泪囊鼻腔吻合手术方式改进

Discussion on improvement of dacryocystorhinostomy

目的探讨泪囊鼻腔吻合术的改进方法。方法回顾总结2009年10月至2012年12月在遵义医学院附属医院眼科收治慢性泪囊炎患者258例（286只眼），采用泪囊鼻腔吻合术治疗，术中用高速磨钻制作骨窗，泪道环形置入硅胶管，8-0可吸收线吻合前后瓣，术后3~6个月拔m硅胶管。结果术后3-6个月，16只眼（5．6％）内眦部轻度异物感，均能耐受；8只眼（2．8％）N4,点及结膜局限性充血，拔管后均好转；5只眼硅胶管上端部分滑出泪小点，均顺利放置同泪道。3例患者挖鼻孔扯断硅胶管滑m，冲洗通畅未冉置管；无N4,点豁裂开等严重并发症。拔管后随访3个月至3年，治愈267只眼，治愈率93．4％（267／286）；有效19只眼，有效率6．6％（19／286）；未见无效及复发患者。结论鼻腔泪囊吻合术采用高速磨钻制作骨窗，泪道环形置入硅胶管，手术效果显著，扩大了鼻腔泪囊吻合术的适应证。

Objective To investigate an improved method of dacryocystorhinostomy. Methods Retrospective reviewed the cases of chronic dacryocystitis at our hospital from October 2009 to De- cember 2013 which were treated by dacryocystorhinostomy. During the dacryocystorhinostomy, the bone hole was made by high-speed drill, placed the ring silicone tube to lacrimal, and anastomosed the front and back flaps mucosal flap with 8-0 absorbable suture. The tube was pulled out 3-6 months after the surgery. All patients were followed up for 3 months to 3 years after the operation. Results Of 16 eyes （5.6%） with mild foreign body sensation and 8 eyes （5.6%） with local conges- tion within 3-6 months were cured after tube pulled out. The slided tube was re-placed back to lacri- mal in 5 eyes （1.7%）. The tom tube was not placed back to lacrimal in 3 eyes （1.0%）. There were no other complications such as lacrimal puncture dehiscence. After follow up time from 3 months to 3 years on tube off, 267 eyes （93.3%） were cured, 19 （6.7%） improved. There were no invalid and relapsed patients. Conclusions Improved dacryocystorhinostomy with the bone hole made by high-speed drill and placed the ring silicone tube to lacrimal, enhance the effect of surgery and ex- pand the indications of dacryocystorhinostomy.