基于骨性鼻泪管走向的逆行充气泪道CT造影三平面重组技术的初步研究  

Preliminary Study on Three-plane Reconstruction Technique of Retrograde Inflated Lacrimal Duct CT Imaging Based on the Trend of Nasolacrimal Duct

作　　者：李露茜 周希彬[1] 王菲[1] 陶海[1,2] LI Luxi;ZHOU Xibin;WANG Fei;TAO Hai(The Third Medical Center,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 [2]解放军医学院,北京100853

出　　处：《中国中医眼科杂志》2024年第5期414-418,424,共6页China Journal of Chinese Ophthalmology

基　　金：军队科研项目(BLB23C003)。

摘　　要：目的基于骨性鼻泪管走向的逆行充气泪道电子计算机断层扫描(CT)造影三平面重组技术,评估其检查泪囊前泪道阻塞患者的鼻泪管和泪囊通畅情况的准确性和安全性。方法纳入2022年10月—2023年12月的泪囊前泪道阻塞患者43例(57只眼),行充气前CT横轴位扫描,判断鼻泪管和泪囊空气存留情况。对充气前CT横轴位扫描鼻泪管和泪囊未充满空气的患者,使用自行设计制作的经鼻泪管下口逆行充气和气压监测系统使患者泪道充填空气,行CT横轴位扫描,并记录拍摄过程中最大鼓气气压值。对泪道CT横轴位扫描结果进行三维重建和以骨性鼻泪管走向的横轴位、冠状位和矢状位三平面重组分析其通畅情况,再与手术中探查结果对比,评估其准确性。同时观察并发症和不良反应,评估其安全性。结果(1)一般情况:逆行充气前,43例(57只眼)泪道阻塞患者中,泪囊及鼻泪管均充满空气有3例(4只眼),而空气未充满有40例(53只眼)。(2)逆行充气试验:逆行充气后,未完全充满空气的53只眼,鼻泪管和泪囊被气体均充满的33只眼,未见气体填充20只眼。术中验证33只眼的鼻泪管和泪囊均通畅,而20只眼中12只眼为鼻泪管下段真性阻塞,而8只眼鼻泪管无阻塞,该检查方法的灵敏度为80.4%,特异度为100.0%,准确率为84.9%。鼻腔鼓气的最佳气压值的参考范围为8~9 kPa。(3)并发症和不良反应:检查过程中及检查后均未见任何并发症和不良反应。结论基于骨性鼻泪管走向的逆行充气泪道CT造影三平面重组技术可以全程清晰显示双侧鼻泪管,有助于对于前泪囊阻塞患者的鼻泪管和泪囊通畅情况进行判断,安全性好,对临床治疗术式的选择有一定的指导意义。OBJECTIVE To evaluate the accuracy and safety of the three-plane reconstruction technique of retrograde inflated lacrimal duct computed tomography(CT)imaging based on the trend of nasolacrimal duct in examining the patency of the nasolacrimal duct and lacrimal sac in patients with pre-sacicular lacrimal duct obstruction.METHODS A total of 43 cases(57 eyes)of pre-sacicular lacrimal duct obstruction from October 2022 to December 2023 were selected.Axial CT scans were performed before inflation to assess the presence of air in the nasolacrimal duct and lacrimal sac.Patients with incomplete air filling in the nasolacrimal duct and lacrimal sac on pre-inflation axial CT scans were subjected to retrograde inflation and pressure monitoring using a selfdesigned and manufactured system through the inferior nasal meatus.CT axial scans were performed after air filling,and the maximum inflation pressure during imaging was recorded.Three-plane reconstruction of lacrimal duct CT axial scans and analysis of its patency in three planes,axial,coronal,and sagittal,based on the trend of nasolacrimal duct were conducted.The results were compared with intraoperative findings to assess accuracy.Simultaneously,complications and adverse reactions were observed to evaluate safety.RESULTS(1)General situation:Before retrograde inflation,among the 43 cases(57 eyes),three cases(four eyes)had both the lacrimal sac and nasolacrimal duct filled with air,while 40 cases(53 eyes)had incomplete air filling.(2)Retrograde inflation test:After retrograde inflation,among the 53 eyes with incomplete air filling,both the nasolacrimal duct and lacrimal sac were fully filled with air in 33 eyes,while no air filling was observed in 20 eyes.Intraoperative verification showed that the nasolacrimal duct and lacrimal sac were unobstructed in 33 eyes,while 12 eyes among the 20 eyes had true obstruction in the lower segment of the nasolacrimal duct,and eight eyes had no obstruction in the nasolacrimal duct.The sensitivity of this examination method was 80.4%,spec

关 键 词：泪囊前泪道阻塞 泪道CT造影 空气造影剂 逆行充气 三平面重组技术 

分 类 号：R777.2[医药卫生—眼科]