中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2014年
10期
766-771
,共6页
王婷婷%陶海%韩毳%王朋%白芳%张健
王婷婷%陶海%韓毳%王朋%白芳%張健
왕정정%도해%한취%왕붕%백방%장건
泪器阻塞%鼻泪管%体层摄影术,X线计算机%内窥镜检查%体位
淚器阻塞%鼻淚管%體層攝影術,X線計算機%內窺鏡檢查%體位
루기조새%비루관%체층섭영술,X선계산궤%내규경검사%체위
Lacrimal duct obstruction%Nasolacrimal duct%Tomography,X-ray computed%Endoscopy%Posture
目的 探讨CT泪道逆行插管造影检查法用于无法实施常规泪道造影检查的泪囊前泪道阻塞患者的实用性和安全性及其相关影响因素.方法 前瞻性研究.选取2011年5月至2012年3月武警总医院眼科泪器病中心诊治的泪囊前泪道阻塞性疾病(包括泪点、泪小管、泪总管的阻塞)患者54例(75只眼),包括:上下泪小点闭锁3例(5只眼)、上下泪小管阻塞15例(24只眼)、泪总管阻塞18例(28只眼)、陈旧性上下泪小管断裂18例(18只眼),均应用0°、30°耳内镜镜头经鼻观察鼻泪管下口,选取鼻泪管下口开放者65只眼,按照仰卧位头后仰角度不同,将患者分成头后仰角度10°、20°、30°和40°共4组,采用随机数字表的方法随机将患者分配入不同的体位检查组,分别包括15只眼、17只眼、17只眼、16只眼.在内镜辅助下,将硬膜外麻醉导管插入前段弯曲的钝头插管导引针,随后将其插入患眼鼻泪管下口,之后将硬膜外麻醉导管继续插入鼻泪管6 mm,以此为插管成功标准.测量成功者插管导引针弯曲部分长轴与插管导引针长轴之间的夹角(θ),记录每组插管成功的例数.对插管成功者(44只眼),经硬膜外麻醉导管注入造影剂(安射力),按相同体位立即行泪道CT.观察CT泪道造影图像特点,并与手术中探查结果比较.结果 65只眼鼻泪管下口开放者,插管成功44只眼.头后仰10°组(15只眼)、头后仰20°组(17只眼)、头后仰30°组(17只眼)、头后仰40°组(16只眼),插管成功例数分别为4只眼、15只眼、13只眼、12只眼,各组获得治疗成功的患者比例分别为26.67％、88.24％、76.47％、75.00％(x2=15.81,P=0.0012).Scheffe法进行各组之间插管成功率比较,头后仰10°组插管成功率明显低于其他3组,差异均有统计学意义(P＜0.05);头后仰20°组、头后仰30°组、头后仰40°组之间插管成功率差异均无统计学意义(P＞0.05).插管成功者θ角范围在93.2°～120.5°之间,平均值108°,θ多分布在104°～115°之间.44只眼插管成功者,注入造影剂行CT检查显示:38只眼CT图像上显示泪道内有造影剂滞留,CT泪道造影结果与术中探查结果基本一致.结论 CT泪道逆行插管造影检查法适用于鼻泪管下口开放的泪囊前泪道阻塞患者的术前检查,为此类患者的诊断和治疗方案提供影像学依据,实用、安全.其影响因素较多,主要有鼻泪管下口形态、患者体位以及插管导引针前段弯曲角度.
目的 探討CT淚道逆行插管造影檢查法用于無法實施常規淚道造影檢查的淚囊前淚道阻塞患者的實用性和安全性及其相關影響因素.方法 前瞻性研究.選取2011年5月至2012年3月武警總醫院眼科淚器病中心診治的淚囊前淚道阻塞性疾病(包括淚點、淚小管、淚總管的阻塞)患者54例(75隻眼),包括:上下淚小點閉鎖3例(5隻眼)、上下淚小管阻塞15例(24隻眼)、淚總管阻塞18例(28隻眼)、陳舊性上下淚小管斷裂18例(18隻眼),均應用0°、30°耳內鏡鏡頭經鼻觀察鼻淚管下口,選取鼻淚管下口開放者65隻眼,按照仰臥位頭後仰角度不同,將患者分成頭後仰角度10°、20°、30°和40°共4組,採用隨機數字錶的方法隨機將患者分配入不同的體位檢查組,分彆包括15隻眼、17隻眼、17隻眼、16隻眼.在內鏡輔助下,將硬膜外痳醉導管插入前段彎麯的鈍頭插管導引針,隨後將其插入患眼鼻淚管下口,之後將硬膜外痳醉導管繼續插入鼻淚管6 mm,以此為插管成功標準.測量成功者插管導引針彎麯部分長軸與插管導引針長軸之間的夾角(θ),記錄每組插管成功的例數.對插管成功者(44隻眼),經硬膜外痳醉導管註入造影劑(安射力),按相同體位立即行淚道CT.觀察CT淚道造影圖像特點,併與手術中探查結果比較.結果 65隻眼鼻淚管下口開放者,插管成功44隻眼.頭後仰10°組(15隻眼)、頭後仰20°組(17隻眼)、頭後仰30°組(17隻眼)、頭後仰40°組(16隻眼),插管成功例數分彆為4隻眼、15隻眼、13隻眼、12隻眼,各組穫得治療成功的患者比例分彆為26.67％、88.24％、76.47％、75.00％(x2=15.81,P=0.0012).Scheffe法進行各組之間插管成功率比較,頭後仰10°組插管成功率明顯低于其他3組,差異均有統計學意義(P＜0.05);頭後仰20°組、頭後仰30°組、頭後仰40°組之間插管成功率差異均無統計學意義(P＞0.05).插管成功者θ角範圍在93.2°～120.5°之間,平均值108°,θ多分佈在104°～115°之間.44隻眼插管成功者,註入造影劑行CT檢查顯示:38隻眼CT圖像上顯示淚道內有造影劑滯留,CT淚道造影結果與術中探查結果基本一緻.結論 CT淚道逆行插管造影檢查法適用于鼻淚管下口開放的淚囊前淚道阻塞患者的術前檢查,為此類患者的診斷和治療方案提供影像學依據,實用、安全.其影響因素較多,主要有鼻淚管下口形態、患者體位以及插管導引針前段彎麯角度.
목적 탐토CT루도역행삽관조영검사법용우무법실시상규루도조영검사적루낭전루도조새환자적실용성화안전성급기상관영향인소.방법 전첨성연구.선취2011년5월지2012년3월무경총의원안과루기병중심진치적루낭전루도조새성질병(포괄루점、루소관、루총관적조새)환자54례(75지안),포괄:상하루소점폐쇄3례(5지안)、상하루소관조새15례(24지안)、루총관조새18례(28지안)、진구성상하루소관단렬18례(18지안),균응용0°、30°이내경경두경비관찰비루관하구,선취비루관하구개방자65지안,안조앙와위두후앙각도불동,장환자분성두후앙각도10°、20°、30°화40°공4조,채용수궤수자표적방법수궤장환자분배입불동적체위검사조,분별포괄15지안、17지안、17지안、16지안.재내경보조하,장경막외마취도관삽입전단만곡적둔두삽관도인침,수후장기삽입환안비루관하구,지후장경막외마취도관계속삽입비루관6 mm,이차위삽관성공표준.측량성공자삽관도인침만곡부분장축여삽관도인침장축지간적협각(θ),기록매조삽관성공적례수.대삽관성공자(44지안),경경막외마취도관주입조영제(안사력),안상동체위립즉행루도CT.관찰CT루도조영도상특점,병여수술중탐사결과비교.결과 65지안비루관하구개방자,삽관성공44지안.두후앙10°조(15지안)、두후앙20°조(17지안)、두후앙30°조(17지안)、두후앙40°조(16지안),삽관성공례수분별위4지안、15지안、13지안、12지안,각조획득치료성공적환자비례분별위26.67％、88.24％、76.47％、75.00％(x2=15.81,P=0.0012).Scheffe법진행각조지간삽관성공솔비교,두후앙10°조삽관성공솔명현저우기타3조,차이균유통계학의의(P＜0.05);두후앙20°조、두후앙30°조、두후앙40°조지간삽관성공솔차이균무통계학의의(P＞0.05).삽관성공자θ각범위재93.2°～120.5°지간,평균치108°,θ다분포재104°～115°지간.44지안삽관성공자,주입조영제행CT검사현시:38지안CT도상상현시루도내유조영제체류,CT루도조영결과여술중탐사결과기본일치.결론 CT루도역행삽관조영검사법괄용우비루관하구개방적루낭전루도조새환자적술전검사,위차류환자적진단화치료방안제공영상학의거,실용、안전.기영향인소교다,주요유비루관하구형태、환자체위이급삽관도인침전단만곡각도.
Objective To observe practicality and safety of CT-RIDC for the patients with presaccular lacrimal obstruction and study the related factors.To provide guidance for the diagnosis and treatment of the patients with presaccular lacrimal obstruction.Methods Fifty-four patients (75 eyes) with presaccular lacrimal obstruction,including 3 cases (5 eyes) of upper and lower lacrimal punctum atresia,15 cases (24 eyes) of superior and inferior canalicular obstruction,18 cases (28 eyes) of common canaliculus obstruction,18 cases(18 eyes) of old laceration of superior and inferior canalicular,were recruited.All patients underwent the examination by using 0° and 30° ear endoscope and the imaging characteristics of the inferior orifice of nasolacrimal duct were obtained.Fifty-three cases (65 eyes) with the opening inferior orifice were randomly divided into four groups (15 eyes,17 eyes,17 eyes,16 eyes) according to different angle of head hypsokinesis in the supine position.The OM lines back along the sagittal plane of the head back 10°,20°,30°,40° were measured.The angles of head hypsokinesis were set in accordance with the OM line measurement results.Intubation was successful when the intubation guided needle within the set of epidural anesthetic catheter aided with endoscopy was inserted into the inferior orifice of nasolacrimal duct and then the epidural anesthetic catheter was inserted into the lacrimal duct 6 mm.The angle(θ) between the long axis of the curved part of the intubation guided needle and the long axis of the guided needle was measured.The numbers of intubation success cases in each group were recorded.x2 test was used to compare intubation success rate under the different angle of head hypsokinesis.Scheffe method was used to compare intubation success rate between each group.Contrast medium was then injected into lacrimal duct through the epidural anesthetic catheter for patients with successful intubation and CT scan was carried out.3D model of lacrimal passage was reconstructed with CT axial scanning.Results The intubation guided needle was successfully inserted into the inferior orifice of nasolacrimal duct in 44 eyes among 65 eyes with the opening orifice.The number of successful intubation cases were 4 eyes,15 eyes,13 eyes,12 eyes and the intubation success rate was 26.67％,88.24％,76.74％,75.00％ according the angle of head hypsokinesis 10° group(15 eyes),20° group(17 eyes),30° group(17 eyes),40° group(16 eyes).The intubation success rate of head hypsokinesis 10° group was significantly lower than that of the other groups.Multiple Comparison by Scheffe Test demonstrated that there was a remarkable difference (P ＜ 0.05) in the intubation success rate between head hypsokinesis 10° group and the other three groups.There were no significant differences in the intubation success rate among head hypsokinesis 20° group,head hypsokinesis 30° group and head hypsokinesis 40° group.The mean of θ was 108° with a range of 93.2°-120.5° by measuring the angle θ of the successful intubation cases.According to the frequency distribution plot,most θ was in 104°-115°.The successful intubation cases (44 eyes) underwent CT scan in the same position immediately after injected contrast medium(Optiray) through the epidural anesthetic catheter.CT images of 28 eyes showed retained contrast medium in the nasolacrimal duct and lacrimal sac.The findings from CT-DCG images were basically agreed with the operation.Conclusions CD-RIDC may apply to pre-operative examination for the patients with the opening orifice and presaccular lacrimal obstruction.It provideed imaging evidence for diagnosis and therapy and it was safe and practical.Many factors could affect CD-RIDC.The main verified facors were the shape of the inferior orifice of nasolacrimal duct,head position of the patient and the bending angle of the tip of intubation guided needle.
