泪囊造影CT在创伤性泪道损伤中的作用

Role of computed tomographic dacryocystography in lacrimal path damage

目的:探讨泪囊造影CT在创伤性泪道损伤中的诊断价值,为鼻内镜下泪囊鼻腔吻合术提供指导。方法:对28例创伤性泪道损伤患者行泪囊造影薄层CT扫描,在同步工作站进行容积成像、最大密度投影、曲面重建、三维重建等以显示泪囊的形态、泪囊窝骨折移位情况及泪道阻塞部位,并观察钩突与泪囊窝的关系,测量泪囊窝前上部上颌骨额突与后下部泪骨的厚度,中鼻甲腋分别至泪囊顶、泪囊底之间的距离。结果:泪囊造影CT能显示泪囊的形态、泪囊窝骨折移位情况、泪道阻塞部位以及钩突与泪囊窝的关系,发现泪小管堵塞6例,泪囊阻塞14例,鼻泪管阻塞8例;泪囊窝前上部及后下部骨质的平均厚度分别为(2.96±0.30)mm和(0.02±0.005)mm,中鼻甲腋至泪囊顶、泪囊底之间的距离分别为(6.80±1.50)mm、(4.00±1.80)mm(P<0.05)。结论:泪囊造影CT结合容积成像、最大密度投影、曲面重建、三维重建等均能清晰显示泪囊形态、泪囊窝骨折移位情况及泪道阻塞部位,分析钩突与泪囊窝的关系,为鼻内镜下泪囊鼻腔吻合术提供临床指导。

Objective：To explore the diagnostic role of computed tomographic dacryocystography （CTDCG） in lacrimal path damage and provide operative approach guidance for the endoscopic transnasal daeryocystorhinostomy （DCR）. Method：Twenty-eight cases with lacrimal path damage underwent CTDCG. The following reconstruction techniques including volume rendering（VR）, multiple planar reconstruction（MPR）, maximum intensity projection （MIP） and three-dimensional reconstruction（3-d R）were done on the real-time workstation. The morphology of dacryocyst, displacement fracture of the lacrimal fossa （FS） and the relationship between the uncinate process （UP） and the FS were observed. The thickness of inner walls of anterosuperior and posteroinferior aspects of lacrimal fossa was measured. Result.. The morphology of dacryocyst, the displacement fracture of the lacrimal fossa and the block site of the lacrimal passage could be displayed clearly by CTDCG with the following reconstruction techniques including VR, MPR,MIP and 3-d R, 6 cases of canaliculus obstruction, 14 cases of lacrimal sac obstruction,8 cases of lacrimonasal duct obstruction were showed. Meanwhile the relationship between the UP and the FS could also be showed clear. The average bony thickness of the anterosuperior part o5 FS was （2.96 ± 0.30）mm, while the bony thickness of the posteroinferior half was （0.02±0. 005）mm,and the distance between the top and bottom of dacryocyst to the operculum of the middle turbinated （OMT） are （6.80 ±1.50）mm, （4.00 ± 1.80）mm respectively（P〈0.05）. Conclusion：The morphology of dacryocyst, the displacement fracture of the lacrimal fossa, block site of the lacrimal passage and the relationship between the UP and FS can be clearly displayed by CTD- CG,which provide operative approach guidance for the endoscopic transnasal dacryocystorhinostomy.