再次泪囊鼻腔吻合术分析及体会

Analysis and comprehension of repeat dacryocystorhinostomy

目的分析探讨造成需再次泪囊鼻腔吻合术的原因及其应采取的相应对策。方法通过对32例（32只眼）再次泪囊鼻腔吻合术，详细观察，了解分析其失败的具体原因，并采取相应的治疗措施。结果在32例再次泪囊鼻腔吻合术中，发现其失败原因系泪囊未完全切开者11例，前唇吻合缝线脱落或前唇过长、过宽，致使引起前后唇接触粘连，或前唇下陷粘连者12例，吻合腔肉芽组织增生7例，泪囊过小（萎缩）2例。经再次手术的32例随访3个月，泪道冲洗通畅30例，不畅2例。成功率93．75％。结论术中细致操作，掌握好有关手术技巧及其具有预防和处理并发症的能力，是避免再次手术，取得手术成功的关键。

Objective To analyze the causes and treatment strategy for repeat dacryocystorhinostomy. Methods Thirty-two patients with repeat dacryocystorhinostomy were observed and analyzed for the causes of the failure of first dacryocystorhinostomy.Results Among 32 patients needed repeat dacryocystorhinostomy,the failure causes of first dacryocystorhinostomy included incomplete incision of the mucosa of the lacrimal sac（ 11 cases） ,adhesion of the anterior lip with posterior lip for the suture fall off or the anterior lip too longer or wider （ 12 cases） ,hyperplasy of granulation tissue in the inosculating cavity （7 cases） ,and 2 cases with too small lacrimal sac （atrophy）.During the follow-up of 3 months in 32 patients,irrigation of lacrimal passage was unblocked in 30 cases and blocked in 2 cases, thus the achievement ratio was 93.75%.Conelusiorts The key point of achievement a successful dacryocystorhinostomy and avoidance to repeat operation included careful manipulation in operation, possessing perfect surgical skill and ability to prevent and treat complications.