鼻内镜下泪囊鼻腔造口术疗效观察及影响因素分析

目的观察鼻内镜下泪囊鼻腔造口术治疗慢性泪囊炎的疗效并分析影响手术疗效的相关因素。方法 58例(58眼)慢性泪囊炎患者,于鼻内镜下行泪囊鼻腔造口术,术中以明胶海绵固定泪囊黏膜瓣。术后鼻腔应用鼻用激素,鼻内镜下术腔护理并行泪道冲洗,术后随访半年以上。结果所有患者均于术后随访6~16个月(11.94±2.97)。本组患者55例一次性治愈,1例术后再行泪道置管后好转,2例无效,总有效率96.55%(56/58)。结论鼻内镜下泪囊鼻腔造口术损伤小,术后恢复快,手术成功率高,可以作为治疗慢性泪囊炎的首选术式。     

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。     

鼻内镜鼻腔泪囊造口联合泪道置管治疗慢性泪囊炎92例临床分析

目的分析鼻内镜下鼻腔泪囊造口术联合泪道置管的手术方法和治疗效果。方法对92例慢性泪囊炎患者行鼻内镜泪囊造口术联合泪道置管、术后冲洗。结果手术平均时长约1小时,术后无颌面部瘢痕形成,89例治愈,患者溢泪消失,泪道冲洗通常无阻塞,鼻内镜检查示造口上皮化完全,造口规则无狭窄、黏连,3例好转溢泪症状减轻,泪道冲洗畅通,鼻内镜示造口处黏膜增厚、造口狭窄,治愈率96.74%。结论鼻内镜下鼻腔泪囊造口术联合泪道置管术后反应少,复发率低,术后能减少疤痕形成,降低泪囊术后阻塞可能,提高手术成功率,值得推广。     

经鼻内镜鼻腔泪囊开放术治疗慢性泪囊炎

目的 分析经鼻内镜鼻腔泪囊开放术治疗慢性泪囊炎的手术方式及治疗效果。方法 收治慢性泪囊炎患者30例,均行鼻内镜下泪囊开放术,术后行泪道冲洗,随访6~12个月,观察手术疗效。结果 手术均顺利进行,30例术中、术后均无并发症发生,治愈28例(93.3%),好转2例(6.6%)。结论 鼻内镜下鼻腔泪囊开放术视野清晰、无面部瘢痕,治疗慢性泪囊炎效果良好,符合外科手术微创和美容的要求。     

单纯泪道探通术治疗新生儿泪囊炎

目的:评价单纯泪道探通术对新生儿泪囊炎的治疗效果.方法:对49例生后3月～13月新生儿泪囊炎的治疗效果进行回顾性分析.患儿治疗前应用10%水合氯醛进行灌肠,待入睡后应用泪道探针行单纯泪道探通治疗.结果:全部病例均一次性治愈,无严重并发症发生.结论:借助10%水合氯醛催眠后,单纯行泪道探通术是治疗新生儿泪囊炎的简单、有效方法.     

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。     

鼻内窥镜下泪囊鼻腔吻合术治疗慢性泪囊炎

慢性泪囊炎既往手术治疗多经鼻外进行 ,术后常在面部留下永久性瘢痕。为免此遗憾 ,我科自1 996年以来 ,开展鼻内窥镜下泪囊鼻腔吻合术治疗1 0 2例 ( 1 0 8眼 )本病患者 ,取得了良好效果。现报告如下。1　资料与方法1 .1　临床资料慢性泪囊炎 2 0 2例 ( 2 0 8眼 ) ,女 1 68例 ( 1 74眼 ) ,男 34例 ( 34眼 ) ;年龄 1 6～ 68岁。病程 6个月～ 42年。均有长期溢泪症状 ,药物治疗无效。检查 :1 91眼挤压泪小点处溢脓。术前常规行泪道探通术。按治疗方法随机分为两组 :内窥镜组 :1 0 2例 ( 1 0 8眼 ) ,采用鼻内窥镜下泪囊鼻腔吻合术。其中 1 0例有…     

鼻内镜下鼻腔泪囊吻合术治疗复杂性慢性泪囊炎

目的 分析鼻内镜下鼻腔泪囊吻合术治疗复杂性慢性泪囊炎的临床效果。方法 对12例（14眼）复杂性慢性泪囊炎采用鼻内镜下经鼻行鼻腔泪囊吻合术。术后鼻腔应用局部激素及泪道冲洗。结果 术后随访6个月~3年,治愈11眼,好转1眼,无效2眼;治愈率为78.6%,好转率为7.1%,无效率为14.3%,总有效率85.7%,无1例出现严重手术并发症。结论 鼻内镜下治疗复杂性慢性泪囊炎较传统鼻外进路鼻腔泪囊吻合术视野清晰,可同时处理鼻内病变且损伤小,操作更精细,效果较好,术后恢复快,更具有可行性。     

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。     

Endoscopic marsupialization of congenital nasolacrimal duct cyst with dacryocoele

A congenital nasolacrimal duct cyst is an uncommon condition in the newborn usually treated by ophthalmologists. Prolapse or expansion of the cyst into the nose may lead to respiratory distress and difficulty in feeding as newborns are obligate nose breathers, which needs the involvement of the Otolaryngologist in diagnosis and management. The authors report a series of 8 children presenting with a congenital nasolacrimal duct cyst and dacryocoele and highlight the importance of endoscopic nasal examination of newborns presenting with respiratory problems. Diagnostic studies included intranasal endoscopy and CT scanning of the nasolacrimal system and nose. All the patients were treated by endoscopic marsupialization of the cyst. Nasolacrimal duct abnormality should be considered in the differential diagnosis of neonatal respiratory distress and nasal obstruction. Nasal endoscopy is essential in the work-up of all children with nasal obstruction and respiratory distress. CT scanning is the investigative method of choice. Endoscopic marsupialization followed by lacrimal duct irrigation is effective in the treatment of congenital nasolacrimal duct cyst and results in complete resolution of symptoms.     

Results of endoscopic assisted probing for congenital nasolacrimal duct obstruction in older children

PURPOSE: To evaluate the results of lacrimal probing with the use of nasal endoscopy and identify the anatomical anomalies responsible for the symptoms in older children. METHODS: Fifty-two eyes of 40 children with congenital nasolacrimal duct obstruction underwent primary probing of the lacrimal duct under general anaesthetic in conjunction with nasal endoscopy. Patients followed up for at least 6 months. Cure was defined as complete resolution of symptoms or minimal symptoms brought on by cold or wind. RESULTS: The age range was 12-126 months. In 30/52 (57.7%) eyes the symptoms were attributed to a single mechanical obstruction. Seven eyes had canalicular stenosis. Three eyes had upper nasolacrimal duct obstruction. Nine eyes had narrow duct and nine eyes had atresia of the distal end of the duct. Two eyes had only intranasal abnormalities. In 16/52 (30.76%) eyes a combination of anomalies was responsible for the symptoms. Nine eyes had canalicular stenosis in association with: either a membrane at the valve of Hasner in four, or a narrow duct in three, or intranasal anomalies in two. Two eyes had punctual stenosis and narrow duct. Two eyes had narrow duct and tight inferior turbinate. Three eyes had abnormal openings in association with stenotic ducts. Six (11.54%) eyes had functional blockage. With the use of endonasal endoscopy, intranasal anomalies identified in 12 eyes and treated in nine. One eye had large inferior conchae. One eye had inferior concha adherent to lateral nasal wall. One eye had redundant nasal mucosa. Three eyes had tight inferior turbinate. Three had abnormal openings. In three eyes the probe went submucosally. The overall success rate was 84.6% (44/52 eyes). Eight eyes remained unchanged. Endoscopically treated cases contributed to the overall success by 17.31%. CONCLUSION: Multiple anatomical anomalies within the lacrimal system and abnormalities of the nose are quite common in older children. Lacrimal probing remains the primary treatment and nasal endoscopy is a useful adjunct to probing increasing the success rate of the procedure.     

Nasal obstruction in the neonate secondary to nasolacrimal duct cysts

The neonate is an obligate nasal breather and any form of nasal obstruction causes respiratory distress during feeding and sleeping. We report two patients with unusual causes of respiratory distress secondary to nasolacrimal duct cysts. The failure of the lacrimal duct to perforate at the distal end results in dacryocystitis and cyst formation. Removal of the nasal wall of the cyst resolves the obstruction and the dacryocystitis. The nasolacrimal duct cyst is an unusual, but readily treated, cause of neonatal respiratory distress.     

The technique of nasendoscopy in the evaluation of nasolacrimal duct obstruction in children

Epiphora in infancy is most commonly the result of failure of canalisation of the nasolacrimal duct and most cases resolve spontaneously within 12 months. Lacrimal probing is the standard operative treatment when conservative expectant management fails. While this carries a high success rate, it does not reliably localise the site of obstruction, can create a false passage and may induce traumatic stenosis in the lacrimal passages. Nasendoscopy in conjunction with the lacrimal probing overcomes these problems as the procedure is performed under direct vision. The precise site of opening of the nasolacrimal duct is ascertained, the nature of obstruction established and the risks of false passage creation minimised. We report this technique of endoscopic assessment of lacrimal probing, and the outcome results of twenty such procedures performed on thirteen children.     

第五代泪道内镜微钻疏通联合人工鼻泪管置入治疗鼻泪管阻塞的临床观察

目的 探讨第五代泪道内窥镜下泪道疏通联合人工鼻泪管置入治疗鼻泪管阻塞的临床疗效。 方法 选取2014年1月至2015年12月诊治的61例(61眼)鼻泪管阻塞患者为研究对象,采用泪道内窥镜下微钻疏通联合人工鼻泪管置入术治疗。 结果 随访观察6个月,治愈48例(48眼),好转8例(8眼),有效率91.8%,无效5例(5眼)。 结论 第五代泪道内窥镜下微钻疏通联合人工鼻泪管植入治疗鼻泪管阻塞安全、有效,创伤小,并发症少。     

Neonatal respiratory distress secondary to bilateral intranasal dacryocystocoeles

Obstruction of the nasolacrimal duct is a common congenital abnormality reported in up to 84% of neonatal patients [J. Yohendran, A.C. Wignall, E.J. Beckenham, Bilateral congenital dacryocystocoeles with concurrent intranasal mucocoeles causing respiratory distress in a neonate, Asian J. Surg. 29 (2) (2006) 109-111; M.J. Cunningham, J.J. Woog, Endonasal endoscopic dacryocystorhinostomy in children, Arch. Otolaryngol. Head Neck Surg. 124 (1998) 328-333; D. Guery, E.L. Kendig, Congenital impotency of the nasolacrimal duct, Arch. Ophthalmol. 97 (1979) 1656-1658]. Rarely, obstruction results in the development of an intranasal lacrimal duct cyst, or dacryocystocoele, which arises inferolateral to the inferior turbinate [H.R. Jin, S.O. Shin, Endoscopic marsupialisation of bilateral lacrimal sac mucoceles with nasolacrimal duct cysts, Auris Nasus Larynx 26 (1999) 441-445]. These lesions can cause nasal obstruction and, when bilateral, significant respiratory compromise. We present the case of a 3-day-old infant with bilateral intranasal lacrimal duct cysts causing nasal obstruction and intermittent respiratory compromise. The diagnosis was suspected on clinical examination and confirmed on MRI. The patient was successfully managed by bilateral endoscopic marsupialisation and probing of the nasolacrimal ducts. We also present a review of the literature surrounding investigation and management of intranasal lacrimal duct cysts.     

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。     

Nasal endoscopy in the treatment of congenital lacrimal sac mucoceles

PURPOSE: To determine the incidence of intranasal cysts associated with lacrimal sac mucoceles and the cure rate with nasal endoscopic cyst marsupialization. DESIGN: Interventional case series. METHODS: SETTING: University-affiliated teaching hospital. PATIENT POPULATION: Twenty-five infants with non infected or infected lacrimal sac mucoceles or dacrocystitis without obvious mucocele were consecutively enrolled. INTERVENTION PROCEDURES: Management included local lacrimal massage, parenteral antibiotics, and when still symptomatic, nasolacrimal duct probing with concomitant nasal endoscopy. Intranasal cysts identified were marsupialized until the distal end of the nasolacrimal duct probe was visualized. MAIN OUTCOME MEASURES: Presence of intranasal cyst identification and cure rate. RESULTS: Infants were 4 days to 10 weeks old (mean 19 days). Forty-eight percent had a bluish cutaneous mass inferior and lateral to the lacrimal sac. Twenty percent were bilateral. At presentation, 76 percent had dacrocystitis. Fourteen percent had respiratory distress. Only one child responded to medical management. At endoscopy, 23 of 24 infants had ipsilateral intranasal cysts. The one child without nasal cyst had recurrent dacrocystitis and no mucocele. All children with mucocele were cured except one child with residual nasolacrimal duct obstruction. CONCLUSIONS: Lacrimal sac mucoceles were almost always associated with intranasal cysts. Nasal endoscopy is a valuable addition to the treatment plan for lacrimal sac mucoceles not responding to a brief trial of massage or infantile dacrocystitis. To avoid potential complications, we recommend against waiting until infection occurs before proceeding with surgery.     

泪囊在鼻内镜泪囊鼻腔造口术中的解剖学研究及临床应用

目的 探讨经鼻内镜泪囊鼻腔造口术中泪囊在鼻腔外侧壁的解剖学定位.方法 对12具(24侧)成人尸头的泪囊在鼻腔外侧壁上的投影位置进行解剖学测量,为62例(85侧)慢性泪囊炎鼻泪管阻塞患者行经鼻内镜鼻腔泪囊造口术.结果 解剖学测量结果提示,15侧(62.5%)泪囊上界位于中鼻甲腋上方,9侧(37.5%)泪囊上界位于中鼻甲腋下方.临床结果:62例(85侧)术后随访6个月以上,治愈50例(70侧,82.3% ),好转8例(9侧,10.6%),无效4例(6侧,7.1%),总有效率为92.9%.结论 以中鼻甲腋前上0.7 cm为上界,腋前下0.3 cm为下界,钩突前缘向上延线为泪囊后界定位泪囊进行鼻腔泪囊造口为较佳选择.