自制新型引流支架在泪囊鼻腔吻合术中的应用  

A new type of lacrimal sac nasal drainage stents used in endoscopic dacryocysto-rhinostomy

作　　者：张庆[1] 张将[1] 石明华[1] 

机构地区：[1]武汉爱尔眼科医院,中国湖北省武汉市430063

出　　处：《国际眼科杂志》2013年第2期386-389,共4页International Eye Science

摘　　要：目的:鼻内窥镜下泪囊鼻腔吻合术(endonasal endoscopic dacryocystorhinostomy,EES-DCR)中在造瘘口放置自制新型泪囊鼻腔引流支架,并将鼻腔黏膜移植贴附于造瘘口前壁创面上,观察这种改进的可行性及有效性。方法:选取连续的单纯性慢性泪囊炎患者30例,行EES-DCR术,手术方式在传统的手术方法上主要进行以下改进:造瘘口做好后,剪除大部分造瘘口后方所作鼻黏膜瓣,在造瘘口中放置自制硅胶材料的泪囊鼻腔引流支架,将剪下的黏膜贴附在造瘘口前壁和支架间,手术后定期冲洗泪道并用鼻腔内窥镜检查造瘘口情况,包括移植鼻黏膜存活情况,泪囊鼻腔引流支架的位置,吻合口是否通畅,周围组织上皮化等,术后1mo拔出吻合口泪囊鼻腔引流支架,随访3～6mo。结果:患者30例手术均顺利完成,手术时间18～55(平均32.3±8.7)min,术后所有患者移植的鼻黏膜均存活,创面恢复平整,造瘘口均通畅,没有肉芽组织过渡增生阻塞造瘘口以及引流支架移位、嵌顿等并发症。结论:造瘘口内自制硅凝胶泪囊鼻腔引流支架留置联合鼻黏膜瓣前壁移植贴附不但提高EES-DCR的手术成功率,而且减少了术后护理,是一种简单易行、疗效确切、安全高效的鼻内窥镜下泪囊鼻腔吻合的新方法。AIM： To discuss the feasibility and effectiveness of a new surgical method of endoscopic dacryocystorhinostomy （EES-DCR） in simple chronic dacryocystitis patients, in which, a new self-made lacrimal sac nasal drainage stents inserted in the stoma and a nasal mucosa flap attached to the anterior wall of the anastomotic stoma. METHODS： Consecutive 30 cases of simple chronic dacryocystitis underwent OK EES-DCR surgery, surgical operation in the traditional methods had the following major improvements： after stoma was finished, cut off most of the nasal mucosa flap, attached to the anterior wall of the stoma and a new silicone material lacrimal sac nasal drainage stents that made by ourselves placed in the stoma, making nasal mucosa flap closely phase with anterior wall of anastomotic stoma. After the surgery, regular washing of lacrimal was made, observed the stoma with nasal endoscopy, including the survival of transplanted nasal mucosa, the place of the nasal lacrimal drainage stent, whether anastomotic patency, epithelialization of the tissue surrounding the stoma. Pulled out the nasal lacrimal drainage stent after 1 month and followed up to 3 to 6 months later. RESULTS： All 30 operations were successfully completed. The operation time ranged from 18 minutes to 55 minutes, an average of 32.3±8.7minutes. Postoperatively, the transplanted nasal mucosa of all patients successfully survived, wound healing formation, fistula were patent, there was no complications such as proliferation of granulation tissue blocked the transition ostomy mouth, artificial stent displacement or incarceration. CONCLUSION： Self-made silica lacrimal sac nasal drainage stents placed in the stoma combining nasalmucosa flap attached to the anterior wall not only improve the success rate of the operation of EES-DCR, and reduce post-operative nursing, which is a simple, effective, safe and efficient endoscopic dacryocystorhinostomy under the new method.

关 键 词：泪囊炎 内窥镜 泪囊鼻腔吻合术 鼻黏膜瓣 引流支架 

分 类 号：R779.6[医药卫生—眼科]