亚甲蓝及粘弹剂在泪囊鼻腔吻合术中的应用

目的:探讨亚甲蓝及粘弹剂在泪囊鼻腔吻合术中的应用价值。方法:对慢性泪囊炎患者21例21眼(其中6例6眼为小泪囊慢性泪囊炎)施行泪囊鼻腔吻合手术,术中应用亚甲蓝及粘弹剂。术后随访3mo～1a,观察手术疗效。结果:所有21眼中治愈19眼,好转2眼,治愈率90.5%,总有效率100.0%。其中6眼小泪囊慢性泪囊炎中治愈4眼,好转2眼。结论:亚甲蓝及粘弹剂在泪囊鼻腔吻合术中的应用可有效提高手术成功率,小泪囊慢性泪囊炎可作为泪囊鼻腔吻合术的手术适应证。     

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。     

双侧泪囊鼻腔吻合术

近年来,我院对泪囊鼻腔吻合术作了一些改良,成功地为12例双侧慢性泪囊炎患者同时施行泪囊鼻腔吻合术获得成功,报告如下.一般资料:12例中,男1例,女11例.年龄19～76岁.病程6月～12年.2眼合并角膜溃疡,1眼合并成熟期老年性白内障,全身均无严重器质性疾病等手术禁忌症.全部病例均经泪囊碘油造影,泪囊大小4×5～8×12mm.手术方法麻醉:表麻、局麻同单侧泪囊鼻腔吻合术,局麻药中加入肾上腺素2～3滴,注入总量约5ml.手术步骤:沿左眶内下缘作上自内眦韧带的皮肤切口长约2cm.分离软组织至骨膜,切开骨膜并剥离暴露泪囊窝.以骨凿加咬骨钳作1.2×1.2cm左右的方孔.“工”字形切开鼻粘膜及泪囊.依次缝合后、前唇,前唇缝合后加固1针缝于泪前嵴骨膜,然后缝合皮下组织及皮肤.以纱布暂时保护创口.以同样方法行右侧泪囊鼻     

改良泪囊鼻腔吻合术

泪囊鼻腔吻合术在操作过程中视野小而深，粘膜对缝困难等原因，使手术时间延长。作者对吻合方法作了改进，缩短了手术时间，提高了疗效。现将58例术后情况报告如下。临床资料：本文报道58例是随机选择的无手术禁忌证的慢性泪囊炎病例，其中男4例，女54例，年龄最大68岁，最小12岁，1例为泪羹安，术中先切去疾管，1例是泪囊炎并有结石，起病时间最长对年，最短1年2个月。手术方法：（1）术前检查、准备、麻醉及皮肤切口与一般泪囊鼻腔吻合术相同，造骨孔可以比一般吻合术稍小，可作成l（hall（hal大之骨孔即可，当完成造骨孔操作后接着手术骤…     

水囊在泪囊鼻腔吻合术中的应用

目的 观察泪囊鼻腔缝合术中应用水囊作支撑物的效果。方法 463例586眼慢性泪囊炎住院患者，施行泪囊鼻腔吻合术中应用水囊作支撑物，术后观察临床效果。结果 本组手术成功率达100％，无因水囊支撑引起并发症者。结论 以水囊为支撑物，取材方便、操作简单。术后可反复注水，无不良反应，无并发症发生。     

丝裂霉素C在泪囊鼻腔吻合术中的应用

目的 探讨丝裂霉素C用于泪囊鼻腔吻合术中的效果。方法 48例(52眼)慢性泪囊炎施行泪囊鼻腔吻合术。术中将浸有0．4mg／mL丝裂霉素C棉片置于鼻粘膜及泪囊内侧壁与其接触5分钟，遂继续完成手术步骤。结果 本组48例(52眼)，经3月～3年随访，治愈49眼(94．2％)，好转1眼(1．9％)，无效2例(3．8％)。结论 丝裂霉素C用于泪囊鼻腔吻合术，可抑制吻合口、总泪管开口瘢痕及肉芽组织形成，减少吻合口及总泪管闭塞，可提高手术成功率。     

甲基纤维素在泪囊鼻腔吻合术中的应用

目的通过对慢性泪囊炎患者施行泪囊鼻腔吻合术，手术中在制作泪囊鼻黏膜瓣前应用甲基纤维素，评价其在提高泪囊鼻腔吻合术成功率的作用。方法33例（35眼）慢性泪囊炎患者男6例，女27例，年龄27—56岁。由同一经验丰富的医生施行泪囊鼻腔吻合术，手术中在制作泪囊鼻黏膜瓣前自泪小管向泪囊内注入甲基纤维素，使泪囊膨起，内外侧壁分离，在泪囊、鼻黏膜上做“工”字形黏膜瓣，并对端吻合。结果在术后5天、10天用无菌生理盐水充分冲洗泪道，泪道通畅，随访6个月～1年，手术均获得成功。无术中、术后并发症发生。结论甲基纤维素黏度高、弹性好，在泪囊鼻腔吻合术中制作泪囊黏膜瓣前，将甲基纤维素注入泪囊内，泪囊充盈，使泪囊黏膜瓣的制作更准确、完善，提高了手术成功率。     

丝裂霉素C在泪囊鼻腔吻合术中的应用

目的：探讨丝裂霉素C（mitomycin C,MMC)在泪囊鼻腔吻合术中的作用效果。方法：对31例36眼慢性泪囊炎行泪囊腔吻合术，术中一次性使用0．4g/L的MMC，结果：术后随访3－31个月，治愈率为97．2％，吻合口开通率为100％，结论：MMC可作为治疗慢性泪囊炎的一种安全，简单，有效的辅助药物，明显提高了手术成功率。     

泪囊鼻腔吻合术失败32例原因分析

目的：报告32例鼻腔泪囊吻合术失败原因分析及处理办法，以提高手术的成功率。方法：对32例手术失败病例进行原因分析。结果：手术失败的病例有22例为吻合口阻塞，另外9例为骨孔过小，骨桥，骨孔位置不当，1例泪囊未切开。结论：32例手术失败多为手术技巧问题而造成。     

三角瓣式泪囊鼻腔吻合术治疗慢性泪囊炎

目的探讨三角瓣式泪囊鼻腔吻合术治疗慢性泪囊炎的临床应用效果。方法对192例（201眼）慢性泪囊炎应用三角瓣式泪囊鼻腔吻合术治疗。术后随访3～24月。结果全部192例（201眼）随访3月成功201眼,其中144例（146眼）随访3月以上（最长随访24月,平均15．33月）成功146眼。结论三角瓣式泪囊鼻腔吻合术是治疗慢性泪囊炎的有效方法。     

Rubber Tube versus Silicone Tube at the Osteotomy Site in External Dacryocystorhinostomy

Background: In external dacryocystorhinostomy a large bony window is created in the lateral nasal wall and a mucosal anastomosis is created between the lacrimal sac and the nasal cavity. The success of the operation depends on the surgical anastomosis remains patent and converting to a wide enough epithelial-lined passage.

Objective: To compare the efficacy of using rubber versus silicone tubes at the osteotomy of Dacryocystorhinostomy

Design: Prospective, randomized, hospital-based study.

Subjects and Methods: 46 patients diagnosed with primary acquired nasolacrimal duct obstruction were assigned randomly to rubber, silicone or control group. The surgical procedures in the three groups were the same except that in patients of rubber and silicone groups, rubber or silicone tubes were placed at osteotomy opening and removed after 3 months. Transnasal endoscopic findings were recorded at the completion of surgery and at 3 months, 6 months and 9 monthes after surgery for the 3 groups. A computer aided digitizer was used to calculate the surface area of the osteotomy site.

Results: After removal of their tubes, 3 patients in the rubber group had recurrent epiphora (78.0% success), one patient in silicone group (92.86% success) and 4 patients in control group (77.8% success). The average final surface area of the osteotomy opening of patients with rubber group at the end of follow-up was (9.85?mm²) in the silicone group was (17.47?mm²), whereas in the control group was (8.56?mm²).

Conclusion: Silicone tube is better than rubber one in maintaining effective larger osteotomy after Dacryocystorhinostomy. This can improve the long-term success of the operation.     

慢性泪囊炎的鼻内窥镜下手术治疗

目的 评估慢性泪囊炎在鼻内窥镜下行鼻腔泪囊造口术的手术方法和疗效。方法 在局麻下由鼻内径路在鼻内窥镜下施行鼻腔泪囊造孔术．治疗慢性泪囊炎共39例（42眼）。结果 经过6-12个月的随访发现．流脓溢泪症状消失。泪道冲洗通畅．达到治愈标准41眼，流脓溢泪症状减轻．泪道冲洗通而不畅．达到好转标准1眼。结论 本术式操作简便．损伤小，恢复快，并发症少．无面部疤痕．疗效较显著。     

鼻内窥镜下泪囊鼻腔开放术联合丝裂霉素治疗慢性泪囊炎

目的：：探讨鼻内窥镜下泪囊鼻腔开放术联合应用丝裂霉素治疗慢性泪囊炎的疗效。方法：收集73例78眼慢性泪囊炎患者在鼻内窥镜下泪囊鼻腔开放术中联合应用丝裂霉素,随访6~12 mo 观察疗效。结果：所选患者中66例70眼痊愈(90%),2例3眼好转(4%),5例5眼无效(6%)。复发病例5例5眼中,2眼再予鼻内窥镜下清除肉芽,扩大造口,浸有0.4g/L丝裂霉素棉片放置创面约5min,后置麻醉导管,另3眼转上级医院行泪道激光,均获得成功。所有患者没有发生严重的手术并发症。结论：鼻内镜下泪囊鼻腔开放术联合应用丝裂霉素治疗慢性泪囊炎的疗效肯定。     

External Dacryocystorhinostomy: Assessing Factors that Influence Outcome

Purpose: To present the experience of external dacryocystorhinostomy (DCR) at a tertiary referral center and investigate factors that may affect clinical outcomes.

Methods: The clinical records of all patients who underwent external DCR at Sydney Eye Hospital between May 2000 and August 2007 were reviewed. Data were collected in regards to patient demographics, preoperative assessment, operative details, surgical technique, postoperative management, and clinical outcomes. This information was then analyzed, with emphasis on factors that influence surgical outcomes and success.

Results: A total of 338 cases were reviewed. The mean age at time of surgery was 64.82 years and the majority of patients were female (65%). Epiphora was the major preoperative symptom. Assisted local anesthesia and day stay surgery were the most common surgical settings. There was a statistically significant difference in theatre time between consultant and trainee surgeons (P < 0.00001). The mean final follow-up time was 11 months. Overall, 77.3% of patients had full resolution of symptoms and 20.8% had partial resolution. Only five patients (1.9%) had no resolution of symptoms. There was no significant difference in outcomes between consultants and trainees. Patients with anatomical nasolacrimal obstruction had significantly better outcomes compared with functional obstruction (P?=?0.04). The postoperative fluorescein dye disappearance test was a good predictor of clinical success (P?=?0.005). Silicone intubation for greater than 6 months was associated with better outcomes (P?=?0.002).

Conclusions: The results at our tertiary center are comparable to results stated in the literature. In our series, only the amount of nasolacrimal obstruction and duration of postoperative intubation influenced surgical success.     

Long-Term Results of Simultaneous Bilateral External Dacryocystorhinostomy in Cases with Bilateral Dacryostenosis

ABSTRACT

Objectives: To evaluate the long-term results of simultaneous bilateral external dacryocystorhinostomy (EX-DCR) in cases with bilateral dacryostenosis. Methods: Thirty-four eyes of 17 consecutive patients with a history of bilateral epiphora were included in the study between 2007 and 2011. Demographic information, etiology of the obstruction, history of lacrimal surgery, type of anesthesia, duration of surgery, incidence of postoperative nasal bleeding and infection, surgical outcomes, and duration of follow-up were recorded. During the lacrimal irrigation, there was not any passage noticed in the patients’ eyes. The post-operative follow-up was 13 to 44 months (mean 33.6 months). Results: Of 17 patients undergoing simultaneous bilateral EX-DCR with a mean age of 42.8 years, one of the patients had a history of bilateral unsuccessful DCR performed in a different center. One patient had previously failed bilateral probing before undergoing bilateral EX-DCR. This latter patient was a four-month-old baby with bilateral dacryoceles. Bicanalicular silicone intubation was performed in 15 eyes of 10 patients that had a canalicular problem or fibrotic lacrimal sac. It has been discerned that complaints about epiphora disappeared in 33 of the eyes (97%) and that the passage was open during the lacrimal irrigation. One eye with a history of unsuccessful dacryocystorhinostomy failed to respond positively to our operation. Conclusions: In our study, high success rates of simultaneous bilateral EX-DCR were found in both children and adult patients with bilateral dacryostenosis during a long-term follow-up. We believe that simultaneous bilateral dacryocystorhinostomy has medical, social, and economic advantages.     

Dacryocystorhinostomy: History,evolution and future directions

Dacryocystorhinostomy (DCR) is a procedure of choice for nasolacrimal duct obstruction and chronic dacryostenosis in the setting of patent canaliculi and a functional lacrimal pump. Two major approaches are utilized: external, via a transcutaneous incision and endonasal endoscopically guided. The surgery has a high success rate via both approaches. We review the history, evolution, current techniques, complications and future directions of DCR.