泪囊恶性肿瘤

泪囊恶性肿瘤临床上较为少见 ,早期往往不易被识别而误诊为慢性炎症 ,且泪囊肿瘤的组织来源极为复杂 ,很难确定肿瘤是原发于泪囊本身或从邻近组织扩延而来 ,给临床诊治带来一定困难。本文报告了 3例泪囊恶性肿瘤的临床表现和治疗情况介绍如下 (表 )。　　表　 3例泪囊恶性肿瘤的临床表现和治疗结果病例性别年龄病程 临床表现术中所见 病历号病理号 病理诊断术后情况1男 68岁 1 0个月视力右眼 0 7,泪囊区皮下硬结隆起 ,皮肤不痛、不红、压痛 (- )皮下可们及1 5× 3cm小包块质中等有囊性感 ,表面光滑 ,压迫有血性分泌物溢出 (自泪小点 ) ,右…     

泪囊恶性肿瘤误诊1例

泪囊乳头状细胞癌在临床上罕见,其后果严重.我科今年在行泪囊鼻腔吻合术时遇到1例,现报告如下.     

泪囊鼻腔吻合术134例临床分析

近 10 0年来 ,泪囊鼻腔吻合术仍是治疗慢性泪囊炎、泪囊粘液囊肿的首选术式。我院 1994年 1月～ 1999年 5月行泪囊鼻腔吻合术 134例 134眼 ,现就其手术效果及与术后溢泪有关的因素总结分析如下。临床资料 :本组 134例 134眼均为慢性泪囊炎 ,男 45例 ,女 89例 ,年龄最小 11岁 ,最大 78岁 ,平均 46岁 ,右 6 4眼 ,左 70眼 ,病程最短 10天 ,最长 40年。手术方法 :术前经下泪小管作泪囊美蓝染色 ,鼻腔填塞 1%地卡因、1%麻黄素纱条。作滑车下神经、眶下神经及切口处皮肤浸润麻醉。离内眦 4ｍｍ、内眦韧带上方 1ｍｍ顺皮纹作垂直向弧形皮肤切口 ,分…     

泪囊鼻腔吻合术治疗116例慢性泪囊炎临床分析

目的:探讨和分析泪囊鼻腔吻合术治疗慢性泪囊炎的临床疗效。方法:回顾分析116例124眼慢性泪囊炎行泪囊鼻腔吻合术的资料,术后随访1～1.5a,观察手术疗效。结果:治愈103例108眼,占87.1%,好转12例12眼,占9.7%,失败4例共4眼,占3.2%。总有效率为96.8%。结论:泪囊鼻腔吻合术是治疗慢性泪囊炎的首选有效术式,掌握一定的手术技巧、精细操作和术后密切随访、定期泪道冲洗是手术成功的关键。     

泪囊实性肿物的临床病理分析

目的　探讨泪囊实性肿物的临床病理特征。方法　回顾性分析2007年至2017年于我院诊治并经组织病理检查确诊的20例泪囊实性肿物患者的临床资料。结果　20例泪囊实性肿物中，男11例，女9例，发病年龄1~81岁，平均53岁。20例均为单眼发病，均可见为泪囊区肿胀隆起；伴溢泪者15例，同时伴脓性分泌物者4例，血性分泌物者3例；泪囊区及眶周红、肿、疼痛2例。病理结果显示:良性肿物8例，其中肉芽肿3例，炎性肌纤维母细胞瘤3例，鳞状上皮乳头状瘤1例，错构瘤1例；恶性肿瘤12例，其中淋巴瘤6例，恶性黑色素瘤3例，胚胎型横纹肌肉瘤1例，鳞癌2例。预后:4例患者死亡，其中2例为恶性黑色素瘤患者，2例为弥漫性大B细胞淋巴瘤患者；1例鳞癌患者5 a后出现口腔部鳞癌生长；余15例患者未见肿物复发及转移。结论　泪囊肿物临床表现多样，易误诊、漏诊，需引起眼科医师重视，对可疑患者进行相关辅助检查，确诊后根据病理类型及肿物分期行手术、放疗、化疗等个体化综合治疗。     

201例泪囊鼻腔吻合术临床分析

作者于１９７８年～１９９４年间共行泪囊鼻腔吻合术２０１例２１３例，术后均取得满意效果。报告如下：一般情况：２０１例中，男７９例，女１２２例。右眼１０６例，左眼９５例，其中双眼１２例。年龄最小１６岁，最大５６岁，平均３６岁。慢性泪囊炎１８４例（１９２眼），泪囊粘液囊肿１２例（１３眼），鼻泪管阻塞５例（８眼）。手术方法：２０１例全部采用局麻。术前术侧鼻腔填塞１％地卡因与０．１０％肾上腺素纱条。２０％普鲁卡因或利多卡因５ｍｌ加０．１０％肾上朱素少许行筛前Ｎ，眶下Ｎ及内附部浸润麻醉。距内眦角５ｍｍ处向外…     

泪囊鼻腔吻合术879例临床分析

目的分析采用改良的泪囊鼻腔吻合术治疗鼻泪管阻塞患者的临床疗效。方法回顾我科所做的879例采用改良的泪囊鼻腔吻合术治疗鼻泪管阻塞患者的术后效果。结果本组病例中797例（90．7％）达到手术治愈，解除烦恼溢泪症状。结论我科所采用改良的泪囊鼻腔吻合术是治疗鼻泪管阻塞患者的有效方法。     

瘘管切除联合泪囊鼻腔吻合术治疗泪囊瘘临床观察

目的探讨慢性泪囊炎合并泪囊瘘行泪囊瘘管切除联合泪囊鼻腔吻合术的临床疗效。方法对13例（13只眼）慢性泪囊炎合并泪囊瘘行瘘管切除联合低位泪囊鼻腔吻合术,切除瘘管后,泪囊侧切口采用内翻缝合,观察疗效。结果13例患者均无溢泪、溢脓,瘘管无复发,瘘管切除处皮肤愈合良好,皮肤瘢痕不明显,随访l～3年,无复发。结论泪囊瘘管切除联合泪囊鼻腔吻合术是治疗慢性泪囊炎合并泪囊瘘的有效方法。     

泪囊内激光泪囊造孔治疗泪囊炎的临床应用

我科自1993年9月至1994年9月，利用Nd－YAG激光的特性，对43例55眼，鼻泪管阻塞或慢性泪囊炎，进行泪囊内激光泪囊鼻腔造孔加泪道穿线逆行支撑物嵌顿治疗，取得良好的临床效果，现报告如下。一般资料：43例55眼，女性41例，男性2例，年龄最大45岁，最小18岁，平均28．5岁。病程最短3个月，最长120个月，平均叨个月，单眼引眼，双眼12眼，常规检查，出凝血时间，鼻腔，泪小点和泪小管检查，泪道冲先探通。术后染色试验，泪道X线造影，泪道B超（除外占位性病变）等。器械与准备：YNHI型Nd－YAG治疗机，泪点扩张器，硬膜外导管，医用硅胶…     

Benign mixed tumor of the lacrimal sac

Neoplasms of the lacrimal drainage system are uncommon, but potentially life-threatening and are often difficult to diagnose. Among primary lacrimal sac tumors, benign mixed tumors are extremely rare. Histologically, benign mixed tumors have been classified as a type of benign epithelial tumor. Here we report a case of benign mixed tumor of the lacrimal sac.     

Use of ultrasound diagnostics in lacrimal sac diseases

Ultrasonographic examinations of the lacrimal drainage system demonstrated that the Ultrascan System IV apparatus used was not able to represent the normal-size lacrimal canaliculi, the common canaliculus, the lower part of the nasolacrimal duct and the lacrimal ostium. It can be used routinely, however, in the diagnostics of diseases of the lacrimal sac and its surrounding tissue, for surgical indication and in order to examine the postoperative condition, in most cases without other expensive diagnostic methods. The advantages over dacryocystography are that it is simple, quick, and inexpensive, it can be used postoperatively immediately, the patient is not exposed to radiation, it can be used without any contrast medium, and it is useful when the common canaliculus is occluded.     

下泪小管插管泪囊鼻腔吻合治疗泪囊黏液囊肿

目的　探讨适合泪囊黏液囊肿的手术方法、围手术期处理。方法　对 19例 (2 1眼 )泪囊黏液囊肿行泪囊鼻腔吻合术 ,下泪小管留置硬膜外导管 ,围手术期进行相应的处理并回顾分析其疗效。结果　 2 1眼中有 18眼经 1次治疗治愈。 3眼冲洗泪道不通畅而再行第 2次插管 ,其中 2眼治愈。总的治愈率为 95 2 4%。 1眼无效。结论　下泪小管插管泪囊鼻腔吻合术是治疗泪囊黏液囊肿的较好的方法 ,围手术期处理与手术方法和技巧同样是手术成功的关键。     

Pathological, immunohistochemical and microbiologicalal analysis of lacrimal sac biopsies in patients with chronic dacrocystitis

AIM:To analyze cases of obstruction of the nasolacrimal duct which creates a fertile environment for secondary bacterial infection and can result in dacryocystitis,which is a constant threat to cornea and orbital soft tissue and a potential source of endophthalmitis following intraocular surgery. The majority of obstructions of the lacrimal excretory outflow system are acquired ones occurring in adulthood and involving the distal parts of the system. Acquired obstruction may be primary/idiopathic or secondary to a wide variety of infectious, inflammatory, traumatic, mechanical, toxic or neoplastic causes mimicking idiopathic inflammation. These cases are treated by dacryocystorhinostomy (DCR).METHODS:The present study was conducted to determine the histopathologic, immunohistochemical and current microbiologic characteristics of lacrimal sac specimens in patients undergoing external dacryocystorhinostomy.RESULTS:Non-specific lacrimal sac pathology was present in all 33 cases and 81.8% of the cases showed moderate chronic inflammation with a chronic inflammatory score (CIS) ranging between 4 and 6, whereas 12.12% showed severe inflammatory changes with a CIS of 7. Mild degree of inflammation was seen in 6.06% with a CIS of 3. The total prevalence of gram-positive, gram-negative, and culture-negative samples were 59.4%, 37.5%, and 3% respectively.CONCLUSION:Non-specific chronic inflammation with fibrosis is indeed the most commonly reported histopathological finding in lacrimal sac wall biopsy specimens.     

Characterization of lacrimal sac histology: an immunohistochemical study

Background: A prospective observational study in a university hospital setting to study the immunohistochemical (IHC) characteristics of non‐neoplastic human lacrimal sac epithelium. Methods: Twenty paraffin‐embedded specimens of human lacrimal sac were studied using monospecific monoclonal antibodies to 34 beta E12, cell adhesion molecule (CAM 5.2), epithelial membrane antigen (EMA), cytokeratins (CK) 7 and 20, estrogen receptor and progesterone receptor. The distribution and histologic location of IHC staining were examined qualitatively, and the IHC stains scored as positive (+) or negative (?). Results: The haematoxylin–eosin stains were reviewed for tissue morphology. All 20 specimens were positive for 34 beta E12, CAM 5.2, EMA and CK 7 and negative for CK 20, estrogen receptor and progesterone receptor. Conclusion: To our knowledge, this is the first study to characterize the IHC properties of human lacrimal sac epithelium. This epithelium appears to possess consistent IHC properties as it stains for 34 beta E12, CAM 5.2, EMA and CK 7 and this information would be potentially useful in differentiating tumours arising in the region of the lacrimal sac.     

泪腺腺样囊腺癌的MRI特征分析

目的 探讨泪腺腺样囊腺癌（adenoid cystic carcinoma,ACC）的MRI特征,为临床早期诊断提供依据。设计 回顾性病例系列。研究对象 北京同仁医院经手术证实ACC患者26例,术前均行MRI扫描。方法 所有ACC患者常规MRI扫描;同时对动态增强磁共振成像（DCE-MRI）及磁共振扩散加权成像（DWI）图像进行后处理获得相应量化指标。主要指标 ACC动态增强的峰值强化指数（CIpeak）、峰值强化时间（Tpeak）、最大强化指数（CImax）、强化指数曲线（I型为持续上升型,II型为平台型,III型为流出型）、肿瘤平均表观扩散系数（ADC）值。结果  26例均起自泪腺眶部,20例形态不规则,14例边界不清,12例边界清晰,6例累及颅内,9例出现骨质破坏。T1WI呈等或略低信号,其中3例内部出现高信号区;T2WI呈等或稍高信号为主,增强后仅1例强化均匀,25例呈不均匀强化,其中16例伴有内部囊变、坏死区。泪腺ACC峰值强化指数（CIpeak）为0.9±0.41,峰值强化时间（Tpeak）为（109.3±58.5）s, 最大强化指数（CImax）为0.95±0.45。22例时间强化指数曲线中2例为I型,14例为II型,6例为III型。平均ADC值为（1.25±0.30×10-3）mm2·s－1。结论 MRI可以清晰显示泪腺ACC的部位、形态、范围、边界及骨质侵犯,DCE-MRI及DWI为肿瘤的诊断及鉴别诊断提供辅助量化特征。（眼科,2013, 22： 314-319）     

Combined coliform and anaerobic infection of the lacrimal sac

A case is reported of combined coliform and anaerobic bacterial infection of the lacrimal sac, a condition of which there is only one other published case report. In addition, a literature review is presented of the bacteriology of acute dacryocystitis as it applies to this case. Recommendations for the microbiological investigation and management of acute dacryocystitis are made.     

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。