经鼻内窥镜泪囊鼻腔造口自体组织移植再造泪道的应用解剖(英文)  

Applied anatomy of endoscopic transnasal lacrimal duct reconstruction by grafting of autogenous tissue

作　　者：陶海[1] 马志中[2] 吴海洋[1] 侯世科[1] 王朋[1] 王伟[1] 韩毳[1] 

机构地区：[1]武警总医院眼科,北京市100039 [2]北京大学第三医院,北京大学眼科中心,北京市100083

出　　处：《中国组织工程研究与临床康复》2009年第24期4779-4782,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：Armed Police Medical Research Foundation,No.WJ200612~~

摘　　要：背景:经鼻内窥镜下泪囊鼻腔造口自体组织移植再造泪道术是临床上治疗严重道阻塞的新方法,需要积累临床应用解剖学资料。目的:研究泪道的显微外科应用解剖,为经鼻内窥镜泪囊鼻腔造口自体组织移植泪道再造手术提供解剖学依据。设计、时间及单位:2006-07/2007-06在武警总医院眼科实验室完成。材料:经体积分数为10%甲醛防腐处理的成人头颅解剖标本20个,男14个,女6个,共40侧泪道的标本。方法:沿眉弓上缘及枕骨粗隆上10mm连线水平锯开颅盖,去除脑组织,10%硝酸脱钙1周左右,使标本既不改变形态结构,又能用手术刀切割。正中矢状面切开面颅,切除鼻中隔,暴露鼻腔外侧壁。主要观察指标:泪囊窝的长径和前后径,泪囊窝中1/3部在泪前嵴、泪囊窝骨壁中垂线和泪后嵴的厚度,骨性鼻泪管上口、中部和下口横截面积,泪阜-鼻腔水平距、30°斜距和45°斜距,泪阜到鼻泪管上口距离,泪阜到鼻泪管上口连线与鼻底平面的夹角。结果:泪囊窝的长径为(17.85±1.72)mm,泪囊窝的前后径为(6.74±1.28)mm,深度为(3.09±0.78)mm。泪囊窝中1/3部在泪前嵴、泪囊窝骨壁中垂线和泪后嵴的厚度分别为(4.03±0.89),(0.61±0.36),(0.63±0.24)mm,泪前嵴最厚,泪囊窝骨壁中垂线处和泪后嵴均较薄,两者比较差异无显著性意义(P>0.05)。骨性鼻泪管上口、中部和下口横截面积分别为(29.04±3.40),(26.19±2.96),(43.50±5.60)mm2,显示中段最为狭窄(P<0.05)。泪阜-鼻腔水平距、30°斜距和45°斜距分别为(17.23±0.70),(14.51±1.72),(17.34±2.38)mm,30°斜距最短,30°斜距和45°斜距比较差异无显著性意义(P>0.05)。泪阜到鼻泪管上口距离为(11.86±1.84)mm,泪阜到鼻泪管上口连线与鼻底平面的夹角为(49.9±1.8)°(48.0°～54.0°)。结论:泪阜到鼻腔及泪囊的距离和泪阜-鼻泪管上口连线与鼻底平面的夹角对鼻腔外侧壁造口部位选择、隧道的倾斜角度和自体移�BACKGROUND： Endoscopic transnasal lacrimal duct reconstruction by grafting of autogenous tissue is a novel method for treatment of severe lacrimal duct obstruction and it needs detailed anatomical data for surgery. OBJECTIVE： To study the applied microsurgical anatomy of lacrimal duct and to provide anatomical evidence for endoscopic transnasal lacrimal duct reconstruction by grafting of autogenous tissue. DESIGN, TIME AND SETTING： This study was performed at the laboratory of the Department of Ophthalmology, Armed Police General Hospital from July 2006 to June 2007. MATERIALS： Twenty 10% formaldehyde-treated adult cadaveric heads, 14 males and 6 females, comprising 40 lacrimal ducts were included in this study. METHODS： The cadaveric heads were split on the level of the line between the superior border of the superciliary arch and the site 10 mm higher than occipital tuberosity. After removal of brain tissue, the heads were decalcified for approximate 1 week with 10% nitric acid. This promised non-alteration of morphological structure and facilitation for surgical cutting. Following dissection of facial cranium in the median sagittal plane, the nasal septum was excised to expose the lateral wall of the nasal cavity. MAIN OUTCOME MEASURES： The anteroposterior diameter and depth of lacrimal fossa; at middle third level, the thickness of lacrimal fossa at the anterior lacrimal crest, vertical middle line, and posterior lacrimal crest; the cross section area of nasolacrima canal upper opening, middle part, and lower opening; horizontal distance, 30° oblique distance, and 45°oblique distance from lacrimal caruncle to nasal cavity; distance from lacrimal caruncle to nasolacrimal canal upper opening; and the included angle between lacrimal caruncle-nasolacrimal canal upper opening line and Aeby＇s plane. RESULTS： The length, anteroposterior diameter, and depth of lacrimal fossa were （17.85±1.72） mm, （6.74±1.28） ram, and （3.09±0.78） ram, respectively. At middle third level, the thickness

关 键 词：泪道再造术 鼻内窥镜泪囊造口术 自体组织移植 

分 类 号：R318[医药卫生—生物医学工程]