唇粘膜移植泪总管鼻粘膜吻合治疗泪囊缺损

唇粘膜移植泪总管鼻粘膜吻合治疗泪囊缺损旅顺四○六医院眼科方大泉，王行敏，谷秀香，郭涛，王长海对泪囊摘除术后及外伤等原因所致的泪囊破坏、萎缩等患者溢泪，１９８９年以来，我们设计应用唇粘膜移植与泪总管及鼻粘膜吻合手术暂时留置硅胶管支撑治疗２０例２１眼，效...     

泪囊冲洗联合泪囊鼻腔吻合术治疗急性泪囊炎

目的：探讨根治急性泪囊炎的方法。方法：本组共25例(25眼)，泪囊穿刺或经瘘口行泪囊抗生素冲洗1次／d，直至急性炎症控制。然后行改良泪囊鼻腔吻合术。结果：经抗生素冲洗泪囊，泪囊区红肿压痛2d消退6眼，3d消退13眼，4d消退6眼；泪总管阻塞再通23眼，通而不畅2眼。所有患术区解剖层次清晰，术中未发现出血增多和泪囊及鼻粘膜破碎。经3mo～5a随访，25例患溢泪溢脓消失，泪道冲洗通畅获治愈。结论：泪囊冲洗联合泪囊鼻腔吻合是治疗急性泪囊炎的有效方法。     

再次泪囊鼻腔吻合术分析及体会

目的 分析探讨造成需再次泪囊鼻腔吻合术的原因及其应采取的相应对策.方法 通过对32例(32只眼)再次泪囊鼻腔吻合术,详细观察,了解分析其失败的具体原因,并采取相应的治疗措施.结果 在32例再次泪囊鼻腔吻合术中,发现其失败原因系泪囊未完全切开者11例,前唇吻合缝线脱落或前唇过长、过宽,致使引起前后唇接触粘连,或前唇下陷粘连者12例,吻合腔肉芽组织增生7例,泪囊过小(萎缩)2例.经再次手术的32例随访3个月,泪道冲洗通畅30例,不畅2例.成功率93.75%.结论 术中细致操作,掌握好有关手术技巧及其具有预防和处理并发症的能力,是避免再次手术,取得手术成功的关键.     

泪囊结膜囊吻合治疗重度上泪道阻塞

上泪道阻塞治疗多采用泪道探通冲洗、穿线、插管、泪小管吻合或激光成形术等方法，大部分可获治愈，但少数因病变重，或治疗中泪道粘膜因反复受到刺激、损伤、假道形成等，致粘连或阻塞加重，甚至使上泪道完全闭塞，通常的治疗方法难以奏效。我们采用泪囊结膜囊吻合治疗10例(11眼)，现报告如下。     

唇粘膜移植在泪囊鼻腔吻合术中的应用

我们自2001年6月~2003年12月,在泪囊鼻腔吻合术中采用自体唇粘膜移植的方法治疗慢性泪囊炎,取得良好效果,现报告如下。1资料和方法1·1一般资料本组7例(7眼)。男4例,女3例。年龄38~62岁。病程最短1年,最长5年。分别做过泪道冲洗,泪道探通及义管植入,激光泪道成形等治疗。主要症     

新型泪道探针治疗新生儿泪囊炎

目的探讨作者设计制作的新型泪道探针治疗新生儿泪囊炎的临床疗效。方法用新型泪道探针对眼科门诊1032例（1138眼）先天性泪囊炎进行泪道探通。结果 1138眼全部探通成功,其中1次探通成功1116眼（98.07%）,2次探通成功22眼（1.93%）,除极少数患儿有轻度眼睑水肿外,其余均无任何严重并发症发生。结论新型泪道探针操作方便、对泪道无损伤,治疗新生儿泪囊炎效果良好。     

鼻内镜下鼻腔泪囊吻合联合全泪道置管术治疗泪囊黏液囊肿

目的探讨鼻内镜下鼻腔泪囊吻合联合全泪道置管术治疗泪囊黏液囊肿的治疗效果。方法鼻内镜下鼻腔泪囊吻合联合全泪道置管术治疗泪囊黏液囊肿15例（16眼）。男2例（2眼）,女13例（14眼）。术后每周行泪道冲洗2次,1个月后每月冲洗1次,3~4个月拔管,拔管后每周冲洗1次。再1个月后每月冲洗1次,共3次。结果拔管后随访时间3~11个月,平均随访时间（6±1）个月。其中14眼（87.5%）治愈,2眼（12.5%）好转。结论鼻内镜下鼻腔泪囊吻合联合全泪道置管术治疗泪囊黏液囊肿效果良好。     

新生儿泪囊炎治疗方法探讨

目的:分析并探讨新生儿泪囊炎3种常见治疗方法的疗效。方法:分别采用按摩法、加压冲洗法和泪道探通法治疗121例(128眼)新生儿泪囊炎,观察3种疗法的效果。结果:按摩法全部无效,加压冲洗法仅2例(2眼)成功,泪道探通法成功113例(120眼),总成功率95.3%。结论:按摩法虽安全却无效;探通法是治疗新生儿泪囊炎行之有效的简便方法。     

慢性泪囊炎泪囊鼻腔吻合术的改进治疗分析

一、资料和方法 1.一般资料:本组32例(32只眼),男16例,女16例,年龄19～65岁,病程3个月至5年,来诊时均有流泪、流脓、门诊反复冲洗泪道病史,确诊慢性泪囊炎.并通过挤压泪囊区或泪道冲洗返流的脓液量估计泪囊的大小,未采用泪囊造影,本组32只眼泪囊大小适宜均采用泪囊鼻腔吻合术.     

综合疗法治疗新生儿泪囊炎临床观察

目的 探讨新生儿泪囊炎的治疗方法及治疗时间。方法 对78例86眼新生儿泪囊炎患儿采用滴抗生素眼水加压按摩、冲洗泪道和泪道探通方法治疗，并随机观察至少1个月。结果 治疗1个月滴抗生素眼水加压按摩通畅2眼；冲洗泪道通畅7眼；泪道探通成功73眼。总有效率95．35％。结论 综合疗法治疗新生儿泪囊炎安全有效，泪道探通的最佳时间应在3个月后。     

鼻内镜下泪囊鼻腔吻合术联合丝裂霉素C治疗鼻泪道阻塞

目的:探讨鼻内镜下泪囊鼻腔吻合术联合丝裂霉素C(MMC)治疗鼻泪道阻塞的疗效和安全性。方法:选择32例38眼鼻泪道阻塞(或伴泪囊炎、泪囊脓肿)患者,鼻内镜下鼻丘处制成骨孔,切开泪囊并充分翻转泪囊前后瓣,0.1g/L MMC棉球于泪囊吻合口保留48h后取出。结果:术后7d;3,6mo行鼻内镜检查并冲洗泪道。术后7d,治愈34眼,好转3眼,无效1眼,治疗好转率97.4%;术后3mo,治愈32眼,好转4眼,无效2眼,治愈好转率94.7%;术后6mo,治愈32眼,好转4眼,无效2眼,治疗好转率94.7%。所有病例,均未发生鼻出血和眼眶内并发症等术后并发症。结论:鼻内镜下泪囊鼻腔吻合术联合MMC治疗鼻泪道阻塞(或伴泪囊炎、泪囊脓肿)是一种安全有效的治疗方法。     

经鼻内窥镜泪囊鼻腔造口自体组织移植泪道再造术的临床初步报告

目的:探索一种治疗严重泪道阻塞的新手术,探讨经鼻内窥镜下入路的自体大隐静脉或唇粘膜移植泪湖-鼻腔泪道再造手术的有效性和安全性。方法:严重泪小管阻塞并泪囊缺失或萎缩病例18例(18眼),男13例(13眼),女5例(5眼),年龄15~47(平均34.6)岁,将18只患眼随机分成2组,每组9眼。第1组采用经鼻内窥镜造口自体大隐静脉移植泪湖-鼻腔泪道再造,第2组采用经鼻内窥镜造口唇粘膜移植泪湖-鼻腔泪道再造,所造泪道均置入硅胶泪道支架管(直径为2.5mm),3mo后取除。拔管后随访3~10(平均5)mo。术后泪道通畅情况、泪溢症状改善的程度等做统计分析,对不同组织的移植材料的优缺点进行分析和总结。结果:两组患者术后带管3mo期间,泪溢症状即可得到不同程度的改善。再造泪道的上、下口术后愈合好,均未见肉芽组织增生。拔管后第1wk,两组泪道均通畅,大隐静脉组第2wk1例出现泪道狭窄,第4wk出现1例泪道阻塞;口唇粘膜组2wk出现1例泪道狭窄,第4wk出现2例泪道阻塞,第12wk泪道的通畅情况两组均同第4wk。拔管后第12wk,泪道放射性核素99mm锝(TcO4-)显影检查,核素入鼻时间分别为8.58±4.3min和9.16±5.8min,两组差异无显著性意义(χ2检验,P>0.05)。初步结果显示,大隐静脉组(9例)和口唇粘膜组(9例)的治愈病例分别是6例和5例,好转病例均为2例,无效病例数分别为1例和2例。结论:经鼻内窥镜下泪囊窝造口自体大隐静脉和唇粘膜移植再造泪道手术适用于各种原因造成的严重泪道阻塞,且安全、有效;自体大隐静脉和唇粘膜作为移植材料各有优缺点。     

黏弹剂在泪囊鼻腔吻合术中应用的意义

目的探讨黏弹剂的应用对泪囊鼻腔吻合术成功率的影响。方法慢性泪囊炎26例（28眼）,术中在手术显微镜下泪囊腔注入黏弹剂,切开泪囊与鼻腔黏膜吻合,观察术后吻合成功率及复发率。结果术后28眼冲泪道全部通畅。术后随访6个月~2 a,无复发病例。结论在泪囊鼻腔吻合术中,应用手术显微镜及黏弹剂,使泪囊切开更容易,提高了手术成功率。     

泪囊鼻腔吻合术吻合方式选择的探讨

目的探讨泪囊鼻腔吻合术的吻合方式选择及手术技巧。方法通过对135例（152眼）慢性泪囊炎和单纯鼻泪管阻塞,术中根据泪囊的大小和泪囊与鼻黏膜距离分为3组,分别行3种不同的吻合方式。术后随访6—12个月,观察手术效果。结果治愈126眼（82．89％）,好转21眼（13．82％）,无效5眼（3．29％）。结论根据泪囊的大小和泪囊与鼻黏膜距离,选择泪囊鼻腔吻合术的吻合方式,更为合理有效。     

睑缘劈开唇黏膜置换法治疗先天性双行睫

目的探讨睑缘劈开唇黏膜置换法治疗先天性双行睫的手术疗效。方法对19例（34眼）的先天性双行睫患者进行睑缘劈开唇黏膜置换法切除生长异位睫毛的唇间组织，缺损处游离移植唇黏膜，观察术后眼睑和睫毛的位置和形态。结果术后随访36个月，角膜刺激症状消失，双行睫完全消失，睑缘形态良好，正常睫毛排列整齐。结论睑缘劈开唇黏膜置换法治疗先天性双行睫是一种既有效又保持外观的手术方法。     

无鼻内窥镜下RS置管术治疗泪小管断裂的临床疗效

目的：探讨无鼻内窥镜下RS置管术治疗泪小管断裂的临床疗效。

方法：回顾性分析我院2017-09/2018-03收治的泪小管断裂患者52例52眼。根据入院时间顺序分为两组,RS管组32例32眼,环形泪道置管组20例20眼。对比分析两组患者的术中鼻出血、临床疗效和术后并发症情况。

结果：RS管组术中无鼻出血发生,环形泪道置管组鼻黏膜出血15眼,两组差异有统计学意义(P<0.001)。RS管组治愈26眼,好转3眼,无效3眼,治疗有效率为91%; 环形泪道置管组治愈15眼,好转3眼,无效2眼,治疗有效率为90%,两组临床疗效差异无统计学意义(P=0.877)。术后2wk～2mo,RS管组脱管2眼,有1眼在留置未满2wk时从泪小点脱出,给予再次吻合; 另有1眼在术后1～2mo内从泪点抽出,未再次手术,随访时泪道冲洗好转。环形泪道置管组脱管3眼,未再次手术,在以后的随访过程中泪道冲洗好转。两组患者术后并发症差异无统计学意义(P=0.361)。

结论：泪小管断裂需及时手术治疗,采用RS管能提高手术成功率,降低并发症的概率,并且具有操作方法简单、组织相容性好、不影响患者外观等优点。     

Endoscopic dacryocystorhinostomy with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent incarceration

AIM: To investigate the feasibility of endoscopic dacryocystorhinostomy (En-DCR) with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent (NDS) incarceration. METHODS: En-DCRs were performed on 44 chronic dacryocystitis patients (46 eyes) secondary to NDS incarceration from April 2016 to October 2022. The granuloma and scar tissues were separated, and the removal of NDS incarceration was achieved during the surgery; the flap of the lacrimal sac was trimmed and anastomosed with nasal mucosal, a bicanalicular silicone tube was implanted, and lacrimal size and condition were assessed. The tube was removed 3mo after surgery. During the final follow-up of 12mo when the surgery was completed, the complications and the rates of surgical success were assessed. RESULTS: This study covered 40 patients (42 eyes). Intraoperatively, it was found that the lacrimal sac became small, and the sac wall had granulation and scar tissue attached to the incarcerated NDS in all eyes. At 12mo after surgery completed, the rates of the functional and anatomical success reached 80.95% (34/42) and 83.33% (35/42), respectively. Under the effect of intranasal ostial closure, seven eyes failed to achieve anatomical success. No serious complications (e.g., visual impairment, sinusitis, and orbital fat prolapse) was observed. CONCLUSION: With the success rate over 80% and no serious complications, En-DCR with bicanalicular silicone tube implantation is effective in treating chronic dacryocystitis secondary to NDS incarceration.     

Nasolacrimal outflow drainage anomalies in Down's syndrome

PURPOSE: To describe structural abnormalities of the lacrimal drainage system and outcomes after treatment for lacrimal outflow obstruction in children with Down's syndrome. DESIGN: Retrospective comparative interventional case series. PARTICIPANTS: Thirty-eight eyes of 22 consecutive Down's syndrome patients who underwent surgical treatment for nasolacrimal drainage obstruction (mean age, 32 months) and 59 eyes of 44 non-Down's syndrome patients who underwent surgical treatment after 2 years of age. MAIN OUTCOME MEASURES: Resolution of symptoms after surgery and presence of anatomic abnormalities of the lacrimal drainage system other than persistent Hasner's membrane. RESULTS: Among the Down's syndrome eyes, complete or partial resolution was noted in 34 (89%) of 38 eyes; 7 (18%) eyes underwent more than 1 procedure. Twenty-eight (74%) of 38 eyes had anatomic anomalies other than persistent Hasner's membrane; anomalies proximal to the nasolacrimal sac predominated. In comparison, 50 (85%) non-Down's syndrome eyes experienced complete or partial resolution, and 19 (32%) had anatomic abnormalities other than persistent Hasner's membrane; anomalies distal to the nasolacrimal sac predominated. CONCLUSIONS: Compared with older non-Down's syndrome patients, nasolacrimal outflow obstruction in Down's syndrome patients is more often complicated by anomalies of the lacrimal drainage system proximal to the lacrimal sac. Despite this, surgery can be similarly successful. Awareness of the possible peculiarities of lacrimal outflow obstruction in Down's syndrome patients may allow better selection and use of available treatment options.     

Endoscopic dacryocystorhinostomy with mucosal anastomosing in chronic dacryocystitis with three categories of ethmoid sinuses

AIM: To evaluate the outcome of endoscopic dacryocystorhinostomy (En-DCR) with mucosal anastomosis in chronic dacryocystitis patients, with various categories of ethmoid sinuses. METHODS: Between July 2015 and September 2019, 1439 adult patients, representing 1623 affected eyes, presented with chronic dacryocystitis and were scheduled for En-DCR. The categories of ethmoid sinuses were preoperatively determined, using computed tomography-dacryocystography (CT-DCG), and were classified as category 1 (C1), category 2 (C2), and category 3 (C3). No sinuses anterior to the posterior lacrimal crest defined as C1. Sinuses found between the anterior edge of the lacrimal bone and the posterior lacrimal crest defined as C2. Sinuses found anterior to the lacrimal bone suture defined as C3. At the end of surgery, the dacryocyst and nasal mucosa were anastomosed in C1, and the dacryocyst mucosa and anterior ethmoid sinus were anastomosed in C2 and C3 ethmoid sinus patients. The surgical success rate and related complications, in patients with 3 categories of ethmoid cells, were monitored and documented. RESULTS: Postoperative data was obtained for 179 C1 affected eyes, 878 C2 affected eyes, and 432 C3 affected eyes. The overall success rate of En-DCR was 93.0% (1385/1489). Additionally, the success rates were comparable among the different ethmoid categories at 12mo post operation. We demonstrated that the major reason for surgical failure was intranasal ostial closure, due to granulation or scar tissue. CONCLUSION: En-DCR is a feasible and highly effective primary treatment for chronic dacryocystitis. To ensure surgical success, the surgery protocol must be designed in accordance with the category of ethmoid sinuses present in individual patient.     

激光指示光引导鼻内镜下手术治疗外伤性鼻泪管阻塞伴泪囊移位

目的 观察通过激光指示光引导定位泪囊，行鼻内镜下泪囊鼻腔吻合手术治疗泪囊移位的方法。方法 对12例（12眼）经CT、MRI或泪囊造影后证实泪骨、鼻骨、或上颌骨鼻突骨折造成鼻泪管阻塞和泪囊移位，在局麻下激光指示光针于上或下泪小管进入泪囊，鼻内镜光源反复打开和关闭以观察指示光最靠近骨窗的最佳位置，切开相应鼻黏膜，做骨窗，然后顺势扩大鼻黏膜和骨窗口，准确找到泪囊后放入泪囊鼻腔引流支架。结果 12眼外伤性鼻泪管阻塞伴泪囊移位采用上述方法均顺利完成泪囊鼻腔吻合手术，术中大大减少了手术探查寻找泪囊带来的鼻黏膜和骨组织过多的损伤，术中患者痛苦少，术后恢复快，鼻腔换药次数减少。结论 激光指示光引导行鼻内镜下泪囊鼻腔吻合手术其定位准确，操作简单，组织损伤少，手术时间短。