中华眼外伤职业眼病杂志
中華眼外傷職業眼病雜誌
중화안외상직업안병잡지
CHINESE JOURNAL OF OCULAR TRAUMA AND OCCUPATIONAL EYE DISEASE
2014年
8期
627-629
,共3页
泪囊炎,慢性%泪囊鼻腔吻合术,小切口,外路,改良
淚囊炎,慢性%淚囊鼻腔吻閤術,小切口,外路,改良
루낭염,만성%루낭비강문합술,소절구,외로,개량
Dacryocystitis,chronic%Dacryocystorhinostomy,small incision,external route,modified
目的 观察改良小切口外路泪囊鼻腔吻合术治疗慢性泪囊炎的临床效果.方法 回顾性分析小切口手术治疗的慢性泪囊炎36例(36眼)的临床资料.男7例,女29例.年龄15 ～ 66岁.病程,3月～4年.所有患者术前明确诊断为慢性泪囊炎,冲洗鼻泪管不通并有脓液溢出.其中7例曾行泪道激光,6例曾反复冲洗过.手术采用改良小切口外路泪囊鼻腔吻合术,皮肤切口10 mm,以小型眼睑拉勾或缝线牵开暴露术野,钝性分离皮下组织,不切断内眦韧带,蚊式钳轻压造成骨孔,咬骨钳制做超过10 mm的骨孔,骨窗尽可能较大且较低,充分止血,“H”字形切开泪囊及鼻黏膜,6-0可吸收线分别吻合前后瓣,不植管,前瓣悬吊于皮下组织.结果 术后随访1～4年.1例因骨孔内肉芽组织增生,于术后3个月泪道堵塞,患者拒绝进一步处理而继续出现溢泪症状.一例泪道冲洗通畅,但患者仍出现溢泪而无溢脓,未行特殊处理.其余34例效果良好,无明显溢泪或流脓症状,手术成功率为94.4％.所有患者皮肤愈合良好,无明显瘢痕形成.结论 改良小切口外路泪囊鼻腔吻合术,掌握手术技巧,术中精心操作,可显著提高手术成功率并减少并发症的发生.
目的 觀察改良小切口外路淚囊鼻腔吻閤術治療慢性淚囊炎的臨床效果.方法 迴顧性分析小切口手術治療的慢性淚囊炎36例(36眼)的臨床資料.男7例,女29例.年齡15 ～ 66歲.病程,3月～4年.所有患者術前明確診斷為慢性淚囊炎,遲洗鼻淚管不通併有膿液溢齣.其中7例曾行淚道激光,6例曾反複遲洗過.手術採用改良小切口外路淚囊鼻腔吻閤術,皮膚切口10 mm,以小型眼瞼拉勾或縫線牽開暴露術野,鈍性分離皮下組織,不切斷內眥韌帶,蚊式鉗輕壓造成骨孔,咬骨鉗製做超過10 mm的骨孔,骨窗儘可能較大且較低,充分止血,“H”字形切開淚囊及鼻黏膜,6-0可吸收線分彆吻閤前後瓣,不植管,前瓣懸弔于皮下組織.結果 術後隨訪1～4年.1例因骨孔內肉芽組織增生,于術後3箇月淚道堵塞,患者拒絕進一步處理而繼續齣現溢淚癥狀.一例淚道遲洗通暢,但患者仍齣現溢淚而無溢膿,未行特殊處理.其餘34例效果良好,無明顯溢淚或流膿癥狀,手術成功率為94.4％.所有患者皮膚愈閤良好,無明顯瘢痕形成.結論 改良小切口外路淚囊鼻腔吻閤術,掌握手術技巧,術中精心操作,可顯著提高手術成功率併減少併髮癥的髮生.
목적 관찰개량소절구외로루낭비강문합술치료만성루낭염적림상효과.방법 회고성분석소절구수술치료적만성루낭염36례(36안)적림상자료.남7례,녀29례.년령15 ～ 66세.병정,3월～4년.소유환자술전명학진단위만성루낭염,충세비루관불통병유농액일출.기중7례증행루도격광,6례증반복충세과.수술채용개량소절구외로루낭비강문합술,피부절구10 mm,이소형안검랍구혹봉선견개폭로술야,둔성분리피하조직,불절단내자인대,문식겸경압조성골공,교골겸제주초과10 mm적골공,골창진가능교대차교저,충분지혈,“H”자형절개루낭급비점막,6-0가흡수선분별문합전후판,불식관,전판현조우피하조직.결과 술후수방1～4년.1례인골공내육아조직증생,우술후3개월루도도새,환자거절진일보처리이계속출현일루증상.일례루도충세통창,단환자잉출현일루이무일농,미행특수처리.기여34례효과량호,무명현일루혹류농증상,수술성공솔위94.4％.소유환자피부유합량호,무명현반흔형성.결론 개량소절구외로루낭비강문합술,장악수술기교,술중정심조작,가현저제고수술성공솔병감소병발증적발생.
Objective To investigate the clinical efficacy of modified small incision external route dacryocystorhinostomy for chronic dacryocystitis.Methods The medical records of 36 cases of chronic dacryocystitis treated with modified small incision external route dacryocystorhinostomy were retrospectively analyzed.There were 7 male and 29 female patients,aged 15 ～26 years.The duration of diseases ranged from 3 months to 4 years.All cases were diagnosed as chronic dacryocystitis with obstructed nasolacrimal duct and the overflowing of pus.Seven cases had undergone lacrimal laser treatment,and 6 cases had received repeated irrigations of lacrimal passage before surgery.The surgery adopted modified small incision external route dacryocystorhinostomy with 10 mm skin incision.The operative field was exposed by small eye lid retractor or stitches.The subcutaneous tissue was separated by blunt dissection.The 10-mm bone window was made by mosquito forceps and rongeur forceps,without cutting off the canthal ligament.After the bleeding was stopped,H-shaped incisions were made on the lacrimal sac and nasal mucosa.The front and rear flaps of both incisions were sutured each other with 6-0 silk suture with the front flaps suspended in the subcutaneous tissue.Results The patients were followed for 1 to 4 years.34 cases had good clinical effect.The proliferation of granulation tissue in the bone hole occurred in one patient who had epiphora but no pyorrhea at 3 months postoperatively.One case had epiphora with patent lacrimal duct.The surgical success rate was 94.4％.The skin healed well without scarring in all cases.Conclusion For chronic dacryocystitis,modified small incision external route dacryocystorhinostomy can increase surgical success rate and decrease the incidence of surgical complications.
