Diaphragma sellae, Optic chiasm, Pituitary stalk, Applied anatomy

中图分类号:

R323.1

梁金, 漆松涛, 樊俊, 石瑾, 陆云涛, 颜小荣. 鞍膈的解剖特点及其临床意义[J]. 中国临床解剖学杂志, 2013, 31(2): 123-126.

LIANG Jin, QI Song-Chao, FAN Dun, DAN Jin, LIU Yun-Chao, YA Xiao-Rong. Anatomic features of diaphragma sellae and its clinic implications[J]. Chinese Journal Of Clinical Anatomy, 2013, 31(2): 123-126.

参考文献

[1] Guinto BG, Abdo M, Mercado M, et al. Diaphragma Sellae: A Surgical Reference for Transsphenoidal Resection of Pituitary Macroadenomas
[J]. World Neurosurgery, 2011,75(2):286-293.

[2] Asa SL, Ezzat S. The cytogenesis and pathogenesis of pituitary adenomas
[J]. Endocr Rev, 1998, 19(6):798-827.

[3] Hagiwara A, Inoue Y, Wakasa K, et al. Comparison of growth hormone-producing and non-growth hormone-producing pituitary Adenomas: Imaging Characteristics and Pathologic Correlation
[J]. Radiology, 2003, 228(2):533-538.

[4] Zada G, Lin N, Laws ER. Patterns of extrasellar extension in growth hormone–secreting and nonfunctional pituitary macroadenomas
[J]. Neurosurgical Focus, 2010, 29(4):E4.

[5] Madsen H, Borges TM, Knox AJ, et al. Giant pituitary adenomas: pathologic-radiographic correlations and lack of role for p53 and MIB-1 labeling
[J]. AM J Surg Pathol, 2011,35(8):1204-1213.

[6] Songtao Q, Yuntao L, Jun P, et al. Membranous layers of the pituitary gland: histological anatomic study and related clinical issues
[J]. Neurosurgery, 2009, 64(3 suppl):ons1-10.

[7]王剑新, 漆松涛, 彭玉平, 等. 蝶鞍结构与垂体瘤生长方式关系的影像学研究
[J]. 中国医师杂志, 2010, 12(11):1478-1481.

[8] 韦拳堂, 漆松涛, 彭玉平, 等. 垂体窝上口形态学特点与垂体腺瘤生长关系的影像学研究
[J]. 中国微侵袭神经外科杂志, 2012, 17(6):255-257.

[9] Campero A, Yasuda A, Rhoton AL. Microsurgical anatomy of the diaphragma sellae and its role in directing the patern of geowth of pituitary adenomas
[J]. Neurosurgery, 2008, 62(3):717-723.

[10]Cavallo LM, de Divitiis O, Aydin S, et al. Extended Endoscopic Endonasal Transsphenoidal Approach to the Suprasellar Area: Anatomic Considerations-Part 1
[J]. Neurosurgery, 2007, 61(3):24-34.

[11] Rhoton AL. The sellar region
[J]. Neurosurgery, 2002, 51(4 Suppl):S335-374.

[12]Won HS, Han SH, Oh CS, et al. Topographic variations of the optic chiasm and the foramen diaphragma sellae
[J]. Surg Radiol Anat, 2010, 32(7):653-657.

[13]Carmel PW, Antunes JL, Ferin M. Collection of blood from the pituitary stalk and portal veins in monkeys, and from the pituitary sinusoidal system of monkey and man
[J]. J Neurosurg, 1979,50(1):75-80.

[14]Gulsen S, Dinc AH, Unal M, et al. Characterization of the anatomic location of the pituitary stalk and its relationship to the dorsum sellae, tuberculum sellae, and chiasmatic cistern
[J]. J Korean Neurosurg Soc, 2010, 47(3):169-173.

[15]关树森, 于春江, 江涛, 等. 垂体柄与垂体腺瘤显微解剖关系的临床观察
[J]. 中华医学杂志, 2001,81(10):583-585.