鼻内窥镜微创技术在难治性鼻泪管阻塞治疗中的应用

目的探讨应用鼻内窥镜微创技术治疗难治性鼻泪管阻塞的可行性，并探讨其临床意义。方法难治性鼻泪管阻塞56例（65眼）在鼻内窥镜直视下进行泪囊鼻腔造瘘术联合环形人工泪小管植人术，对合并上泪道狭窄或阻塞者，术中于鼻内窥镜直视下，采用WZC-Ⅲ高频电泪道浚通仪进行上泪道浚通术。5眼合并鼻中隔重度偏曲者，同期行鼻内窥镜下鼻中隔偏曲矫形术。术后常规处理，3个月后拔除人工泪小管，随访观察1-3个月。结果术后仅极少数患者存在轻度溢泪及眼内眦部充血，无人工泪小管脱落及其他不适。65眼中53眼溢泪、溢脓等症状消失，治愈率81．5％（53／65）；7眼存在轻度溢泪，无溢脓，有效率10．8％（7／65），5眼症状无改善，无效率7．7％（5／65）。结论鼻内窥镜微创技术为难治性鼻泪管阻塞提供了一种理想的治疗手段，它具有微创、直视下操作、疗效可靠、并发症少、无颜面部瘢痕等优点。

Significance of nasal endoscopic mini-invasive surgery in treatment of refractory naso-Iacrimal duct obstruction

Objective To evaluate the feasibility and significance of naso-endoscopic minimal invasive surgery in the treatment of refractory obstruction of naso-lacrimal passage (DCONP). Methods Fifty-six patients (65 eyes) with refractory obstruction of naso-lacrimal passage (ONLP) were treated by minimal invasive naso-endoscopic surgery,in which 11 patients (15 eyes)with ONLP accompanied with stenosis or obstruction of superior lacrimal duct underwent nasal endoscopic dacryocystorhinostomy (NES-DCR) combined with high-frequency electronic superior lacryoplasty (HFESL) and silicone intubation,and NES-DCR combined with silicone intubation was performed in 7 cases (8 eyes) ONLP with small or heavy fibrous lacrimal sac,6 cases (6 eyes) with mucocele of lacrimal sac,5 cases (5 eyes) traumatic ONLP accompanied with heavy deviated nasal septum,4 cases (4 eyes) whose lacrimal sac was slitted to discharge pus because of acute purulent dacrycystitis,23 cases (27 eyes) undergone unsuccessful operations such as laser lacryocystoplasty,silicone intubation or external dacryocystorhinostomy.The tubes were kept in place for three months after operation.The follow-up time was one month to three months. Results Symptoms was completely resolved in 53 eyes ( 81.5%) and improved in 7 eyes ( 10.8%) and reccurred in 5 eyes(7.7%) with the overall successful rate 92.3%.Except slight epiphora or conjunctival congestion in internal canthus in a few patients and puncta slitting in 3 eyes (4.6%),there was no other complications such as tube fallen off and canalicular granuloma formation. Conclusion naso-endoscopic surgery provide an ideal therapeutic technology for DCONP because of its many advantages such as minimal invasion,being operated under excellent lighting and enlargement,good curative effects,a few complications and no scars on face and so on.