泪囊鼻腔吻合术中前筛窦过度发育的处理

目的 探讨泪囊鼻腔吻合术(dacryocystodlinostomy，DCR)中前筛窦过度发育的处理方法。方法 147例泪囊鼻腔吻合术中发现前筛窦过度发育44例(50眼)。以弯蚊式钳插入患侧中鼻道探查、捏鼻鼓气、向骨孔中注水等方法予以识别。发现单层骨板36例(42眼)，双层骨板8例(8眼)；薄骨板29例(35眼)，厚骨板15例(15眼)。薄骨板以剥离子剥离取出，厚骨板以咬骨钳咬除。结果 术后随访3月～2年，全部患者术后溢泪症状消失，泪道冲洗通畅。结论 在泪囊鼻腔吻合术中正确识别和处理过度发育的前筛窦对提高手术成功率具有重要意义。

Identification and management of the anterior ethmoid sinus overgrowth during dacryocystorhinostomy

Objective To identify and manage the anterior ethmoid sinus overgrowth during dacryocystorhinostomy(DCR).Methods 44 cases (50 eyes)with the anterior ethmoid sinus overgrowth were found in 147 cases(158 eyes) of DCR.36 cases(42 eyes)of 1-layer bone plate and 8 cases (8 eyes) of 2-layer bone plates,which were found by 3 methods:exploring with curved mosquito forceps inserted into middle meatus,pinching the nostrils to close them and the patient was asked to make a forced expiration with his month shut,injected saline mixed gentamycin into the bone hole.In 44 cases (50 eyes),thin bone plates were in 29 cases (35 eyes) and thick were in 15 cases (15 eyes).Thin bone plates were taken out with detacher and thick with rongeur.Results 3 months-2 years after operation,lacrimal passage was unobstructed in all cases and no patient was epiphora.Conclusion Identification and management of the anterior ethmoid sinus overgrowth during DCR are important to improve operating rate of success.