常规探通术不能疏通的婴幼儿先天鼻泪管阻塞的CT-DCG特征及手术方式选择  

Preliminary study on the features of CT-DCG and surgical methods of congenital na⁃solacrimal duct obstruction in infants who can not be dredged by conventional probing

作　　者：王朋[1] 陶海[1] WANG Peng;TAO Hai(Department of the Ophthalmology of the Third Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第三医学中心眼科医学部,北京100039

出　　处：《中国中医眼科杂志》2022年第6期451-455,496,共6页China Journal of Chinese Ophthalmology

基　　金：首都发展基金自主创新项目(2020-2Z-5132)。

摘　　要：目的研究常规探通术不能疏通的婴幼儿先天鼻泪管阻塞的CT泪道造影(CTDCG)的特征及其对手术方式选择的指导意义,对婴幼儿先天鼻泪管阻塞的诊断和治疗提供影像学依据。方法回顾性分析常规探通术不能疏通的先天鼻泪管阻塞的婴幼儿患者34例(41只眼)的病例资料。患者均做CT泪道造影多平面重组检查,显示鼻泪管的冠状位、矢状位和水平位,分析骨性鼻泪管的CT影像特征,包括骨性鼻泪管的走行方向、宽度、形状等,并对CT造影指导下选择的手术方式的治疗效果进行分析。结果(1)CT影像特征:34例患儿中骨性鼻泪管走行呈弓形内弯曲畸形11例(13只眼),外下方斜畸形6例(6只眼),矢状位骨性鼻泪管上段的前壁呈鹰嘴样后弯3例(3只眼),骨性鼻泪管闭锁9例(12只眼),骨性鼻泪管重度狭窄6例(7只眼);(2)分类:按闭锁和重度狭窄的部位不同,骨性鼻泪管闭锁和重度狭窄又可为骨性鼻泪管上段、中段、下段闭锁或重度狭窄。其中以骨性鼻泪管中段和下段同时闭锁或重度狭窄较多,分别为8例(10只眼)和4例(5只眼);(3)手术情况:根据CT造影检查结果选择合适的手术方式,术中所见均与泪道CT造影多平面重组检查结果相符,患者手术后均治愈。结论常规探通术不能疏通的婴幼儿先天鼻泪管阻塞的患者的骨性鼻泪管形状多样,并非都是骨性阻塞;CT泪道造影多平面重组检查能清晰地显示鼻泪管的情况,有助于明确不能探通的原因,对选择合适的手术方式有较好的指导意义。OBJECTIVE To study the characteristics of CT-Dacryocystography(CT-DCG)of congenital nasolacrimal duct obstruction in infants who can not be dredged by conventional probing and its guiding significance for the selection of surgical methods,so as to provide imaging basis for the diagnosis and treatment of congenital nasolacrimal duct obstruction in infants.METHODS The clinical data of thirty-four(fourty-one eyes)with congenital nasolacrimal duct obstruction who can not be dredged by conventional probing were analyzed retrospectively.All patients underwent CT-DCG multiplanar reconstruction to display the coronal,sagittal and horizontal positions of the nasolacrimal duct.The CT image characteristics of the bony nasolacrimal duct were analyzed,including the line direction,width,shape of the bony nasolacrimal duct,and the therapeutic effect of the selected surgical methods under the guidance of CT was also analyzed.RESULTS(1)The CT image characteristics:Among the thirty-four infants,eleven cases(thirteen eyes)showed the arch internal bending deformity of the bony nasolacrimal duct,six cases(six eyes)showed lateral inferior oblique deformity,three cases(three eyes)showed olecranon-like posterior curvature of the anterior wall of the supperior segment of the bony nasolacrimal duct in the sagittal position,nine cases(twelve eyes)had bony nasolacrimal duct atresia,and six cases(seven eyes)had severe bony nasolacrimal duct stenosis.(2)Classification:According to the location of atresia and severe stenosis,bony nasolacrimal duct atresia and severe stenosis can be classified into superior,middle,and inferior segment of bony nasolacrimal duct atresia or severe stenosis.Among them,eight cases(ten eyes)and four cases(five eyes)were found to have middle and inferior segment of bony nasolacrimal duct atresia or severe stenosis.(3)Surgical methods:The appropriate surgical methods were selected according to the results of CT-DCG.The findings during operation were consistent with the results of multiplanar reconstruction of CT-DCG.Al

关 键 词：先天鼻泪管阻塞 婴幼儿 泪道造影 CT多平面重组 

分 类 号：R777.2[医药卫生—眼科]