泪囊鼻内解剖研究及临床应用

目的探讨鼻内镜下鼻腔泪囊造口术的泪囊鼻内表面定位。方法对15具(30侧)成人尸头的泪囊在鼻腔外侧壁上的投影位置进行解剖学测量;并指导临床应用于32例(39侧)慢性泪囊炎鼻泪管阻塞患者的鼻内镜下鼻腔泪囊造口术。结果解剖学测量泪囊大部分(2／3)位于中鼻甲腋上方,小部分(1／3)位于中鼻甲腋下方;泪囊大部分(2／3)位于总泪小管口下方,小部分(1／3)位于总泪小管口上方;内眦韧带横压于泪囊的中部,几乎与总泪小管平行。施行手术的32例(39侧),术后随访半年以上,治愈28例(35侧,89．8％),好转2例(2侧,5．1％),无效2例(2侧,5．1％),总有效率94．9％。结论以中鼻甲腋前上0．2 cm为手术造口中心点,中鼻甲腋前上0．8 cm为上界,腋前下0．4 cm为下界,作弧形黏膜切口及1．2 cm×1．0 cm骨孔,此为鼻腔泪囊造口的最佳位置;利用枪状镊依据鼻外内眦韧带定位泪囊造口的中心点亦不失为一简易可取的方法。

Endonasal anatomy of lacrimal sac and its clinical significance in dacryocystorhinostomy

OBJECTIVE : To explore the intranasal surface localization of the lacrimal sac in endoscopic dacryocystorhinostomy. METHODS: Fiveteen adult cadavers (30 sides) were studied, the data of projection position of the lacrimal sac on the lateral wall of nasal cavity were measured. RESULTS: In 2/3 cadavers, the lacrimal sac is located above the axilla of the middle turbinate, and 1/3 lies below it. A majority of the lacrimal sac (2/3) are located below the entry point of the common lacrimal canaliculus, about 1/3 lies above it. Inner canthal ligament projects on the middle of the lacrimal sac, almost equal to the level of common lacrimal canaliculus. Thirty-two cases (thirty-nine sides) of chronic dacryocystitis were followed-up > 6 months after operation. Thirty-five sides were cured, 2 sides improved and 2 sides ineffective. The cure rate was 89.8%, improve rate 5.1% and ineffective rate 5.1%, respectively, and the total effective rate was 94.9%. CONCLUSIONS: The central position of dacryocystorhinostomy should be 0.2 cm above the front of the axilla of the middle turbinate, to make an curved mucous membrane incision 0.8 cm above and 0. 4 cm below the front of the axilla of the middle turbinate and bone ostium about 1.2 cm x 1.0 cm. It is the best position in endoscopic dacryocystorhinostomy. Locating the inner canthal ligament with a bayonet type forceps to find the projection of lacrimal sac is also a simple and easy method.