泪囊瘘管切除术治疗儿童先天性泪囊瘘

目的评估泪囊瘘管切除术治疗儿童先天性泪囊瘘的效果。方法回顾性分析我院2008年4月至2014年3月采用放大镜下泪囊瘘管切除术治疗的先天性泪囊瘘患儿62例。术后随访3~36个月。结果 62例中男39例,女23例,双眼2例,单眼60例,平均年龄4.5岁。所有患儿瘘管位于内眦部的下方与泪囊或泪总管相连。全部病例均治愈,治愈率为100%。1例术后发生急性泪囊炎,3例术后切口有缝线排异,所有病例术后均无疤痕,无其他并发症发生。结论先天性泪囊瘘可以通过泪囊瘘管切除术治愈。放大镜下泪囊瘘管切除术治疗儿童先天性泪囊瘘简便、安全、效果好。     

先天性泪囊瘘8例治疗分析

目的：探讨先天性泪囊瘘的治疗方法。方法：对8例（9只眼）先天性泪囊瘘患者行瘘管烧灼联合缝合术治疗。结果：6例患者一次成功,2例患者行再次手术,随访2．2月,全部成功。结论：瘘管烧灼联合缝合术是治疗先天泪囊瘘简单有效的方法。     

儿童先天性泪囊瘘的处理

先天性泪囊瘘是一种罕见的发育异常。我们报告１３例（１３眼）先天性泪囊瘘的患儿，因有临床症状而治疗，年龄１／２－１２岁（平均５．８岁）。１３例患儿的症状都是出生后泪溢和瘘口有粘液外溢。４例单纯性泪囊瘘的患儿仅作瘘管切除术；另９例合并鼻泪管阻塞的泪囊瘘患儿，６例作鼻泪管探通术后症状消失，３例作瘘管切除联合鼻泪管探通术。术后症状消失，随访４－８８月（平均４８月）。我们认为对有症状的先天性泪囊瘘的患儿，瘘管切除或联合鼻泪管探通术是简单、方便而有效的处理方法。     

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。     

儿童先天性泪囊瘘的手术治疗

先天性泪囊瘘是一种少见的先天性泪道发育异常。关于本病的治疗文献少有报道,自1993年以来,我科共收治有临床症状的儿童先天性泪囊瘘2 0例,手术效果满意,现报告如下。1　临床资料1.1　一般资料　先天性泪囊瘘患儿2 0例2 0眼,其中男16例,女4例,均系足月产儿。右眼11例,左眼9例。     

Nd：YAG激光治疗先天性泪囊瘘

ＮｄＹＡＧ激光治疗先天性泪囊瘘肖军徐春蓉张民众皮炼红自１９９４年我院眼科共收治７２例（７８只眼）先天性泪囊瘘患者，其中３７例（４１只眼）为无症状未治疗者。３５例（３７只眼）为瘘口明显溢泪者，少数伴有局部皮肤湿疹及糜烂。我们采用ＮｄＹＡＧ术对有症状的３...     

鼻腔内窥镜下鼻腔泪囊造瘘术治疗慢性泪囊炎体会

目的 探讨鼻腔内窥镜下鼻腔泪囊造瘘术治疗慢性泪囊炎的疗效和安全性.方法 对我院2012年1月至2013年1月鼻腔内窥镜下鼻腔泪囊造瘘术治疗慢性泪囊炎的83例（95只眼）患者进行回顾性研究,观察其疗效和安全性.结果治愈86只眼（90.53%）,好转7只眼（7.37%）,无效2只眼（2.10%）.所有病例均经6个月以上随访,效果满意.结论 鼻腔内窥镜下鼻腔泪囊造瘘术治疗慢性泪囊炎安全、有效.     

慢性泪囊炎鼻内镜下泪囊鼻腔造瘘术治疗58例

我科采用鼻内镜下鼻腔泪囊造瘘术治疗慢性泪囊炎58例,现报告如下。1资料与方法1．1资料2004年8月至2009年1月我科采用鼻内镜下泪囊鼻腔造瘘术治疗慢性泪囊炎患者58例（60眼）,     

先天性泪囊瘘手术治疗体会

0引言先天性泪囊瘘是一种泪道发育异常,常开口于内眦角鼻下方。我院2006-01/2010-04共收治先天性泪囊瘘9例10眼,经手术治疗取得良好效果,现报道如下。1临床资料先天性泪囊瘘患者9例10眼中男3例,女6例,年龄6mo~10岁。双侧患者1例,单侧8例。9例的瘘口都位于内眦角鼻下方,皮肤表面可见一圆形细小直径约0.5mm大小的瘘道口,7例从生后自瘘口有水样分泌物外溢,2例有黏液样分泌物自瘘口外溢。术前均行常规眼部检查。经下泪小管冲洗泪道,见皮肤瘘管口有透明液体外溢。所有病例均于全身麻醉下行泪囊瘘管切除术。消毒术眼,术中沿瘘口旁1mm处环形切开皮肤,沿瘘管壁分离肌层约5~6mm长至瘘管根部,     

招飞对象中瘘管搔刮术治疗先天性泪囊瘘的初步研究

目的:探讨瘘管搔刮术对招收飞行学员对象中先天性泪囊瘘患者的治疗作用。方法:我区2005-03/2008-03招飞体检中,确诊先天性泪囊瘘患者11例13眼,其中5例7眼行瘘管搔刮术治疗,6例6眼行瘘管切除术治疗。结果:患者11例均一次成功,随访16±5.6mo,全部无复发,但行瘘管切除术者有3例因术后遗留瘢痕较大而于复检时被淘汰。结论:瘘管搔刮术是根治招飞对象中先天性泪囊瘘单纯患者的有效方法,可使之符合招飞标准并得以选择性保留,符合新形势下空军"重功能、轻形态"的招飞思想。     

Congenital lacrimal sac fistula: intraoperative visualization by polyvinyl siloxane cast

We report the intraoperative use of polyvinyl siloxane impression material to demonstrate the anatomy of the lacrimal sac, canaliculi, and lacrimal duct in a case of congenital lacrimal sac fistula. A 1-week-old boy was examined for tearing since birth. Examination revealed a left congenital lacrimal sac fistula. After a failed surgery to close the fistula with silicone intubation at 6 months of age, the patient underwent endonasal dacryocystorhinostomy performed at 14 months of age, aided by intraoperative injection of polyvinyl siloxane (trade name Reprosil) to mark and protect the nasolacrimal sac and facilitate endonasal visualization. A polyvinyl siloxane cast demonstrated the anatomy of the accessory canaliculus causing nasolacrimal duct obstruction. Postoperatively, the epiphora resolved and the fistula remained closed. The polyvinyl siloxane cast provides a 3-dimensional "ex vivo " model of the lacrimal sac, upper duct, and canalicular anatomy, and can be used in dacryocystorhinostomy surgery to identify and protect the lacrimal sac.     

泪道瘘管临床分析

目的 分析泪道(?)管的臨床特征和形成原因。方法 對13例泪道(?)管進行回顧性臨床分析。结果 13例泪道(?)管中10例為泪囊瘼,3例為泪小管(?),前者主要由先天、炎症和手術處理不當所致,治療可酌情予保守或手術治療;后者多由外傷引起,治療多用手術。結論 泪道(?)管少見,多為泪囊(?),主要與先天、感染、外傷和手術有關;治療以手術為主。     

Congenital lacrimal system anomalies mimicking recurrent acute dacryocystitis

We describe 2 cases of congenital lacrimal system anomalies that mimicked recurrent acute dacryocystitis. Two patients with painful swelling below the medial canthal tendon who were referred for acute dacryocystitis were evaluated clinically with findings suggestive of lacrimal system anomalies. Both patients presented in adulthood and both had a history of recurrent presumed acute dacryocystitis without epiphora. Both patients had complete absence of the lower puncta on the involved side. Irrigation via the upper system showed lacrimal drainage system patency in both cases. Surgical exploration confirmed the diagnosis of lacrimal system anomalies. The first patient had a lacrimal sac diverticulum; the second patient had a fistula connected to the common canaliculus with an adjacent cyst. Both patients were successfully treated with excision of the outpouchings. Congenital lacrimal drainage system anomalies should be considered in the diagnosis of recurrent dacryocystitis in cases where the lacrimal system appears patent. The infection can involve a fistula or diverticulum.     

先天性鼻泪管阻塞不同年龄采用不同方法的治疗效果

目的探讨先天性鼻泪管阻塞根据不同年龄采用不同方法治疗效果。方法选取在本院接受治疗并有随诊记录的先天性鼻泪管阻塞的患儿97例（117眼）。根据年龄大小的不同而分别采取泪囊按摩、加压冲洗及泪道探通3种治疗方法并行疗效统计。结果年龄1～3个月患儿42例（52眼）,选用泪囊挤压按摩法,31眼治愈,占59．62％。4个月～1岁患儿34例（41眼）,选用加压冲洗法,一次治愈36眼,占87．80％。1～2岁患儿21例（24眼）,选用泪道探通法,一次治愈18眼,占75．00％。结论根据年龄大小,选择性采取泪囊挤压按摩、加压冲洗及泪道探通更为合理而有效治疗先天性鼻泪管阻塞。     

The management of pediatric lacrimal problems

The most common cause of tearing in the pediatric age group is blockage of the distal end of the nasolacrimal duct at the valve of Hasner. Evaluation with fluorescein using the dye disappearance test and the primary dye test, although not always as accurate as in adults, is possible. Conservative treatment is attempted initially followed by probing and, if necessary, silicone intubation. Less common causes of tearing are punctal atresia and congenital lacrimal sac fistula, which are usually diagnosed later, requiring opening of the atretic membrane and excision of the fistula tract, respectively. Amniotoceles are usually seen within a week of birth and are treated aggressively with medication and/or probing to prevent acute dacryocystitis.     

An Atypical Case of Lacrimal Sac Fistula Located on the Temporal Side of the Lateral Canthus

We report a case of congenital lacrimal sac fistula located on the temporal side of the lateral canthus. A systemically healthy 1-year-old girl came to the outpatient clinic with a complaint of tearing on the temporal side of the right lateral canthus since birth. On examination, a small orifice was found in the skin on the temporal side of the lateral canthus. There was no evidence of inflammation or swelling within the opening. Surgeons carried out an operation under general anesthesia. They passed a probe through the lacrimal orifice and advanced it toward the lacrimal sac. Next, they introduced saline to the inferior punctum and found that it drained to the lateral fistula. The lower lid stretched as the dissected fistula was pulled. After the operation, the patient was free of the symptom. This paper is to report a case of congenital lacrimal sac fistula located on the temporal side of the lateral canthus.     

Recurrent Dacryocystitis and Lacrimocutaneous Fistula Caused by a Retained Griffiths’ Collar Button Stent

Abstract

A 42-year-old man presented with a white plastic-like material exposed in the left medial canthal area, with a fistula and purulent discharge. He had undergone endonasal dacryocystorhinostomy 7 years earlier for left eye epiphora; he had persistent postoperative epiphora and recurrent dacryocystitis despite multiple drainage attempts and antibiotics elsewhere. Computed tomography showed bilateral enlarged cystic lacrimal sacs, with a well-defined contoured tunnel-like hole at the center of the left sac. Treatment included excision of the foreign body, which was a Griffiths’ collar button nasolacrimal stent, excision of the fistula tract, and revision dacryocystorhinostomy with implantation of bicanalicular silicone stent. He recovered with no further symptoms or complications. This case highlights the importance of follow-up for removal of an implanted Griffiths’ stent after dacryocystorhinostomy. Patients with recurrent dacryocystitis may benefit from a detailed history of previous surgery, careful examination, and imaging to evaluate for endogenous and exogenous foreign bodies such as lacrimal sac calculi, and retained lacrimal sac stents.     

Congenital lacrimal fistula

PURPOSE: Congenital lacrimal fistula is a rare abnormality of the lacrimal system. The patients may be asymptomatic but treatment of those with symptoms such as epiphora and dacryocystitis is still controversial. METHODS: The clinical findings, methods of surgical treatment and results were evaluated in seven patients (four male, three female) with congenital lacrimal fistula. Three were asymptomatic, types of surgical treatment were fistula excision with dacryocystorhinostomy (DCR) (two cases), fistula excision with conjunctival DCR (one case) and closed fistula excision alone (one case). RESULTS: Three of the four patients who underwent surgery had relief of symptoms. The fistula recurred in the case that had undergone fistula excision alone. CONCLUSIONS: It is difficult to design controlled studies to detect which method is superior for the treatment of lacrimal fistula, considering the small number of cases in the literature. We recommend treating each case according to its own characteristics.     

Congenital fistulas of the lacrimal sac

Four patients with congenital lacrimal sac fistulas are presented. All cases were unilateral and not associated with an occluded nasolacrimal duct. In three cases, the fistula and surrounding skin were surgically removed. The fourth case required no treatment. Microscopic examination revealed that the fistulas were lined with stratified, squamous epithelium with or without keratosis, suggesting that they may have developed as outgrowths from the sac or common canaliculus.