急诊显微手术治疗泪小管断裂

目的探讨泪小管断裂断端的找寻规律和防止术后瘢痕收缩的方法,提高急诊泪小管断裂吻合术的成功率。方法在眼科手术显微镜下仔细寻找11例泪小管断裂患者(含年龄9个月者)的泪小管断端,以硬膜外麻醉导管作支撑管,以眼科9-0尼龙线行三点对位吻合,支撑管留置至术后20～90d。结果11例均成功吻合泪小管,术后20d至3个月拔管后无泪溢。结论术中耐心寻找泪小管断端,仔细对位缝合皮肤,术后以硬膜外麻醉导管作留置支撑管可以提高手术成功率。     

Changes in Expression of Connexin 32, Bile Canaliculus-Like Structures,and Localization of Alkaline Phosphatase in Primary Cultures of Fetal Rat Hepatocytes

We devised an experimental design in primary cultures of fetal rat hepatocytes for studying hepatocyte differentiation over a short period. In the present study, hepatocytes were first cultured for 3 days in dexamethasone-supplemented medium and then for an additional 3 days in dexamethasone- or epidermal growth factor-supplemented medium. In hepatocytes cultured continuously in dexamethasone-supplemented medium, the expression of connexin 32 increased and bile canaliculus-like structures and localization of alkaline phosphatase in the plasma membrane around bile canaliculus-like structures were maintained. Few cells incorporated bromodeoxyuridine. On the other hand, in most of the hepatocytes cultured in epidermal growth factor-supplemented medium, the expression of connexin 32 was minimally recognized, bile canaliculus-like structures were shortened or eliminated, and alkaline phosphatase was localized as numerous fine spots throughout the cytoplasm. More than 20% of all hepatocytes incorporated bromodeoxyuridine.The present study suggests that in hepatocytes, there is a close relationship among connexin 32 expression, the maintenance of bile canaliculus-like structures, and the localization of alkaline phosphatase to the plasma membrane around the bile canaliculus-like structures, and this indicates that the present experimental model is useful for studying hepatocyte differentiation over a short period.     

鼻内窥镜直视下泪小管断裂吻合术治疗泪小管断裂的疗效观察

目的 探讨在鼻内窥镜直视下泪小管断裂吻合术治疗泪小管断裂的临床疗效。方法 回顾性研究2016年1月～2019年1月在我院眼科就诊的泪小管断裂患者36例,分为两组,对照组实施传统泪小管断裂吻合术,观察组实施鼻内窥镜下泪小管断裂吻合术,每组18例。比较两组手术中置入泪道引流管的时间,术中出血情况,术后6 h、24 h、48 h疼痛评分以及治疗总有效率。结果 观察组术中置入泪道引流管时间较对照组短,术中出血情况较对照组少(P0.05),术后6 h、术后24 h疼痛评分低于对照组(P0.05),术后48 h两组疼痛评分差异无统计学意义(P0.05)。对照组与观察组临床疗效差异无统计学意义(P0.05)。结论 鼻内窥镜下泪小管断裂吻合术可提高泪小管断裂患者手术中置入泪道引流管时间,早期可减轻患者疼痛,值得借鉴。     

Worst泪道探针法治疗泪小管断裂的护理

丁基胶塞因具有良好的气密性，较强的惰性，更高洁净度、更安全的生物性能等优点，成为国家在制药行业限期强制推广使用的药用包装材料。国食药监注（2004）391号明确规定：2005年1月1日起禁止所有药品采用普通天然胶塞包装。但丁基胶塞作为输液瓶胶塞在临床应用中存在一定缺陷。如穿刺时致输液器针梗不易全部插入胶塞中，输液过程中出现掉、退针，从而诱发护患纠纷。本研究发现，将输液器穿刺针柄嵌入铝盖与胶塞之间，可有效地解决上述问题，现报道如下。     

小儿外伤性泪小管断裂T型硅胶支撑管置管术的疗效观察

目的:观察T型硅胶支撑管置管术治疗小儿外伤性泪小管断裂的效果。方法:回顾性病例研究。选取南京市第三医院2016年8月至2020年1月住院的小儿外伤性泪小管断裂者25例(25眼),采用"双套环"技术顺行置入T型支撑管。术后3～6个月拔管,拔管后随访1～3个月,观察疗效。结果:25例中,治愈21例(84.00%,21/25...     

大鼠松果体组织结构的增龄变化

目的；观察大鼠松果体组织结构的增龄变化。方法：应用计算机图像分析和透射电镜研究了幼年，青年和老年大鼠松果体。结果：随着年龄增加，大鼠松果体的体积依次增大，每个视野内松果体实质面积和实质细胞数减少，间质增生，衰退的松果体暗细胞在各年龄组大鼠松果体中均非常少见，实质细胞间存在与血管周隙和神经胶质细胞周隙相通的细胞间小管。结论：随着年龄增加，大鼠松果体的实质细胞总数和松果体细胞总数下降或衰退的暗细胞总灵敏增加，从而导致松果体分泌功能下降的观点，值得商榷，大鼠松果体分泌物可能通过细胞间小管-血管周隙和神经胶质细胞周隙-囊上皮孔而直接释放到蛛网膜下隙的脑脊液中，结缔组织增生可阻碍其释放。     

鼻内窥镜微创技术在难治性鼻泪管阻塞治疗中的应用

目的探讨应用鼻内窥镜微创技术治疗难治性鼻泪管阻塞的可行性，并探讨其临床意义。方法难治性鼻泪管阻塞56例（65眼）在鼻内窥镜直视下进行泪囊鼻腔造瘘术联合环形人工泪小管植人术，对合并上泪道狭窄或阻塞者，术中于鼻内窥镜直视下，采用WZC-Ⅲ高频电泪道浚通仪进行上泪道浚通术。5眼合并鼻中隔重度偏曲者，同期行鼻内窥镜下鼻中隔偏曲矫形术。术后常规处理，3个月后拔除人工泪小管，随访观察1-3个月。结果术后仅极少数患者存在轻度溢泪及眼内眦部充血，无人工泪小管脱落及其他不适。65眼中53眼溢泪、溢脓等症状消失，治愈率81．5％（53／65）；7眼存在轻度溢泪，无溢脓，有效率10．8％（7／65），5眼症状无改善，无效率7．7％（5／65）。结论鼻内窥镜微创技术为难治性鼻泪管阻塞提供了一种理想的治疗手段，它具有微创、直视下操作、疗效可靠、并发症少、无颜面部瘢痕等优点。     

Medial canthal tendon repair for moderate to severe tendon laxity

Background: Medial canthal tendon laxity is a common cause of epiphora and ocular irritation. It is difficult to treat due to the proximity of the lower canaliculus and punctum to the tendon. Methods: The results of a prospective series of patients with involutional medial canthal tendon laxity between 1997 and 2002 were reviewed. Symptoms and measured laxity were recorded before and after medial canthal tendon repair. The medial canthal tendon was routinely repaired through a cut along the lid margin extending from the punctum medially. This avoids a vertical cut onto the anterior lamella of the eyelid, which is useful if a skin graft is required. Results: Twenty lower eyelid medial canthal tendon repairs were performed on 17 patients. Preoperatively, the lower punctum in all patients was able to be distracted to the medial limbus or further and in 50% of cases, the lower lid punctum was able to be distracted to the pupil midline or further. Postoperatively all patients had reduction of their medial canthal tendon laxity. Postoperatively in 85% of cases the lower punctum was not able to be distracted beyond the medial limbus; however, 15% of cases still had significant residual laxity. Eighty‐five per cent of patients reported improvement in symptoms. Conclusions: This is an effective procedure in the majority of patients with moderate to severe medial canthal tendon laxity; however, residual lower lid laxity persisted in some patients.     

Anatomical analysis of the human lacrimal drainage pathway under an operating microscope

Mesoscopic structures of the lacrimal drainage pathway were observed under an operating microscope in six cases of 5 adult cadavers. In all these cases the upper and lower canaliculi fused to form the common canaliculus. Two cases with a large common canaliculus showed large projections of mucosa which reduced the inner space of the common canaliculus. The remaining 4 cases with a small common canaliculus did not show any projections. These findings indicate that the human lacrimal system can function physiologically through a small narrow space of the common canaliculus.Abbreviation DSI direct silicone intubation