经泪囊切开逆行探通泪小管断裂吻合术

目的 评价泪小管断裂时经泪囊切开，逆行探查泪小管鼻侧断端吻合手术的疗效。方法 外伤性下泪小管断裂93例(93眼)，上下泪小管均断裂11例(11眼)，先采用注气或注液法、直视法、试探法、探通法等均不奏效时，即改为泪囊切开法，经泪囊切开逆行探查寻找泪小管鼻侧断端，进而行泪小管吻合术。结果 104例均经3月至5年以上的随访，自觉不流泪，冲洗泪道通畅者96例(92．30％)；自觉轻微流泪，冲洗泪道通而不畅者6例(5．77％)；流泪，冲洗泪道不通者2例(1．93％)。结论 泪囊切开法找到泪小管断端准确率高。     

泪囊切开逆行探查法在泪小管吻合术中的应用

目的 探讨外伤性泪小管断裂吻合术中寻找鼻侧断端的方法。方法 对收治的难以寻找鼻侧断端的泪小管断裂伤28例，采用泪囊切开逆行探查法寻找鼻则断端，然后进行泪小管吻合术。结果 经随访观察6月—2年，27例获得治愈，仅有l例术后6月发生阻塞，改用泪道激光治疗痊愈。结论 泪囊切开逆行探查法对于治疗难以寻找鼻侧断端的泪小管断离病例，不失为一种疗效较好的手术方法。     

泪囊切开法在泪小管断裂吻合术中的应用

目的:探讨泪囊切开法在泪小管断裂吻合术中的应用。方法:对收治的难以寻找鼻侧断端的泪小管断裂患者21例21眼,采用泪囊切开逆向寻找鼻侧断端方法。结果:患者21例经随访1～2a,20例有效,总有效率95.2%。结论:泪囊切开逆向寻找鼻侧断端对难于寻找鼻侧断端的泪小管断裂伤是快捷、有效的手术方法。     

逆行插管寻找下泪小管断端吻合术的应用

目的探讨逆行插管寻找泪小管鼻侧断裂端治疗泪小管断裂手术方法及术后效果。方法45例（45眼）外伤性泪小管断裂,采用各种办法寻找失败后、切开泪囊,自泪囊内泪总管开口逆行插入带有钢芯硬膜外麻醉导管,连接泪小管两断端吻合断端。结果45例均顺利吻合断裂泪小管,术后泪道冲洗42例通畅,3例冲洗不通。结论对于泪小管断裂者,逆行插管寻找泪小管断端是一种手术吻合成功率高,效果良好的方法,是常规下行插管失败病例的一种可靠的补充措施。     

陈旧的下泪小管断裂手术治疗

目的 观察两种治疗陈旧的下泪小管断裂的手术方式的效果.方法 回顾性分析在我院就诊的36例陈旧的下泪小管断裂,分别采用经上泪点和泪囊切开两种方式逆行寻找下泪小管鼻侧断端的手术方法,术后随访观察比较两种术式的效果.结果 36例中有6例经上泪点逆行寻找下泪小管鼻侧断端成功,其余30例经泪囊切开逆行寻找下泪小管鼻侧断端成功,均成功置入双路环形硅胶管.术后3个月拔管,随访6个月以上.29例（80.6％）治愈,5例（13.9％）基本治愈,2例（5.5％）无效.结论 逆行寻找下泪小管断端联合双路环形硅胶管置入是治疗陈旧的下泪小管断裂的有效方法.     

亚甲蓝染色法在下泪小管吻合术中的应用

目的：探讨亚甲蓝染色法寻找泪囊侧泪小管断端在泪小管吻合术中的应用价值。方法：采用亚甲蓝染色法寻找泪囊侧下泪小管断端,进行泪小管吻合术。结果：２７例２７眼下泪小管断裂,泪囊侧下泪小管断端经亚甲蓝染色标记明显,２７眼中２６眼（９６．３０％）找到泪囊侧断端,吻合手术顺利。随访３～６月,２６眼中手术成功２４眼（９２．３０％）,好转１眼（３．８５％）,未愈１眼（３．８５％）。结论：采用亚甲蓝染色法,染色标记     

陈旧性泪小管离断的修复

目的 探讨陈旧性泪小管离断的手术方法和效果。方法 陈旧性外伤性下泪小管断裂15例，于外伤后半月至6月进行吻合手术，采用直视法、弯针法和泪囊切开法寻找泪小管鼻侧断端。结果 吻合成功13例，成功率达86．6％。随访观察3月至2年，患者无溢泪，冲洗泪道通畅10例，占76．9％。患者轻微溢泪，冲洗通畅3例。结论 直视法是最实用的寻找泪小管鼻侧断裂的方法，如不成功，则采用弯针法或泪囊切开法。     

自制器械的泪小管断端探查

目的 寻找简捷有效的泪小管断端探查方法。方法 自制一头端闭合，距头端28mm及30mm有2侧孔的硬膜外导管，从上泪点插入至下鼻道，上端注入生理盐水，可在下泪小管鼻侧断端形成水流，以确定下泪小管鼻侧断端，然后进行泪小管吻合术。结果 19例均一期完成了泪小管断裂吻合术，结论 自制器械可提高泪小管断端探查的准确率。缩短手术时间，是一种有效的泪小管断端探查方法。     

泪囊切开逆向置管吻合术治疗外伤性泪小管断裂

目的探讨外伤性泪小管断裂吻合的手术方法。方法对收治的难以寻找鼻侧断端的泪小管断裂患者32例(32只眼),采用泪囊切开逆向置管吻合术。结果32例经随访半年至2年,31例有效,总有效率96. 9%。结论泪囊切开逆向置管吻合术对于治疗难于寻找鼻侧断端的泪小管断裂伤是疗效肯定可供选择的手术方法。     

逆行注水法及丝裂霉素C修复泪小管断裂

目的探讨泪小管断裂修复术中，逆行插管注水法寻找鼻侧断端的可行性以及丝裂霉素C（MMC）预防吻合口纤维化的临床疗效。方法对46例（46眼）外伤性泪小管断裂，在鼻内窥镜下从鼻泪管下端开口逆行插管注水，寻找鼻侧断端，并于术中及术后应用MMC。结果46眼均顺利找到鼻侧断端，成功吻合。随访6-36月：泪溢症状消失，冲洗泪道通畅35眼；泪溢症状减轻，冲冼泪道通畅7眼。有效率为91．30％；泪溢症状无改善，冲洗泪道不通4眼，无效占8．70％。结论对外伤性泪小管断裂，尤其是上、下泪小管同时断裂或泪总管断裂，采用逆行插管注水是寻找鼻侧断端的可靠方法。MMC可抑制吻合口的纤维化，提高疗效。     

泪囊切开逆向插管治疗复杂性泪小管断裂伤

目的:探讨经泪囊切开逆向插管法治疗复杂性泪小管断裂的手术效果。方法:外伤性泪小管断裂患者45例,采用经泪囊切开逆向置硬膜外麻醉导管吻合泪小管断裂。结果:45例经6mo～1a随访观察,获得解剖复位,自觉不流泪,冲洗通畅者40例(89%);自觉轻微流泪,冲洗泪道通而不畅者3例(7%);冲洗泪道不通者2例(4%)。结论:经泪囊切开逆向插管法是一种治疗复杂性泪小管断裂的有效方法。     

Modified canaliculo-dacryocystorhinostomy.

The management of cases with common canalicular obstruction poses a difficult problem. Nineteen patients presenting with common canalicular obstruction of unknown cause or in association with trauma, encysted mucocoele and previous sac surgery, were operated on by the modified canaliculodacryocystorhinostomy technique. The surgery involves a microsurgical dissection at the site of the common canalicular obstruction followed by anastomosis to the sac or nasal mucosa with silicone tube intubation of the passage using an improvised metallic introducer. The procedure was successful in 13 of the cases in a follow-up period varying from 4 months to 15 months. The complications included extrusion of the tube and nasal bleeding. The indications of the procedure, the precise technique and precautions to avoid intra and post operative complications have been elaborated in the paper.     

anastomosis lacrimal sac conjunctival sac in severe laceration of lacrimal canaliculus

PURPOSE:To investigate the clinical effect of anastomosis lacrimal sac conjunctival sac in the treatment of severe laceration of lacrimal canaliculus. METHODS:A total of 19 cases (19 eyes) with laceration of lacrimal canaliculus underwent anastomosis lacrimal sac conjunctival sac.All the patients were followed up for 3 to 24 months postoperatively. RESULTS:Among all the 19 patients (19 eyes), 14 cases were cured,3 cases wre markedly improved and 2 cases had no effect,and the effect rate was 89.47%. CONCLUSION:Anastomosis lacrimal sac conjunctival sac is an effective surgical technique in the management of severe laceration of lacrimal canaliculus.     

泪小管断裂吻合术96例效果分析

目的 手术显微镜下直接寻找泪小管鼻侧断端吻合置管术的临床效果.方法 在手术显微镜下在复原伤口后寻找泪小管鼻侧断端,以硬膜外麻醉导管作为泪小管内支撑,吻合泪小管.结果 96例中6例内眦皮肤裂伤处愈合欠佳,泪小管断端裂开,远期溢泪,7例拔管后随访泪道不通畅,其余83例均痊愈,治愈率占86.46%.结论 手术显微镜下直接寻找到泪小管鼻侧断端的成功率较高,且行吻合修复术后恢复泪道排泪功能效果肯定.     

泪小管断裂吻合术两种置管方法的比较

目的 探讨泪小管吻合手术技巧,比较两种泪道置管的疗效.方法 回顾分析95例(95眼)下泪小管断裂吻合术,其中直接夹取法取出鼻泪道引线37例,注水擤鼻法取出鼻泪道引线30例,均逆行置入硅胶管;直接置入硬膜外麻醉管28例,采用X2检验比较两种置管方法的疗效.结果 95例泪小管断端均成功找到.注水擤鼻法取出鼻泪道引线优于直接夹取法.逆行硅胶管置入有效率达97.01%(65/67),直接硬膜外导管置人有效率达82.14%(23/28),差异有统计学意义(X2=4.06,P<0.05).结论 泪小管断裂吻合术中,硅胶管逆行置入疗效优于硬膜外导管直接置入.注水擤鼻法能快捷取出鼻泪道引线,顺利逆行置入义管,适合在基层医院开展.     

新型泪道逆行置管术治疗鼻泪管阻塞

目的探讨新型泪道逆行置管术的临床效果及其特点等。方法选择在门诊治疗的鼻泪管阻塞及合并慢性泪囊炎患者,在局部麻醉下用泪道探通导引针将泪道引流管从鼻泪管下口置入泪道。术后治疗中观察引流管的位置、洁净度、溢泪及泪囊分泌物性状和被引流排出情况等,2～4周后拔管。按治疗后随诊时间的长短分组：（1）A组：统计1997年5月至2001年12月,深圳市中医院眼科治疗3年以上患者521例（613只眼）,作为远期治疗效果观察组;（2）B组：统计2003年10月至2005年10月深圳市眼科医院治疗0．5至1．5年的381例患者（411只眼）,及同期北京市顺义区医院眼科治疗的5例患者（6只眼）,共386例患者（417只眼）,作为近期治疗效果观察组。运用卡方检验对两组间治愈率进行比较。结果术后一般1周左右泪道冲洗通畅;2—3周溢泪症状消除;1～3周泪囊分泌物被引流排除干净,但个别患者黏液性分泌物持续3个月,予二次置管,二次置管治愈率为92．3％（23／26）。治愈率：A组为84．5％,B组为88．2％。两组治愈率比较,差异无统计学意义（P〉0．05）。手术、麻醉可导致短时间的患者复视和不适感,未见并发症。结论新型泪道逆行置管术,操作安全简便,基本无创伤,手术预后好,可作为治疗鼻泪管阻塞、慢性泪囊炎的方法。     

泪道逆行置管治疗慢性泪囊炎临床观察

目的：评价泪道逆行置管术治疗慢性泪囊炎的有效性、安全性。 方法：选取2009-12/2011-12来本院就诊的慢性泪囊炎患者42例42眼,在局部麻醉下将泪道再通管逆行置入鼻泪管内,术后3~6mo拔管,拔管后随访6mo,观察其有效性及并发症发生情况。 结果：所有42例患者均顺利置入泪道再通管,常规3~6mo拔管。42例患者中40例患者拔管时泪道冲洗通畅。拔管后6mo有效率88%,发生并发症3例。 结论：泪道逆行置管治疗慢性泪囊炎操作简单,适用范围广,有较好的有效性及安全性,值得推广。     

Histopathologic changes in the lacrimal sac of dacryocystorhinostomy patients with and without silicone intubation

PURPOSE: To evaluate the histopathologic impact of dacryocystorhinostomy (DCR) and silicone intubation on the lacrimal sac. METHODS: Biopsy materials were taken from the sac wall and fixed (primary biopsy) in 224 patients undergoing DCR between 1995 and 2003 in our institution. A total of 23 patients underwent a second operation as the result of restenosis, and a secondary biopsy specimen was taken from the sac wall. During the initial operation, DCR and silicone intubation were combined in 13 patients (group 1), and only DCR without silicone intubation was performed in 10% patients (group 2). The histopathologic findings of the primary and secondary biopsy specimens were compared in these 23 recurrent cases. In addition, the secondary biopsy findings in the intubation and nonintubation groups were compared to determine the possible effects of the silicone intubation on the sac mucosa. RESULTS: Endonasal examination of restenosis cases revealed macroscopic cicatrization. One of the cases with silicone intubation had pyogenic granuloma and two had polypoid granulation tissue at the site of anastomosis. Inflammatory polypoid development at the site of anastomosis was also observed in one case without intubation. The primary biopsy specimens of those 23 patients undergoing a second operation revealed the following findings: chronic inflammatory changes, mild fibrosis, focal ulceration in the epithelium, and a decrease in the number of goblet cells. In the secondary biopsy specimens, 2 patients in group 1 had polypoid granulation tissue, 1 patient had pyogenic granuloma, and 3 patients had exudate reflecting acute inflammation. In group 2, granulation tissue was observed in 1 case, and 2 patients had acute inflammation. There were no differences in the primary and secondary biopsy specimens of the two groups with respect to chronic inflammatory changes, focal ulceration, and the number of goblet cells (p = 0.31; 0.31, 0.65). A marked increase in fibrosis was observed in the secondary biopsy specimens of all cases (p < 0.0001). There were no significant differences between the intubation and the nonintubation groups in terms of secondary biopsy specimens (p > 0.05). CONCLUSIONS: The marked increase in the intensity of fibrosis observed in the secondary biopsy specimens of all cases was the result of the tissue repair reaction against surgical manipulation rather than the effect of the silicone tube.