改良鼻内镜下鼻腔泪囊造口术

目的提高鼻腔泪囊造口术的成功率。方法于泪囊在鼻腔外侧壁的投影,即中鼻甲的前端,鼻丘处,“工”形切开鼻腔黏膜,形成前后二个“门”形黏膜瓣,磨开骨壁,造口约1 cm,泪囊内侧壁也做同样较小的“工”形切开,形成相似的“门”形泪囊壁瓣,将其前后分别与鼻腔黏膜瓣对应缝合,覆盖骨性造口缘,使造口表面光滑,无纤维肉芽和瘢痕组织形成,不易造成阻塞。硬膜外麻醉导管自泪点进入泪道系统,并自下鼻道鼻泪管开口及造口处拉出,形成两条通道。结果术后7 d拆除固定于造口处的导管上的高分子膨胀材料,“门”形瓣缝合处已愈合,无黏膜的上下部分骨面已有上皮爬行,造口表面黏膜红润、光滑,冲洗泪道通畅,溢泪症状消失。本组慢性泪囊炎的治愈率为97%。结论本改良鼻内镜下鼻腔泪囊造口术的造口光滑,不易形成肉芽。而硬膜外麻醉导管所形成的第二条通道,更加保证了手术的成功。

Modified endoscopic nasal lacrimal ostomy

Objective To improve the successful rate of nasal lacrimal ostomy. Methods Nasal mucosa were subjected to a ＂工＂-shaped incision from the front of the middle turbinate, the nose dome, to estabhsh two ＂门＂-shaped flaps. The medial wall of the lacrimal sac was also subjected to ＂工＂-shaped incision to form a ＂门＂-shaped wall flap tear of their nasal mucosa before and after the flap was sutured to cover the bony edge of the stoma. Epidural catheters were inserted from the point of the tears into the lacrimal system and pulled out under the meatus nasolacrimal duct opening and stoma. Results Seven days after removal of Polymer expansion materials fixed in the stoma catheter, the ＂门＂-shaped flap suture was cured and epiphora symptoms disappeared. The curative rate was 97 %. Conclusion This method is good in forming a smooth stoma and the second channel of the epidural catheter ensures the success of the surgery.