鼻内镜及影像学定位在鼻腔泪囊造口术中的应用  

Application of endoscopy and image stereotactic technique in dacryocystorhinostomy

作　　者：时文杰[1] 王学敏 陈志良[1] 张玉庚[1] 孙沛勇[1] 王晓非[1] 

机构地区：[1]天津市第一中心医院耳鼻咽喉头颈外科,天津300192 [2]解放军第四六四医院眼科,天津300192

出　　处：《中国耳鼻咽喉头颈外科》2007年第12期707-709,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨鼻内泪囊的解剖及影像学定位在泪囊手术中的临床应用价值。方法对20例(26眼)慢性泪囊炎患者术前进行CT泪囊造影三维重建,确定泪囊大小及影像学定位;术中以上颌线作为定位开放泪囊的参考标志,行鼻内镜下鼻腔泪囊造口术。结果CT泪囊造影片能清晰显示泪囊大小以及与周围结构的关系,并可任意径线及角度适时测量。术中以上颌线作为手术进路的标志均能准确开放泪囊,20例(23眼)中,大泪囊10眼术后无造口闭塞,治愈率100%;中泪囊11眼术后有1眼仍有少量流泪,但较术前明显好转,治愈率90.9%;小泪囊2眼中有1眼术后仍有明显流泪,内镜检查发现造口粘连、阻塞,治愈率50%。结论术前计算机三维重建泪囊造影对鼻内镜下鼻腔泪囊造口术具有重要应用价值。上颌线可以作为泪囊手术进路的参考标志之一。OBJECTIVE To explore the clinical value of image stereotactic technique in localization of the lacrimal sac in endoscopic dacryocystorhinostomy. METHODS Preoperative dacryocyst iodized oil opacification CT 3D-reconstruction were performed in 20 cases （26 eyes） with chronic dacryocystitis in order to estimate the size of lacrimal sac and conform image localization. The maxillary line was considered as a labeling mark during operation. RESULTS The size of lacrimal passage could be displayed with dacryocyst iodized oil opacification CT and the relation between lacrimal sac and structures around it could be observed and measured freely. In endoscopic dacryocystorhinostomy, lacrimal sac was opened correctly with maxillary line as a mark. Ten eyes with big lacrimal sac had unobstructed stoma, and the cured rate was reached to 100 %; One of 11 eyes with moderate lacrimal sac still have slight lacrimation after operation, but obviously improved compared with preoperation, the cured rate in patients with moderate lacrimal sac was 90.9 %. In 2 eyes with small lacrimal sac, 1 eye still shed tears severely. CONCLUSION The technique of preoperative dacryocyst iodized oil opacification CT 3D-reconstruction is of great value in endoscopic dacryocystorhinostomy. Maxillary line can be a labeling mark in confirming of lacrimal sac during operation.

关 键 词：内窥镜检查 成像 三维 泪囊鼻腔吻合术 

分 类 号：R779.6[医药卫生—眼科]