鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎的临床效果  

Clinical Analysis of Endoscopic Dacryocystorhinostomy in the Treatment of Traumatic Dacryocystitis

作　　者：魏丽[1] 黄世威[1] 吴帅[1] 崔极哲[1] Li Wei;Shiwei Huang;Shuai Wu;Jizhe Cui(Department of Ophthalmology,Second Hospital of Jilin University,Changchun 130000,China)

机构地区：[1]吉林大学第二临床医院眼科中心,长春130000

出　　处：《中华眼视光学与视觉科学杂志》2020年第2期119-123,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:探讨术前解读泪道造影和眼眶CT的重要性以及鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎的治疗效果。方法:回顾性研究。统计分析2016年4月至2019年3月在吉林大学第二临床医院行鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎的患者资料13例(14眼),包括病史、术前泪道造影、眼眶CT片和术中情况。术后观察患者症状改善与否,泪道冲洗结果及鼻内镜下观察造口的情况,随访6个月评估手术疗效。结果:通过CT阅片发现3眼泪囊移位(其中1眼合并泪骨骨折),6眼同时合并上颌骨额突和鼻骨骨折(其中1眼见瘢痕组织增生于骨折片间),5眼仅见鼻泪管骨折,泪囊位置及局部解剖未见明显异常。14眼均成功行鼻内镜下泪囊鼻腔造口术,其中1眼因泪囊移位明显联合植入泪囊鼻腔引流支架。12例(13眼)治愈,1例(1眼)未愈。术中易出血,术后无并发症,随访6个月均无复发。结论:鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎安全有效,并发症少。术前阅读泪道造影CT片有助于术中泪囊的准确定位和完全暴露,提高手术效率。Objective:To explore the importance of an accurate interpretation ofhelical CT-dacryocystography before endoscopic dacryocystorhinostomy and its surgical technique for the treatment of traumatic dacryocystitis.Methods:This was a retrospective study.Analysis of 13 patients(14 eyes)who underwent nasal endoscopic dacryocystorhinostomy in the Second Hospital of Jilin University from April 2016 to March 2019 and included medical history,preoperative helical CT-dacryocystography and intraoperative conditions.According to whether the patient's symptoms improved,whether lacrimal tract irrigation was unobstructed,and whether the dacryocystorhinostomy was open,follow-up was performed for 6 months to evaluate the effect of surgery.Results:Through accurate CT readings,3 eyes were found to have lacrimal sac displacement(one of which combined with lacrimalbone fracture),6 eyes had amaxillary frontal process and nasal bone fracture(one of which had scar tissue proliferating between fractures),and the remaining 5 eyes only had nasolacrimal duct fractures,no obvious abnormalities in their positions and the local anatomy of the lacrimal sac.All 14 eyes were successfully treated with endoscopic dacryocystorhinostomy.Treatment for one of the eyes was combined with alacrimal sac nasal drainage stent due to the displacement of the lacrimal sac.Twelve patients(13 eyes)were cured,one patient(one eye)was notcured.Bleeding was easily controlled during the operation.There were no complications occurring after the operation,and no recurrence after at least 6 months of follow-up.Conclusions:Endoscopic dacryocystorhinostomy for the treatment of traumatic dacryocystitis is safe and effective,with few complications.An accurate preoperative reading of the helical CT-dacryocystography is helpful for accurate positioning and complete exposure of the lacrimal sac,which helps the endoscopic dacryocystorhinostomy go smoothly.

关 键 词：外伤性泪囊炎 鼻内窥镜 泪囊鼻腔造口术 泪道造影 计算机断层扫描 

分 类 号：R77[医药卫生—眼科]