鼻泪管解压术治疗慢性泪囊炎的影像学研究

发布时间：2018-06-12 19:03

本文选题：泪囊炎 + 鼻泪管　；参考：《临床耳鼻咽喉头颈外科杂志》2017年04期

【摘要】：目的:探讨鼻内镜下鼻泪管解压术治疗慢性泪囊炎新术式的可行性。方法:1对22侧慢性泪囊炎患者给予30%碘海醇注射液进行泪囊造影,见造影剂从泪小管反流停止推药,立即进行泪道CT扫描;2应用Sinuses TracheaⅠ软件重建泪道及其周围结构三维可视图;3应用该软件对泪囊、鼻泪管进行模拟"切削"减压。结果:1泪道阻塞发生率分别是泪小管段4.5%(1/22)、泪囊段22.7%(5/22)、移行段13.6%(3/22)、鼻泪管段36.4%(8/22)、Hasner瓣段22.7%(5/22),其中移行段、鼻泪管段和Hasner瓣段占72.7%(16/22);2三维可视结构显示鼻泪管外侧壁是由上颌骨的泪沟构成,内壁由泪骨降突及下鼻甲的上行泪骨突构成;3从下鼻道观察,鼻泪管由下鼻甲骨围成,形成坚硬的鼻泪管及其开口内侧壁;4削去下鼻甲前端在鼻腔外侧壁的附着处即鼻泪管内侧壁,使膜鼻泪管得到充分开放,为解除鼻泪管阻塞创造可扩张空间。结论:鼻内镜下鼻泪管解压术治疗慢性泪囊炎具有可行性,且保留了膜性泪道完整性,避免了因切开泪囊肉芽增生、瘢痕形成导致泪道再次阻塞等并发症。
[Abstract]:Objective: To explore the feasibility of endoscopic nasolacrimal duct decompression for the treatment of chronic dacryocystitis. Methods: 1 to 22 sides of chronic dacryocystitis, 30% Iohexol Injection were given dacryocystigraphy, and the contrast agent was removed from the lacrimal canaliculus to stop the drug, and the lacrimal duct CT scan was performed immediately; 2 should be used to reconstruct lacrimal duct and its surrounding node with Sinuses Trachea I software. A three-dimensional visual map was constructed. 3 the software was used to simulate "cutting" decompression of lacrimal sac and nasolacrimal duct. Results: the incidence of 1 lacrimal duct obstruction was 4.5% (1/22), 22.7% (5/22), 13.6% (3/22), 36.4% (8/22), Hasner segment 22.7% (5/22) of the lacrimal duct, 72.7% (16/22) of the nasolacrimal duct and Hasner segment; 2 three-dimensional. The visual structure shows the lateral wall of the nasolacrimal duct, which is made up of the lacrimal groove of the maxilla. The inner wall is composed of the descending dacrimal bone and the upper lacrimal bone process of the inferior turbinate. 3 from the lower nasal canal, the nasolacrimal duct is surrounded by the lower nasal Oracle, forming a hard nasolacrimal duct and the medial wall of the opening. 4 the inner wall of the nasolacrimal duct at the front of the lateral nasal wall of the inferior turbinate, that is, the medial wall of the nasolacrimal duct. The membranous nasolacrimal duct is fully open to create an expansible space to relieve the obstruction of the nasolacrimal duct. Conclusion: endoscopic nasolacrimal duct decompression is feasible for chronic dacryocystitis, and preserves the integrity of the membrane lacrimal duct, avoiding complications such as the incision of dacryocyst granulosis and the formation of the cicatricial lacrimal passage.
【作者单位】：深圳市第二人民医院耳鼻咽喉科;深圳市龙岗中心医院耳鼻咽喉科医院;
【基金】：深圳市科技计划项目(No:JCYJ20140411150309465) 深圳市耳鼻咽喉疾病重点实验室项目(No:ZDSYS201506050935272)
【分类号】：R779.6

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