不同进路泪囊鼻腔造孔术治疗慢性泪囊炎的临床研究
发布时间：2019-02-19 09:03
【摘要】：慢性泪囊炎是由于鼻泪管狭窄或阻塞,泪液潴留于泪囊内激发感染而导致的眼部常见疾病,作为眼部的感染病灶,对眼球构成潜在威胁。如果眼球外伤或施行内眼手术,容易引起化脓性感染,发生细菌性角膜溃疡或化脓性眼内炎,严重者者可导致失明。有人形象的称之为“眼球旁的定时炸弹”。 慢性泪囊炎主要是由于泪囊以下的泪道阻塞,即鼻泪管阻塞时泪液无法从泪道排出,积聚于泪囊内,继发细菌感染所致。慢性泪囊炎的诊断并不复杂,通过询问病史,行泪道冲洗后即可确诊。除慢性泪囊炎急性发作时需先抗生素控制急性炎症,转为慢性后再行手术治疗外,一般情况泪道阻塞导致的慢性泪囊炎均可择期行局部治疗,至今治疗慢泪囊炎的方法多种多样,常用的有泪道冲洗法、泪道探通法、泪道植管法、鼻腔泪囊吻合术、激光泪道疏通术等,鼻内镜下泪囊鼻腔吻合术(也有文献称之为鼻内镜下泪囊鼻腔造孔术)及泪小点进路YAG激光辅助下泪囊鼻腔造孔术是泪囊鼻腔吻合术的改良术式。根据手术的原理将治疗慢性泪囊炎的术式分为两类,一类是泪道改道(泪囊鼻腔吻合术、鼻内镜下泪囊鼻腔造孔术、泪小点进路YAG激光辅助下泪囊鼻腔造孔术),另一类是解除原有泪道的阻塞(泪道疏通、鼻泪管植管术、泪道激光疏通等)。由于鼻泪管纤细狭长,位置特殊,解除其阻塞较困难,且容易造成内壁损伤,瘢痕化而再次阻塞。传统的鼻腔泪囊吻合术1904年由Toti首创,由于学者们的改进及手术技巧的提高,鼻腔泪囊吻合术成功率可以达90%以上,但存在容易出血,遗留面部瘢痕,副损伤大等缺点,该术式已经很少在临床中使用。1989年,McDonogh首创了应用鼻内窥镜经鼻腔行泪囊鼻腔造孔术吻合术治疗慢性泪囊炎,由于经鼻腔进路,所以面部不会遗留瘢痕,更容易被患者接受。M W Yung等人总结了鼻内镜下泪囊鼻腔吻合术应用于鼻泪管阻塞导致的慢性泪囊炎的治疗,治愈率达93%。泪小点进路YAG激光辅助下泪囊鼻腔造孔术是在鼻内镜下泪囊鼻腔吻合术的基础上发展起来的一种治疗慢性泪囊炎的术式。本研究通过对两种术式的对比,论证泪小点进路 YAG激光辅助下泪囊鼻腔造孔术的临床使用价值。研究结果显示:采用鼻内窥镜检查、泪道冲洗的形式进行术后随访。A组为泪小点进路YAG激光辅助下泪囊鼻腔造孔术,B组为鼻内镜下泪囊鼻腔吻合术。(1)两种手术方式的时间比较具有显著的统计学差异(P0.01),A组的手术时间要短于B组。(2)两种手术方式出血量的比较,A组显著少于B组(P0.01)(3)两种术式治疗费用比较具有显著的统计学差异(P0.01),A组治疗费用少于B组。(4)治疗效果的比较,两组无明显统计学差异。(5)两组手术并发症无明显统计学差异。 本研究结果表明,泪小点进路YAG激光辅助下泪囊鼻腔造孔术治疗慢性泪囊炎具有用时短,出血少,费用低,疗效高的优点,适合推广。
[Abstract]:Chronic dacryocystitis is a common ocular disease caused by the stricture or obstruction of nasolacrimal duct and the retention of tear in the lacrimal sac to stimulate infection. As an infective focus of the eye, it poses a potential threat to the eyeball. If eyeball trauma or intraocular surgery is easy to cause suppurative infection, bacterial corneal ulcer or suppurative endophthalmitis, severe can lead to blindness. Some people vividly call it the "time bomb next to the eyeball." Chronic dacryocystitis is mainly caused by the obstruction of lacrimal passage below the dacryocyst, that is, when the nasolacrimal duct is blocked, the tear can not be discharged from the lacrimal duct, which accumulates in the dacryocystis and causes secondary bacterial infection. The diagnosis of chronic dacryocystitis is not complicated. In addition to the acute attack of chronic dacryocystitis, the acute inflammation should be controlled by antibiotics first, and then the operation should be performed later. In general, the chronic dacryocystitis caused by obstruction of lacrimal passage can be treated locally. So far, there are a variety of methods to treat chronic dacryocystitis, such as lacrimal passage irrigation, lacrimal passage probing, lacrimal duct implantation, nasolacrimal sac anastomosis, laser lacrimal duct drainage, etc. Endoscopic dacryocystorhinostomy (also known as endoscopic dacryocystorhinostomy) and lacrimal dot approach (YAG laser assisted dacryocystorhinostomy) are the improved methods of dacryocystorhinostomy. According to the principle of operation, the treatment of chronic dacryocystitis was divided into two types: lacrimal duct diversion (dacryocystorhinostomy, endoscopic dacryocystorhinostomy, lacrimal dot approach, YAG laser assisted dacryocystorhinostomy). Another is to remove the obstruction of the original lacrimal passage (lacrimal duct dredging, nasolacrimal tube implantation, lacrimal duct laser dredging, etc.). Because of the narrow and narrow nasolacrimal duct, it is difficult to remove the obstruction of nasolacrimal duct. The traditional nasolacrimal sac anastomosis was initiated by Toti in 1904. The success rate of nasolacrimal sac anastomosis can reach more than 90% due to the improvement of scholars and surgical techniques. In 1989, McDonogh initiated a dacryocystorhinostomy through the nasal cavity for the treatment of chronic dacryocystitis. Because of the transnasal approach, no scar was left on the face. . M W Yung et al summarized the application of endoscopic dacryocystorhinostomy in the treatment of chronic dacryocystitis caused by obstruction of nasolacrimal duct. The cure rate was 933%. YAG laser assisted dacryocystorhinostomy is a new method for the treatment of chronic dacryocystitis based on endoscopic dacryocystorhinostomy. This study demonstrated the clinical value of dacryocystorhinostomy with YAG laser assisted lacrimal punctate approach. The results showed that the patients were followed up by endoscopy and lacrimal passage irrigation. Group A was treated by lacrimal punctate approach YAG laser assisted dacryocystorhinostomy. Group B was treated by dacryocystorhinostomy under nasal endoscope. (1) there was significant difference in the time of operation between the two methods (P0.01), A group was shorter than that in B group; (2) the amount of bleeding in two kinds of operation methods was lower than that in B group. The cost of treatment in group A was significantly less than that in group B (P0.01). (3) there was a significant difference in the cost of treatment between the two groups (P0.01), A group was less than that in group B). (4) the effect of treatment. There was no significant difference between the two groups. (5) there was no significant difference in operative complications between the two groups. The results showed that the treatment of chronic dacryocystitis by YAG laser assisted dacryocystorhinostomy had the advantages of short time, less bleeding, low cost and high curative effect, and was suitable for popularization.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6
[Abstract]:Chronic dacryocystitis is a common ocular disease caused by the stricture or obstruction of nasolacrimal duct and the retention of tear in the lacrimal sac to stimulate infection. As an infective focus of the eye, it poses a potential threat to the eyeball. If eyeball trauma or intraocular surgery is easy to cause suppurative infection, bacterial corneal ulcer or suppurative endophthalmitis, severe can lead to blindness. Some people vividly call it the "time bomb next to the eyeball." Chronic dacryocystitis is mainly caused by the obstruction of lacrimal passage below the dacryocyst, that is, when the nasolacrimal duct is blocked, the tear can not be discharged from the lacrimal duct, which accumulates in the dacryocystis and causes secondary bacterial infection. The diagnosis of chronic dacryocystitis is not complicated. In addition to the acute attack of chronic dacryocystitis, the acute inflammation should be controlled by antibiotics first, and then the operation should be performed later. In general, the chronic dacryocystitis caused by obstruction of lacrimal passage can be treated locally. So far, there are a variety of methods to treat chronic dacryocystitis, such as lacrimal passage irrigation, lacrimal passage probing, lacrimal duct implantation, nasolacrimal sac anastomosis, laser lacrimal duct drainage, etc. Endoscopic dacryocystorhinostomy (also known as endoscopic dacryocystorhinostomy) and lacrimal dot approach (YAG laser assisted dacryocystorhinostomy) are the improved methods of dacryocystorhinostomy. According to the principle of operation, the treatment of chronic dacryocystitis was divided into two types: lacrimal duct diversion (dacryocystorhinostomy, endoscopic dacryocystorhinostomy, lacrimal dot approach, YAG laser assisted dacryocystorhinostomy). Another is to remove the obstruction of the original lacrimal passage (lacrimal duct dredging, nasolacrimal tube implantation, lacrimal duct laser dredging, etc.). Because of the narrow and narrow nasolacrimal duct, it is difficult to remove the obstruction of nasolacrimal duct. The traditional nasolacrimal sac anastomosis was initiated by Toti in 1904. The success rate of nasolacrimal sac anastomosis can reach more than 90% due to the improvement of scholars and surgical techniques. In 1989, McDonogh initiated a dacryocystorhinostomy through the nasal cavity for the treatment of chronic dacryocystitis. Because of the transnasal approach, no scar was left on the face. . M W Yung et al summarized the application of endoscopic dacryocystorhinostomy in the treatment of chronic dacryocystitis caused by obstruction of nasolacrimal duct. The cure rate was 933%. YAG laser assisted dacryocystorhinostomy is a new method for the treatment of chronic dacryocystitis based on endoscopic dacryocystorhinostomy. This study demonstrated the clinical value of dacryocystorhinostomy with YAG laser assisted lacrimal punctate approach. The results showed that the patients were followed up by endoscopy and lacrimal passage irrigation. Group A was treated by lacrimal punctate approach YAG laser assisted dacryocystorhinostomy. Group B was treated by dacryocystorhinostomy under nasal endoscope. (1) there was significant difference in the time of operation between the two methods (P0.01), A group was shorter than that in B group; (2) the amount of bleeding in two kinds of operation methods was lower than that in B group. The cost of treatment in group A was significantly less than that in group B (P0.01). (3) there was a significant difference in the cost of treatment between the two groups (P0.01), A group was less than that in group B). (4) the effect of treatment. There was no significant difference between the two groups. (5) there was no significant difference in operative complications between the two groups. The results showed that the treatment of chronic dacryocystitis by YAG laser assisted dacryocystorhinostomy had the advantages of short time, less bleeding, low cost and high curative effect, and was suitable for popularization.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6
【参考文献】
相关期刊论文 前10条
1 周兵;黄谦;韩德民;崔顺九;刘铭;刘华超;张永杰;;改良经鼻内镜下泪囊鼻腔造孔术[J];中国耳鼻咽喉头颈外科;2008年02期
2 周兵，唐p，
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