改良小切口外路泪囊鼻腔吻合术36例临床观察  

Clinical observation of 36 cases of modified small incision external route dacryocystorhinostomy

作　　者：程晓霞 田超伟[2] 

机构地区：[1]武功县人民医院眼科,陕西712200 [2]西安第四军医大学西京医院眼科

出　　处：《中华眼外伤职业眼病杂志》2014年第8期627-629,共3页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察改良小切口外路泪囊鼻腔吻合术治疗慢性泪囊炎的临床效果。方法回顾性分析小切口手术治疗的慢性泪囊炎36例（36眼）的临床资料。男7例，女29例。年龄15～66岁。病程，3月～4年。所有患者术前明确诊断为慢性泪囊炎，冲洗鼻泪管不通并有脓液溢出。其中7例曾行泪道激光，6例曾反复冲洗过。手术采用改良小切口外路泪囊鼻腔吻合术，皮肤切口10mm，以小型眼睑拉勾或缝线牵开暴露术野，钝性分离皮下组织，不切断内眦韧带，蚊式钳轻压造成骨孔，咬骨钳制做超过10mm的骨孔，骨窗尽可能较大且较低，充分止血，“H”字形切开泪囊及鼻黏膜，6-0可吸收线分别吻合前后瓣，不植管，前瓣悬吊于皮下组织。结果术后随访1—4年。1例因骨孔内肉芽组织增生，于术后3个月泪道堵塞，患者拒绝进一步处理而继续出现溢泪症状。一例泪道冲洗通畅，但患者仍出现溢泪而无溢脓，未行特殊处理。其余34例效果良好，无明显溢泪或流脓症状，手术成功率为94．4％。所有患者皮肤愈合良好，无明显瘢痕形成。结论改良小切口外路泪囊鼻腔吻合术，掌握手术技巧，术中精心操作，可显著提高手术成功率并减少并发症的发生。Objective To investigate the clinical efficacy of modified small incision extemal route dacryocystorhinostomy for chronic dacryocystitis. Methods The medical records of 36 cases of chronic dacryocystitis treated with modified small incision external route dacryocystorhinostomy were retrospectively analyzed. There were 7 male and 29 female patients, aged 15 - 26 years. The duration of diseases ranged from 3 months to 4 years. All cases were diagnosed as chronic daeryocystitis with obstructed nasolacrimal duct and the overflowing of pus. Seven cases had undergone lacrimal laser treatment, and 6 cases had received repeated irrigations of lacrimal passage before surgery. The surgery adopted modified small incision external route dacryocystorhinostomy with 10 mm skin incision. The operative field was exposed by small eye lid retractor or stitches. The subcutaneous tissue was separated by blunt dissection. The 10-mm bone window was made by mosquito forceps and rongeur forceps ,without cutting off the canthal ligament. After the bleed- ing was stopped, H-shaped incisions were made on the lacrimal sac and nasal mucosa. The front and rear flaps of both incisions were sutured each other with 6-0 silk suture with the front flaps suspended in the subcutaneous tissue. Results The patients were followed for 1 to 4 years. 34 cases had good clinical effect. The proliferation of granulation tissue in the bone hole occurred in one patient who had epiphora but no pyorrhea at 3 months postoperatively. One case had epiphora with patent lacrimal duct. The surgical success rate was 94.4%. The skin healed well without scarring in all cases. Conclusion For chronic dacryocystitis, modified small incision external route daeryocystorhinostomy can increase surgical success rate and decrease the incidence of surgical complications.

关 键 词：泪囊炎 慢性 泪囊鼻腔吻合术 小切口 外路 改良 

分 类 号：R779.6[医药卫生—眼科]