鼻腔内窥镜下泪囊造孔术治疗泪道阻塞性疾病观察  

Clinical observation of endoscopic Dacryocystorhinostomy in treating different obstructive diseases of lacrimal duct in nasal endoscope

作　　者：范瑞[1] 牛艳[1] 钟瑞佳[1] 李雪[1] 孙凤[1] 范春雷[1] 

机构地区：[1]爱尔眼科医院集团沈阳爱尔眼视光医院,沈阳110003

出　　处：《中国实用眼科杂志》2014年第5期655-656,共2页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨鼻腔内窥镜下泪囊造孔术治疗不同泪道阻塞性疾病的临床效果。方法回顾分析2010年9月至2012年12月在沈阳爱尔眼科医院应用鼻腔内窥镜下泪囊造孔术治疗不同泪道阻塞性疾病的患者共214例（225只眼）临床资料。所有病例均一次完成，并置入泪道引流装置。术后定期清理鼻腔，3-6个月取出泪道引流装置，观察术后造瘘口上皮化时间、造瘘口的形态以及泪道冲洗结果。结果225只眼均在术后3周至1．5个月造瘘口上皮化，取出泪道引流装置后213只眼造瘘口直径约3mm，其中38只眼在造瘘口周围有肉芽增生，同期将肉芽组织去除，冲洗泪道通畅，12只眼泪道引流装置与周围组织粘连，造瘘口膜闭，冲洗泪道不通畅，经再次处理10只眼造瘘口重新开放。术后观察3个月至2年，225只眼中35只眼造瘘口瘢痕化闭锁，其余190只眼造瘘口大小约1-3mm不等，泪道冲洗通畅，总有效率84．4％（190／225）。结论鼻腔内窥镜下泪囊造孔术治疗不同泪道阻塞性疾病安全、有效，如何降低造瘘口闭锁是提高手术成功率的关键。Objective To investigate the clinical effect of nasal endoscopic Dacryocystorhinosto- my in treating different obstructive diseases of lacrimal duct. Methods A retrospective analysis of 214 patients （225 eyes） with different obstructive diseases of lacrimal duct that were treated by na-sal endoscopic Dacryocystorhinostomy from September 2010 to December 2012. All cases were com-pleted, and entered into the lacrimal drainage device. After operation, regular cleaning of the nasal cavity was performed and, lacrimal drainage device were removed after 3-6months. Postoperative sto-ma fistular, the time of epitheliar morphology and irrigation of lacrimal passage results were ob-served. Results All 225 eyes recovered in 3 weeks to 1.5 months, fistular epithelial lacrimal drain-age device, out of 213 eyes after the stoma diameter of about 3mm, including 38 eyes with hyper-plasia of granulation tissue around fistula, over the same period the granulation tissue removal, irriga-tion of lacrimal passage patency, 12 eyes with lacrimal drainage device with the surrounding tissue adhesion film, stoma closed, irrigation of lacrimal passage was not smooth, after treatment 10 eyes fistula reopened. Three months to 2 years after surgery, 35 out of 225 eyes had fistula scarring atre- sia, the other 190 eyes stoma size ranging from about 1-3mm lacrimal, the total efficiency was 84.4% （190/225）. Conclusions Nasal endoscopic Dacryocystorhinostomy in treating different obstruc-tive diseases of lacrimal duct is safe and effective. How to reduce the fistula orifice atresia is the key to improve the success rate of operation.

关 键 词：鼻腔内窥镜下泪囊造孔术 泪道阻塞 

分 类 号：R777.2[医药卫生—眼科]