改良泪小管断裂即时吻合疗效观察

目的:探讨泪小管断裂即时吻合术中,无论伤前有无溢泪环形置管的可行性,并发症及疗效情况。方法:对67例67眼内眦角或眼睑裂伤致下泪小管断裂即时吻合术中,无论伤前有无溢泪环形置管的可行性,置管保留时间,并发症及拔管后冲洗6mo以上情况追踪研究。结果:患者67例67眼全部成功置管,有62例吻合成功,3例拔管后泪道狭窄,2例拔管后冲洗不通,经泪道YAG激光处理后再通。结论:外伤致泪小管断裂即时吻合术中环形泪道置管法,无论伤前有无溢泪,均能成功置管,且因置管保留在鼻腔内,可较长时间保留,不影响日常生活、工作,保证了在无牵拉的情况下泪小管断端的修复,减少了并发症,疗效良好。     

鼻内窥镜下crawford管置管治疗下泪小管阻塞的临床分析

目的观察鼻内窥镜下crawford管治疗泪小管阻塞的临床疗效。方法在门诊治疗的下泪小管阻塞共42例(53眼),在局麻下行crawford管治疗。根据病情平均3-6个月拔管,拔出泪道硅胶管后,泪道冲洗通畅且无症状为治愈;泪道冲洗通畅,但有一定阻力且偶有流泪为好转;泪道冲洗不通畅为无效;拔管两个月以上再次流泪冲洗不通畅为复发。结果拔管后,治愈41眼(77.36%);好转6眼(11.32%);无效2眼(3.77%);复发4眼(7.55%)。结论鼻内窥镜下crawford管置管是一种有效的治疗下泪小管阻塞的办法。     

Balanced orbital decompression in Graves' orbitopathy: Upper eyelid crease incision for extended lateral wall decompression

INTRODUCTION . This study reports on the results and complications detected in patients with Graves' orbitopathy who underwent balanced medial and lateral wall orbital decompression through concealed incisions. MATERIALS AND METHODS . The medial and lateral orbital walls of nine consecutive patients (14 eyes) were removed. A transnasal endoscopic spheno-ethmoidectomy was performed for the medial wall decompression. A lateral wall decompression was performed via an upper eyelid crease incision which was extended laterally in a relaxed skin tension line. The lateral aspect of the orbit was sculpted with a high-speed surgical drill from the inferior orbital fissure inferiorly and frontal bone of the lacrimal fossa superiorly to the orbital apex posteriorly, including the thick bone of the greater wing of the sphenoid. RESULTS . The decompression was performed for cosmetic purposes in seven patients (10 orbits) and for exposure keratopathy and restrictive myopathy in the remaining two patients (4 orbits). The average follow-up period was 13.6 months. The mean reduction of proptosis was 4.8 mm. The preoperative diplopia in two cases demonstrating restrictive myopathy worsened during the postoperative period. New onset diplopia was not detected in seven cases operated on for cosmetic purposes. All patients were satisfied with their eye status, visual rehabilitation and cosmetic appearance. CONCLUSIONS . The transnasal endoscopic approach for medial wall and extended lateral wall decompression with hidden eyelid crease incision provides a favorable cosmetic and physiologic outcome with proper retroplacement of the globe.     

Ethanol selectively impairs clathrin-mediated internalization in polarized hepatic cells

Although alcoholic liver disease is clinically well-described, the molecular basis for alcohol-induced hepatotoxicity is not well understood. Previously, we determined that the clathrin-mediated internalization of asialoglycoprotein receptor was impaired in ethanol-treated WIF-B cells whereas the internalization of a glycophosphatidylinositol-anchored protein thought to be endocytosed via a caveolae/raft-mediated pathway was not changed suggesting that clathrin-mediated endocytosis is selectively impaired by ethanol. To test this possibility, we examined the internalization of a panel of proteins and compounds internalized by different mechanisms in control and ethanol-treated WIF-B cells. We determined that the internalization of markers known to be internalized via clathrin-mediated mechanisms was impaired. In contrast, the internalization of markers for caveolae/raft-mediated endocytosis, fluid phase internalization or non-vesicle-mediated uptake was not impaired in ethanol-treated cells. We further determined that clathrin heavy chain accumulated at the basolateral surface in small puncta in ethanol-treated cells while there was decreased dynamin-2 membrane association. Interestingly, the internalization of resident apical proteins that lack any known internalization signals was also disrupted by ethanol suggesting that these proteins are internalized via clathrin-mediated mechanisms. This conclusion is consistent with our findings that dominant negative dynamin-2 overexpression impaired internalization of known clathrin markers and single spanning apical residents, but not of markers of fluid phase or raft-mediated internalization. Together these results indicate that ethanol exposure selectively impairs hepatic clathrin-mediated internalization by preventing vesicle fission from the plasma membrane.     

泪道引流管在泪小管断裂中的临床应用价值

目的观察应用泪道引流管治疗泪小管断裂的临床疗效并总结临床应用经验。方法将64例泪小管断裂患者根据手术选用的支撑材料不同分为2组,应用泪道引流管作为支撑的作为研究组,既往应用硬膜外麻醉导管作为支撑的作为对照组,观察并比较2组患者疗效及插管成功率的差异。结果研究组痊愈率(80.95%)和插管一次成功率(95.24%)均显著高于对照组(P<0.05或P<0.01)。结论泪道引流管是治疗泪小管断裂的推荐选择,疗效肯定,可以有效提高插管一次成功率。     

外伤性断离泪小管显微吻合术的临床应用观察

目的评价显微吻合外伤性泪小管断离的临床疗效。方法对32例外伤性泪小管断离患者进行了显微吻合术并留置支撑管,随访1～3年。结果本组病例28例泪道恢复通畅,3例狭窄,仅1例失败。结论应用显微外科技术吻合断离泪小管,手术简便,成功率高,值得推广应用。     

带芯硬膜外管在泪小管断裂吻合术中的应用

目的 探讨泪小管断裂吻合使用带芯硬膜外管的疗效.方法 收集我院2005年3月～2007年3月40例泪小管断裂患者为治疗组,进行带芯硬膜外管吻合植管,与对照组(收集我院2003年3月～2005年2月30例泪小管断裂患者采用硬膜外管直接植管治疗)进行对比.结果 治疗组一次性植管成功率100%,对照组66%,两组之间差异有统计学意义(P＜0.05).植管吻合泪小管时间治疗组为(10±3)min,对照组为(20±5)min,两组对比差异有统计学意义(P＜0.05).手术治愈率治疗组为97.5%,对照组为73.3%,两者比较差异有统计学意义(P＜0.05).手术有效率治疗组为97.5%,对照组为96.5%,两者比较无统计学意义(P＞0.05).结论 ①硬膜外管是泪小管断裂吻合理想的支撑材料;②带芯硬膜外管很好地克服了单纯使用硬膜外管的不足,在提高一次性植管成功率,减少因反复操作给组织带来的损伤,缩短手术操作时间,提高治忿率方面效果明显.