鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎

目的探讨鼻内镜下鼻腔泪囊造孔术治疗慢性泪囊炎的手术方式及临床疗效。方法32例(35眼)采用德国Storz公司0°鼻内镜及手术器械行泪囊鼻腔造孔术,下泪小点植入硬脑膜外麻醉用硅胶导管,留置于中鼻道3~6个月。结果随访6个月至2年,随访30例(32眼),27眼泪道通畅,炎症消退;3眼术后泪囊造口处粘连闭锁,经鼻内镜下开放泪囊造口,泪道恢复通畅。2眼泪道阻塞,检查泪囊造孔处通畅,行泪道冲洗多次,1眼泪道恢复通畅,1眼仍有阻塞,经再次置管处理,恢复正常。结论该术式具有创伤小,面部不遗留瘢痕,操作简便等特点。术后随访是提高手术成功率的重要措施。     

改良鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎

目的:探讨改良鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎的手术方法及其疗效。方法:通过对造孔、泪囊黏膜瓣的切开及固定方式等的改良处理,在鼻内镜下完成泪囊鼻腔造孔术治疗慢性泪囊炎22例(23眼)。结果:术后随访6～10个月,平均8个月。22例(23眼)中,21例(22眼)治愈,症状完全消失,泪道冲洗畅通,内镜检查造孔通畅;1例(1眼)症状改善不明显。总有效率95.7%(22/23)。所有患者未出现严重并发症。结论:改良鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎明显提高了手术成功率,值得临床推广。     

鼻内镜下泪囊鼻腔造孔术结合中药冲洗治疗慢性泪囊炎的疗效观察

目的探讨鼻内镜下泪囊鼻腔造孔术结合中药治疗慢性泪囊炎的手术方法和疗效。方法经鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎患者58例62眼,术后随机分成两组,治疗组36眼术后结合中药冲洗;对照组26眼术后置入扩张管。结果治疗组总有效率为97.22%,显著高于对照组的80.77%（P〈0.05）。结论采用鼻内镜下泪囊鼻腔造孔术结合中药冲洗治疗慢性泪囊炎,具有疗效好、操作简单、并发症少的优点。同时运用的中药代替扩张管的使用,患者更容易接受。术后采用中药冲洗泪道避免了西药大量使用对鼻腔黏膜的刺激,减少了应激反应。     

鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎16例

目的报告鼻内镜下行鼻内鼻腔泪囊造孔术的手术方法及疗效。方法由鼻内径路鼻内镜下施行鼻腔泪囊造孔术,治疗慢性泪囊炎共16例(16眼)。结果治愈12眼,好转2眼,无效2眼,有效率87.5%(14/16)。结论本术式操作简便,损伤小,恢复快,无面部瘢痕,疗效显著。     

鼻内窥镜下泪囊鼻腔造孔术治疗慢性泪囊炎

目的探讨鼻内窥镜下施行泪囊鼻腔造孔术治疗慢性泪囊炎的方法.方法回顾分析经鼻腔泪囊鼻腔造孔术治疗慢性泪囊炎45例的临床资料.结果45例中治愈38例,占84.4%,好转5例,占11.2%,无效2例,占4.4%.结论在鼻内窥镜下行泪囊鼻腔造孔术治疗慢性泪囊炎(鼻泪管阻塞)与经皮泪囊鼻腔造孔吻合术相比,具有临床疗效好,操作简单,术中出血少,术后面部无疤痕等优点.     

鼻内境泪囊鼻腔造孔术远期疗效随访

目的总结分析慢性泪囊病变患者鼻内镜下经鼻行泪囊鼻腔造孔术治疗的临床远期随访观察结果，探讨影响手术远期疗效的因素。方法对275例（310眼）慢性泪囊病变患者采用鼻内镜下经鼻行泪囊鼻腔造孔术。术前行泪囊碘油造影，手术在局部麻醉或全身麻醉下进行，根据泪囊大小或病变情况决定术终泪道放置泪道硅胶扩张管。术后随访包括鼻内镜检查处理、泪道冲洗及鼻腔局部糖皮质激素应用。结果随访3～60个月，随访超过1年（远期）者211例（230眼），治愈率75．3％，好转率11．7％，无效13．0％，总有效率87．0％。9眼术后1年发现自然泪道复通，但泪囊鼻腔造孔瘢痕闭锁。无手术并发症。结论鼻内镜下泪囊鼻腔造孔术远期效果较好。扩大造孔骨窗，减少黏膜损伤和手术创面，以及随访清创有助于提高手术成功率。鼻泪管黏膜在手术造孔引流后，有可能发生可逆性转变，重新发挥泪道的泪液排泄作用。     

鼻内镜下泪囊鼻腔造孔术造孔的处理

目的:探讨更好地处理鼻内镜下泪囊鼻腔造孔术造孔的方法。方法:102例(109眼)慢性泪囊炎患者于鼻内镜下行泪囊鼻腔造孔术,术中用银夹固定造孔,术后给予综合治疗,并随访3～73个月。结果:治愈99眼(91.0%),好转5眼(4.5%),有效率95.5%。结论:泪囊鼻腔造孔术用银夹固定造孔,术后辅以综合治疗,可有效防止造孔的狭窄、闭锁。     

鼻内镜下鼻腔泪囊吻合术38例临床效果分析

目的 研究鼻内镜下鼻腔泪囊吻合术的临床效果,分析手术无效的原因。方法 对38例(38眼)慢性泪囊炎患者施行鼻内镜下鼻腔泪囊吻合术,观察术后泪道通畅程度, 分析手术无效原因。结果 患者手术过程均顺利,术后随诊 6个月,治愈36例、36眼占94.7% , 无效2例、2眼占5.3%。无效者1例为鼻息肉患者术后息肉复发,造口处反复有肉芽组织增生,经多次局部处理,终至闭锁,患者拒绝再次手术;1例为颌面部复合型骨折致慢性泪囊炎,术后溢泪,但无再溢脓。结论 鼻内镜下鼻腔泪囊吻合术具有方法简便、出血少、无面部瘢痕、手术视野清晰、术中损伤小、患者痛苦轻、并发症少等优点。     

内窥镜下鼻内泪囊鼻腔造孔术治疗慢性泪囊炎的疗效观察

目的研究鼻内窥镜下鼻内泪囊鼻腔造孔术治疗慢性泪囊炎的疗效.方法慢性泪囊炎36例、38眼在鼻内窥镜明视下行鼻内泪囊鼻腔造孔术治疗.结果手术成功35例,其中2例行二次手术后成功,手术成功率为97.2%,3例经鼻外切口泪囊鼻腔造孔术后复发者均一次手术成功.手术失败1例(2.8%).结论鼻内窥镜下鼻内泪囊鼻腔造孔术是治疗慢性泪囊炎的有效方法,经鼻外泪囊鼻腔造孔术失败者亦适用此法.     

鼻内镜下银夹固定泪囊造孔治疗慢性泪囊炎

目的探讨经鼻内镜下利用银夹固定泪囊造孔治疗慢性泪囊炎。方法对39例(42眼)慢性泪囊炎病人经鼻内镜行泪囊鼻腔造口,用银夹把造口处泪囊黏膜和鼻腔黏骨膜固定吻合,无需置管让其形成瘘口。所有病例随访3个月以上,对其疗效观察分析。结果手术治愈36眼(85.7%),好转3眼(7.1%),无效3眼(7.1%)。无效3眼为泪囊狭窄所致,改留置腰麻管2个月后泪道部分通畅。结论经鼻内镜银夹固定泪囊造孔治疗慢性泪囊炎,操作简便、方便,疗程短,有良好的治疗效果,是较理想的手术方式。     

鼻内镜下手术治疗慢性泪囊炎的经验体会

目的 探讨鼻内镜下手术治疗慢性泪囊炎的经验。方法 选择2006年5月至2010年3月收治的213例(225眼)慢性泪囊炎、鼻泪管堵塞患者,其中慢性泪囊炎行颜面部切口手术复发25眼,均行鼻内镜下手术治疗。造瘘口均采用EC耳脑胶黏合固定成形。结果 213例(225眼)中,同期行鼻中隔高位偏曲矫正33眼,钩突肥大切除20眼,中鼻甲前端息肉样变切除19眼,鼻息肉切除16眼。术后完全无溢泪199眼,好转19眼,无效7眼。有效率96.8% 。结论 泪囊内壁黏膜完全切开且无张力外翻是手术成功的关键,造瘘口行EC耳脑胶吻合牢固可靠。术后定期鼻内镜下换药是手术治疗不可缺少的环节。     

鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的手术探讨

目的 探讨经鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的手术方式、技巧及临床疗效。方法 采用鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎28例(30眼),术后在鼻内镜下行常规泪道冲洗及鼻腔清理换药。结果 所有病例随访6个月,治愈率93.33%,总有效率100% 。结论 经鼻内镜下泪囊鼻腔吻合术是治疗慢性泪囊炎的理想方法,具有创伤性小、治愈率高、不影响美容的特点。     

鼻内镜下泪囊鼻腔吻合术治疗慢性泪囊炎

目的 探讨经鼻内镜泪囊鼻腔吻合术的方法与临床效果。方法 1991年11月-2006年3月采用鼻内镜下泪囊鼻腔吻合术治疗慢性泪囊炎患者144例（155眼）。回顾分析其临床资料，总结手术方法，观察临床疗效。结果 144例患者（155眼）术后随访1年，治愈率为87．7％（136／155），显效率4．5％（7／155），有效率1．9％（3／155），无效5．8％（9／155），总有效率94．2％（146／155）。结论 严格掌握手术适应证、熟悉有关解剖、牢记手术操作要点，鼻内镜下泪囊鼻腔吻合术是治疗慢性泪囊炎的一种有效方法，同时对鼻-鼻窦疾病的治疗及术后随访处理是提高鼻内镜下泪囊鼻腔吻合术疗效的有效手段。     

鼻内镜辅助下鼻泪道再通术治疗新生儿期泪囊炎

目的 探讨在鼻内镜辅助下行鼻泪道探通术治疗新生儿期泪囊炎的手术时机及临床疗效。方法 选取大连市妇女儿童医疗中心(集团)收治的22例(43眼)新生儿期泪囊炎患儿,其中男6例、女16例,平均年龄22 d,所有患儿均有体温升高、患侧面部鼻部肿胀明显,患侧内眦以下泪囊区红肿及压痛,伴有大量脓性分泌物等症状,在保守治疗无效的情况下,行鼻内镜辅助下鼻泪道探通术,术后观察泪囊炎的治疗效果。结果 22例泪囊炎患儿均行泪道探通术治疗,术后随访8个月～2年,所有患儿症状均好转。结论 年龄<3个月患儿因泪道阻塞出现感染、红肿等症状时,保守治疗无效可行泪道探通,鼻内镜辅助手术可精确定位,避免鼻腔黏膜损伤。     

Bilateral nasolabial cysts associated with recurrent dacryocystitis

OBJECTIVE: Nasolabial cysts are rare, nonodontogenic, soft-tissue, developmental cysts occurring inferior to the nasal alar region. They are thought to arise from remnants of the nasolacrimal ducts and they are frequently asymptomatic. We report a rare case of bilateral nasolabial cysts accompanied by bilateral chronic dacryocystitis. CASE REPORT: A 48-year-old woman suffering from bilateral chronic dacryocystitis was referred to our department for endonasal dacryocystorhinostomy. She had undergone external dacryocystorhinostomy on the left side a few years earlier. Physical examination and computed tomography scan revealed nasolabial cysts bilaterally inferior to the nasal alar region. The cysts were removed via a sublabial approach and endoscopic dacryocystorhinostomy was performed on the right side. Ten months after surgery, the patient was asymptomatic. CONCLUSION: There may be a correlation, due to embryological reasons, between the presence of nasolabial cysts and the presence of chronic dacryocystitis. Both can be corrected surgically, under the same anaesthesia, without visible scar formation.     

眼内光导纤维引导下经内镜鼻腔泪囊造口术

目的：寻找用于经内镜鼻腔泪囊造口术时引导泪囊定位的方法。方法：在眼内光导纤维引导下对7例（8眼）慢性泪囊炎患者进行鼻腔泪囊定位。结果：7例患者均顺利完成手术，术中出血10～20ml，术后恢复良好，无感染。5例患者行二次手术，均留置麻醉导管3～6个月后拔管，拔管后每个月行泪囊冲洗1次。随访1年以上无再阻塞，无并发症发生。结论：眼内光导纤维可用于经内镜鼻腔泪囊造口术中进行泪囊定位。     

Endonasal carbon-dioxide laser assisted dacryocystorhinostomy verses external dacryocystorhinostomy

This is a prospective, non-randomized study to evaluate and compare the results, morbidity and surgical time for endonasal carbon-dioxide laser assisted dacryocystorhinostomy and external dacryocystorhinostomy. 70 consecutive patients of chronic dacryocystitis with nasolacrimal duct obstruction were selected for the study. 36 patients under went endonasal CO2 laser assisted dacryocystorhinostomy and 34 had external dacryocystorhinostomy. Selection of the type of operation was left to the patient's choice. All the patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Patients not willing for the external incision were selected for endonasal laser assisted dacryocystorhinostomy and others were operated via external approach. Silicone tubes were put in all the patients for three months after surgery. The final follow up was 12 months after the removal of silicone tubes. The patency of the lacrimal passage was confirmed by irrigation, and patients were questioned about their symptoms. The success rates, 12 months after removal of silicone tubes were 100% in endonasal CO2 laser assisted dacryocystorhinostomy and 88.24% in external dacryocystorhinostomy. The surgical time of endonasal laser assisted dacryocystorhinostomy was 38 minutes as compared to 62 in external dacryocystorhinostomy. Complication rate in both groups was almost equal. Thus, we came to the conclusion that Endonasal CO2 laser assisted dacryocystorhinostomy is a better surgical option to external dacryocystorhinostomy in cases of chronic dacryocystitis with nasolacrimal duct obstruction, with shorter surgical time.     

改良鼻内窥镜下泪囊鼻腔造孔术的临床观察

［摘要］目的：探讨改良鼻内窥镜下泪囊鼻腔造孔术的方法及疗效。方法：常规于鼻内窥镜下制作骨孔后，制作较大的泪囊黏膜瓣，并采用自制的前针孔缝合针将泪囊、鼻腔黏膜瓣重叠缝合固定于内眦部皮肤的深面。结果：随访3～21个月，42例、56眼中，治愈38例、51眼，好转3例、4眼，无效1例、1眼。治愈率为91.1%，总有效率为98.2%。结论：鼻内窥镜下泪囊鼻腔吻合术可有效地防止吻合口远期瘢痕挛缩闭锁，具有较好的疗效。     

改良经鼻内镜下泪囊鼻腔造孔术

目的报道经鼻内镜下泪囊鼻腔造孔术的改良及其疗效,就改良手术方法和目的进行探讨。方法采用改良经鼻内镜下泪囊鼻腔造孔术治疗的慢性泪囊炎患者31例(35眼)。男性4例,女性27例。年龄9～70岁,平均31岁。术前行泪囊碘油造影。随访6～20个月。结果31例(35眼)慢性泪囊炎,双眼患者4例;2例(2眼)为鼻内镜手术损伤致泪囊炎。前期泪囊鼻腔激光手术病史4例(5眼),鼻外径路手术2例(2眼)。28例(91.4%,32/35眼)治愈,症状消失,鼻腔造孔通畅。1例术后1周取出膨胀海绵时发生鼻腔黏膜瓣位置移位;2例术后6个月造孔瘢痕闭锁,其中1例再手术后治愈。总有效率97.1%(34/35眼)。结论保留鼻腔黏膜瓣并以此修复裸露骨质,可最大程度避免和减少骨质和瘢痕增生,有助于提高和取得满意的临床泪囊鼻腔造孔治疗效果。     

Pediatric endocanalicular diode laser dacryocystorhinostomy: results of a minimally invasive surgical technique

The purpose of this study was to evaluate the effectiveness of endocanalicular diode laser dacryocystorhinostomy (DCR), which is a minimally invasive surgical technique, in pediatric patients with congenital nasolacrimal duct obstruction (NLDO). A retrospective study was carried out on patients treated between October 2008 and August 2009 for nasolacrimal duct obstruction with an endocanalicular diode laser procedure. Patients diagnosed as having nasolacrimal duct obstruction were included in this study and an endocanalicular diode laser procedure was performed. The main outcome measures were patients’ previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora. Eighteen children (10 girls, 8 boys) with a mean age of 6.11 ± 2.08 years (range, 4–10) underwent 20 endocanalicular laser DCR operations for congenital NLDO. In all eyes (100%), there was a history of epiphora and chronic dacryocystitis; two (10%) presented with acute dacryocystitis. Previous procedures included probing and irrigation of all eyes (100%) and silicone tube intubation in nine eyes (45%). None of the patients underwent any previous DCR operations. During a mean postoperative follow-up period of 20.50 ± 3.24 months (range, 14–24 months), the anatomical success rate (patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 85%. Endocanalicular diode laser DCR is an effective treatment modality for pediatric patients with congenital NLDO that compares favorably with the reported success rates of external and endoscopic endonasal DCR. Moreover, it has an added advantage of shorter operative time, less morbidity and avoidance of overnight admission.