钩突与泪囊窝影像解剖关系及其在泪囊鼻腔开放术中的意义

Imaging anatomic study of uncinate process and lacrimal fossa and its role in the endoscopic transnasal dacryocystorhinostomy

目的研究钩突与泪囊窝的影像解剖及其在鼻内镜下泪囊鼻腔开放术中的意义。方法分析80例鼻窦薄层CT扫描的影像资料,测量泪囊窝骨质厚度,观察钩突与泪囊窝、泪骨的解剖关系;18例泪囊炎患者行鼻内镜下鼻腔泪囊开放术,通过钩突中、下部附着定位泪骨,行泪骨入路向上扩大开放泪囊,记录手术过程,观察其可行性。结果泪囊窝前上部及后下部骨质的厚度为(2.96±0.33)mm,(0.02±0.01)mm(P<0.05),泪囊窝前上部骨质厚度大于后下部,差异有统计意义;在泪囊窝下端,钩突往往附于泪囊窝后部,往上逐渐靠前,于中部连接于泪骨或上颌骨额突,上部连接于中鼻甲外侧或眶纸板上。16例慢性泪囊炎患者在钩突前方成功经泪骨切开向上扩大暴露泪囊,2例钩突上部附于上颌骨额突太靠前者予钩突上部切除后暴露泪囊。结论准确认识钩突与泪骨、泪囊窝的解剖关系,有助于鼻内镜下行泪囊鼻腔开放时定位、暴露泪囊,避免手术并发症。

Objective To explore the relationship between the uncinate process and the lacrimal fossa, and to provide guidance for the surgical approach of the endoscopic transnasal dacryocystorhinostomy. Methods The relationship between uncinate process and lacrimal fossa was observed in 80 cases. The thickness of the lacrimal fossa was measured. 18 patients with dacryocystitis were treated with endoscopic transnasal dacryocystorhinostomyduring which process the lacrimal bone was located anterior to the attachment of the medial or low part of the uncinate process to the lateral nasal wall, the lacrimal bone was nibbled away, and the lacrimal sac was then exposed upward. The feasibility was observed. Results The average bony thickness of the anterosuperior part of lacrimal fossa was （2.96 ± 0.33） mm, while the bony thickness of the posteroinferior half was （0.02±0.01）mm（P〈0.05）. The uncinate process was more frequently located posterior to the lacrimal fossa at the lower level, then adjacent to lacrimal bone or the frontal process of maxillary bone at the intermediate level, last adjacent to the lateral middle turbinate or orbital lamina at the upper level. lacrimal sac were successfully exposed in endoscopic transnasal dacryocystorhinostomy in 16 cases anterior to the attachment of the uncinate process, in 2 cases after partial removal of uncinate process because the superior part of unicinate process was located too anteriorly. Conclusion Accurately recognizing the anatomic relationship of uncinate process and lacrimal fossa helps to improve the efficiency of surgery and avoid complications.