泪囊鼻腔吻合联合泪道内窥镜下泪小管置管治疗泪囊囊肿

目的探讨泪囊鼻腔吻合联合泪道内窥镜下泪小管置管术治疗泪囊囊肿的效果。方法泪囊囊肿16例（16眼）在局麻下行泪囊鼻腔吻合术的同时应用泪道内窥镜系统对泪小管泪总管进行检查,针对阻塞部位进行激光或电钻治疗后,逆行植入环形泪小管内硅胶管。1周拔除引流管,拆除皮肤缝线。3~6个月拔除泪小管内硅胶管。术后随访6个月~2 a,观察术后囊肿治愈率,泪道冲洗通畅情况及泪溢症状是否改善。结果泪囊囊肿全部消失,有效率100%。泪道冲洗通畅14例占87.5%,2例有部分回流占12.5%。以上患者溢泪症状基本消失。结论泪囊鼻腔吻合联合泪道内窥镜下泪小管置管术治疗泪囊囊肿的疗效显著。     

鼻腔泪囊吻合联合泪小管置管治疗伴有泪小管阻塞的泪囊炎

目的：探讨伴有泪小管阻塞的泪囊炎患者经鼻内镜鼻腔泪囊吻合术联合泪小管置管术的手术疗效。 方法：伴有泪小管阻塞的泪囊炎患者27例,给予经鼻内镜下泪囊鼻腔吻合术联合泪小管置管,泪小管阻塞采用泪道内窥镜下激光泪道探通术,环形置管。 结果：患者27例均顺利完成手术,均未见手术并发症。所有患者术后均定期随访6mo,治愈25例,有效2例,无效0例。治愈率为93%。 结论：鼻内镜下鼻腔泪囊吻合联合泪小管置管治疗泪囊炎合并泪小管阻塞具有视野清晰,创伤小,恢复快,远期疗效确切,避免分次手术等优点,值得广泛推广。     

Anatomic landmarks in lacrimal surgery from an ophthalmologist's point of view: Clinical findings of external dacryocystorhinostomy and dacryoendoscopy

Epiphora is a common clinical symptom of nasolacrimal duct obstruction. However, it is present in several pathologies and can lead to decreased quality of life for patients. A careful clinical examination including a detailed patient's history and diagnostic tests such as the fluorescein dye disappearance test and diagnostic syringing of the lacrimal duct are essential. Depending on the time of presentation (congenital, primary, or secondary acquired), grade (subtotal or total) and location of the stenosis, different surgical approaches can be considered. These are subdivided into minimally invasive (transcanalicular) and anastomosing (dacryocystorhinostomy) procedures. Furthermore, the anatomical landmarks and the site of surgical intervention differentiate the surgical techniques into endoscopic or transcutaneous. Modern intubation techniques offer a large spectrum of therapeutic possibilities enabling patient care to be customized and individualized. Knowledge of the topographical anatomy is crucial for achieving greater success and a lower complication rate. Clin. Anat. 30:1034–1042, 2017. © 2017 Wiley Periodicals, Inc.     

Dacryoendoscopic surgery and tube insertion in patients with common canalicular obstruction and ductal stenosis as a frequent complication

Purpose  To report the performance of a new technique and strategy for treating common canalicular obstruction (CCO). Since ductal stenosis is a frequent complication of CCO, access to the whole lacrimal passage is important for CCO treatment. Methods  In a retrospective, nonrandomized clinical trial, 46 patients (57 CCO cases, 42–93 years old) were treated with either dacryoendoscopic canalicular incision (EI) dacryoendoscope-guided tube insertion (EGT), EI plus inferior meatal dacryocystorhinostomy (iDR)/EGT, EI plus endonasal dacryocystorhinostomy (enDCR), or external canaliculo-DCR depending on the degree of ductal stenosis. The dacryoendoscope was used for incisional positioning, examination and guidance. Results  Ductal stenoses/obstructions were complicated in 14 of 57 CCO cases (24.5%). The success rate after 6–25 months of postoperative follow-up was 89.5% (51/57 cases). The success rates after EI/EGT alone, EI plus enDCR, and EI/EGT plus iDR were 90.4% (38/42 cases), 100% (4/4 cases), and 90% (9/10 cases), respectively. In one case, false passages through the submucosa of the canaliculi were identified, and the surgical approach was converted from EI/EGT to canaliculo-DCR. Conclusions: EI/EGT alone is an effective, minimally invasive method for treatment of simple CCO. Additional lacrimal surgery (iDR/EGT, enDCR, and canaliculo-DCR) is effective for complicated CCO