鼻腔泪囊造口术的泪囊鼻内解剖研究

Endonasal anatomy of lacrimal sac to endoscopic transnasal dacryocystorhinostomy

目的:探讨鼻腔泪囊的解剖结构及其与毗邻的关系,为鼻内镜下鼻腔泪囊造口术提供解剖学指导。方法:对15具(30侧)成人尸头的泪囊投影在鼻腔外侧壁上的解剖特点进行研究,同时观察了内眦韧带与泪囊的解剖关系。结果:泪囊在鼻腔外侧壁上的解剖位置投影大部(2/3)位于中鼻甲附着处(中鼻甲腋)前端上方,小部位于其下方;泪囊小部分(1/3)位于泪总管开口上方水平,大部位于该口下方;内眦韧带几乎横压于泪囊中部。中鼻甲腋可越过泪囊后界(11侧)或中线(1侧)。使用以内眦韧带为基准点的泪囊鼻外定位法,30侧标本全部定位于泪囊投影区较中心的位置。结论:建议术前行泪囊碘油造影CT检查,手术造口中心位置约为中鼻甲附着处以上1.5～2.0mm处稍前方。泪总管开口与泪囊的解剖关系恒定,术中使用激光光纤行泪道探查,并以透过鼻腔外侧壁上的光斑为定位标志相对精确,以内眦韧带为基准点的泪囊鼻外定位法准确度亦高。

Objective：To provide clinical guidance for the endoscopic transnasal dacryocystorhinostomy. Method：Fifteen adult cadavers （30 sides） were studied on the projection anatomy of lacrimal sac on the lateral wall of nasal cavity and the relationship between lacrimal sac and inner canthal ligament were studied, too. Result： A major portion of the sac （2/3） was located above the insertion anterior to the middle turbinate and, quite a part （1/3） of the sac lied above the entry point of the common canaliculus. Inner canthus ligament almost projected on the middle of the sac. The insertion of the front of the middle turbinate could pass the posterior facies （11 sides） even the long axis （1 side） of lacrimal sac. A localization method based on inner canthus ligament showed the degree of accuracy of 80%. Conclusion：Dacryocyst iodized oil opacification CT scan should be performed. Surgical stoma location is about 1.5-2.0 mm above and slightly anterior to the insertion of the middle turbinate. A localization method based on inner canthus ligament shows a high accuracy. The common canaliculus entry point is comparatively permanent, a laser optical fiber should be used for lacrimal passages exploration on the surgery, and the light spot directed toward lacrimal bone on the nasal lateral wall is exactly as an identification marker.