第五代泪道内镜微钻疏通联合人工鼻泪管置入治疗鼻泪管阻塞的临床观察

目的 探讨第五代泪道内窥镜下泪道疏通联合人工鼻泪管置入治疗鼻泪管阻塞的临床疗效。 方法 选取2014年1月至2015年12月诊治的61例(61眼)鼻泪管阻塞患者为研究对象,采用泪道内窥镜下微钻疏通联合人工鼻泪管置入术治疗。 结果 随访观察6个月,治愈48例(48眼),好转8例(8眼),有效率91.8%,无效5例(5眼)。 结论 第五代泪道内窥镜下微钻疏通联合人工鼻泪管植入治疗鼻泪管阻塞安全、有效,创伤小,并发症少。     

Adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct: a case report

OBJECTIVES: To present the clinical presentation, workup, surgical approach, and pathological findings of the first case report of a patient with adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct. STUDY DESIGN: Retrospective review of the records of a case of adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct. METHODS: The clinical presentation, workup, surgical approach, and pathological findings were reviewed. RESULTS: A 51-year-old man presented with a 10-year history of recurrent epiphora of the right eye. At dacryocystorhinostomy a small lesion was visualized within the lumen of the lacrimal sac. A biopsy specimen was consistent with adenocarcinoma. En bloc resection was accomplished using a lateral rhinotomy and medial maxillectomy. The final specimen showed adenocarcinoma ex-pleomorphic adenoma. The patient was given postoperative radiation therapy. He was free of disease 16 months after treatment. CONCLUSIONS: Lacrimal sac tumors should be considered in the differential diagnosis of chronic epiphora. Management of nasolacrimal adenocarcinoma requires complete surgical resection. Radiation treatment in and of itself is not curative but may be useful as adjuvant therapy. Carcinoma ex-pleomorphic adenoma can develop in the lacrimal sac and nasolacrimal duct.     

Transoral laser marsupialization of epiglottic cysts

OBJECTIVE: The objective of this study is to investigate the safety and effectiveness of laser marsupialization of epiglottic cysts via a transoral route. STUDY DESIGN: A prospective clinical series. METHODS: Twenty-eight consecutive patients with epiglottic cyst underwent laser marsupialization of an epiglottic cyst via a transoral approach. Pre- and postoperative laryngoscopic examinations were carried out. RESULTS: A total of 28 patients were enrolled, including 19 males and 9 females, ranging in age from 38 to 69 years, with a mean age of 54 years. Among these patients, 23 had a lumpy throat, and the remaining 5 had a voice alternation. The diameters of the cysts ranged from 1 to 3 cm. No perioperative bleeding or airway swelling was noted in any patient. The postoperative follow-up period ranged from 4 to 41 (mean, 16) months. No recurrence was found during the follow-up examinations. CONCLUSION: Transoral laser marsupialization is a simple, safe, and effective method for treatment of epiglottic cysts. This procedure has the potential to serve as the treatment of choice in the management of this condition.     

Bilateral congenital nasolacrimal duct cysts mimicking bilateral choanal atresia

Congenital nasolacrimal duct cyst (CNLDC) is a rare neonatal condition that can be life threatening when it occurs bilaterally. Herein we report a neonate with bilateral CNLDC that caused respiratory distress and was treated successfully with surgery. Post surgery, the patient was discharged from hospital without any complications. The case details, differential diagnosis, and management of CNLDC are discussed, along with a review of the relevant literature.     

鼻内窥镜手术治疗蝶、筛窦囊肿17例报告

目的：对鼻内窥镜手术治疗蝶、筛窦囊肿疗效进行评估。方法：回顾总结１７例鼻内窥镜手术治疗蝶、筛窦囊肿及３～９年随访的资料。结果：１７例在内窥镜下均良好暴露术野,术后囊腔得到充分引流;１５例获得满意疗效,无严重并发症发生。结论：鼻内窥镜下囊肿开放引流术是一种治疗蝶、筛窦囊肿安全、有效的方法     

鼻内镜下鼻泪管前径路和后径路切除上颌窦良性病变

目的 探讨鼻内镜下上颌窦内侧壁入路切除上颌窦良性病变的手术径路及手术方法的可行性及疗效.方法 2003年6月至2010年8月,采用鼻内镜下经鼻腔鼻泪管前径路和鼻泪管后径路的多种方式切除上颌窦良性病变139例,其中内翻性乳头状瘤43例、真菌性上颌窦炎63例、上颌窦囊肿28例、出血坏死性息肉3例、骨瘤2例.所有病例术前行CT检查,可疑内翻性乳头状瘤患者同步行MRI检查.鼻泪管前方径路采取3种方式:梨状孔入路、泪前隐窝入路(包括解剖鼻泪管和不解剖鼻泪管2种方式)、梨状孔鼻泪管人路,共治疗97例;鼻泪管后方径路也采取3种方式:下鼻甲翻转、双蒂下鼻甲、单蒂下鼻甲,共治疗42例.观察患者术后疗效.结果全部病例在鼻内镜下经鼻彻底清除病变,保护了鼻泪管,保留了下鼻甲,无一例发生鼻泪管损伤和下鼻甲坏死.术后鼻塞、头痛、闷胀不适、异味、牙疼和麻木感等症状逐步消失.9例感觉鼻腔干燥,经鼻腔冲洗等处理后1个月左右逐渐消失.随访6 ～79个月,骨瘤和出血坏死性息肉未见复发.所有真菌性上颌窦炎患者术中均可见窦腔黏膜明显水肿、增厚,术后3个月左右逐渐消失,无一例复发.2例上颌窦囊肿患者术后10个月和18个月在上颌窦其他部位再发,但囊肿小且无临床症状未作处理.内翻性乳头状瘤患者有3例复发,1例术后17个月上颌窦口上方局限性肿物突出,病理示乳头状瘤复发,门诊予以清理后随访1年未见复发;1例于术后15个月前筛处复发,行筛窦广泛切除后随访3年未见复发;1例术后26个月上颌窦后外侧壁局部复发,二次行蒂在前方单蒂下鼻甲方式手术,术后1年再次复发,行鼻内镜下Denker手术,随访18个月未见复发征象.所有病例术后3个月上颌窦创面上皮、瘢痕覆盖,下鼻甲形态良好,下鼻道开窗者较术中明显瘢痕变小,且引流通畅无闭锁.结论鼻内镜下鼻泪管前、后径路上颌窦手术可以减小创伤,充分暴露窦腔视野,并为术后内镜复查和复发后的处理提供了视窗;保留下鼻甲避免了鼻腔外侧壁去除过多而导致的术后干燥、结痂、头痛等并发症.     

经鼻鼻内镜下泪囊造口定位的解剖与临床研究

目的调查经鼻内镜下鼻腔泪囊造口术的解剖定位资料。方法经鼻内镜下解剖16具湿性成人尸头32侧泪囊,确定泪囊鼻腔造口的最佳解剖位置标志;并结合2例手术失败病例和12例尚未行手术的慢性泪囊炎病例的相关影像学资料,对比分析最佳解剖定位数据。结果泪囊上、下点与鼻小柱和鼻翼交界点及"中鼻甲腋"(即中鼻甲前端位于鼻腔外侧壁的附着处)的距离分别为33.0±3.3mm、44.6±4.9mm和6.8±1.4mm、3.2±1.6mm;2例手术失败病例的泪囊鼻腔开口位置较低。结论手术中,应在中鼻甲腋前上方定位鼻腔内泪囊开口。     

鼻内镜下上颌骨囊肿开放术

目的:探讨鼻内镜下上颌骨囊肿开放术的有效性和可行性。方法:对13例侵犯上颌窦或鼻腔底的上颌骨囊肿在鼻内镜下行上颌骨囊肿开放术,即行鼻内镜下囊肿下鼻道或鼻腔底开放术,囊肿囊壁被全部或部分切除。结果:随访6～36个月,13例患者未出现面部隆起、鼻塞及鼻腔溢液等症状,囊肿无复发。结论:鼻内镜下上颌骨囊肿开放术适用于侵犯上颌窦或鼻腔底的上颌骨囊肿,较传统手术创伤小,简单高效,受侵牙齿可尽量保存。     

Endoscopic marsupialization of congenital nasolacrimal duct cyst with dacryocoele

A congenital nasolacrimal duct cyst is an uncommon condition in the newborn usually treated by ophthalmologists. Prolapse or expansion of the cyst into the nose may lead to respiratory distress and difficulty in feeding as newborns are obligate nose breathers, which needs the involvement of the Otolaryngologist in diagnosis and management. The authors report a series of 8 children presenting with a congenital nasolacrimal duct cyst and dacryocoele and highlight the importance of endoscopic nasal examination of newborns presenting with respiratory problems. Diagnostic studies included intranasal endoscopy and CT scanning of the nasolacrimal system and nose. All the patients were treated by endoscopic marsupialization of the cyst. Nasolacrimal duct abnormality should be considered in the differential diagnosis of neonatal respiratory distress and nasal obstruction. Nasal endoscopy is essential in the work-up of all children with nasal obstruction and respiratory distress. CT scanning is the investigative method of choice. Endoscopic marsupialization followed by lacrimal duct irrigation is effective in the treatment of congenital nasolacrimal duct cyst and results in complete resolution of symptoms.     

国人成人鼻泪管的解剖学测量

目的：对成人鼻泪管局部解剖有进一步认识。方法：对国人成人４０具（８０侧）尸头鼻腔进行解剖学测量。结果：发现鼻泪管在下鼻道的开口有５种类型,其中以裂隙型多见;有７例存在２个开口。７３例鼻泪管及开口位置进行解剖学测量,鼻泪管平均长度１４．１４ｍｍ;前鼻孔内下缘交点至同侧鼻泪管开口前缘平均距离为２９．００ｍｍ（简称孔口距）;下鼻甲附着缘前端至鼻泪管开口前缘平均距离为１１．０７ｍｍ;前鼻孔内下缘交点至同侧     

鼻泪管黏膜相关淋巴组织形态学分析

目的 :探讨鼻泪管黏膜相关淋巴组织的组织学特点 ,初步揭示泪道炎症不易治愈的局部原因。方法 :通过常规苏木精 伊红染色 ,利用图像分析仪对兔鼻泪管、鼻腔、咽腔和气管黏膜中的淋巴滤泡发育情况 ,高内皮静脉 (HEV)的分布情况及其周围淋巴细胞浸润的密度进行分析。结果 :鼻泪管黏膜组织中淋巴滤泡和HEV的数量及其周围淋巴细胞浸润的程度均低于鼻腔、咽腔和气管黏膜 (P <0 .0 1)。结论 :正常情况下鼻泪管黏膜的局部免疫反应程度低于鼻腔、咽腔和气管黏膜 ,其黏膜下淋巴组织欠发达可能是泪道炎症不易治愈的主要原因。     

经鼻泪道扩张联合丝裂霉素C治疗鼻泪管阻塞

目的 评价经鼻泪道扩张联合丝裂霉素Ｃ（MMC）治疗鼻泪管阻塞的疗效和临床应用价值。方法 将60例鼻泪管阻塞患者随机分为丝裂霉素组(A组)和硅胶管组（B组）,经鼻泪道扩张后A组局部使用MMC,B组逆行置入硅胶管,随访6个月,观察治疗成功率。结果 经鼻泪道扩张联合MMC与逆行置入硅胶管术的疗效差异无统计学意义（Ｐ＝０.058）。结论 经鼻泪道扩张联合MMC治疗鼻泪管阻塞可取得与逆行置入硅胶管术相似的临床疗效,具有操作简便、费用低廉、治疗时间短、创伤小、恢复快等优点。     

泪囊窝的应用解剖研究

目的 :明确泪囊窝的解剖学特点 ,为鼻内镜下鼻腔泪囊造孔术提供参考。方法 :对 2 3具 (4 6侧 )成人尸头泪囊窝的骨性结构构成及骨壁的厚度和倾斜角度进行测量。结果 :泪囊窝中部的骨性构成中上颌骨额突所占比例略大于泪骨 ,且变异较大 ;泪囊窝后壁与冠状面呈大约 2 0°的倾角。结论 :在鼻内镜鼻腔泪囊造孔术中 ,应对眶壁行CT检查 ,以明确不同类型泪囊窝骨性构成情况下手术可能遇到的问题 ,防止术中眶内并发症或由于造孔过小导致术后鼻泪管阻塞 ,症状不能缓解     

泪道激光联合引流管植入治疗泪道阻塞的临床观察

目的 研究泪道激光联合引流管植入对泪道阻塞患者眼表状态的影响。 方法 选取2014年1月~2015年12月收治的120例泪道阻塞患者,采用数字奇偶法随机分为对照组和观察组,每组60例,其中对照组行常规手术治疗,观察组行泪道激光联合引流管植入术。分析观察组术前、术后1个月及术后2个月的泪膜破裂时间和泪液分泌量。 结果 对照组治疗总有效率为75.0%低于观察组约91.7%(P<0.05);观察组各个时间段的泪膜破裂时间比较差异无统计学意义(P>0.05);术后2个月患者的泪液分泌量较治疗前差异无统计学意义(P>0.05);术后1个月泪液分泌量较治疗前上升,差异有统计学意义(P<0.05)。 结论 泪道激光联合引流管植入治疗泪道阻塞患者,可取得较好的治疗效果,且对患者眼表状态无明显影响。     

泪囊计算机三维重建的初步研究

目的：探讨计算机三维重建技术在泪囊解剖研究中的应用。方法：采用螺旋CT扫描重建技术,在西门子Volume Navigator工作站上对泪囊及周边相关结构进行三维重建。结果：计算机三维重建图像可显示泪囊及鼻泪管系统的三维解剖关系。重建结构能够以单独或联合方式显示,并可绕任意轴进行旋转,任意经线及角度均可适时测量。结论：计算机三维重建技术对泪囊的解剖研究具有重要应用价值。